Unleashing “Civilian Power”: A New American Diplomacy through Neglected Tropical Disease Control, Elimination, Research, and Development

Abstract

In a November/December 2010 article published in the influential journal Foreign Affairs, United States Secretary of State Hilary Rodham Clinton articulated a new vision for American diplomacy and development through the strengthening of what she terms ‘‘civilian power’’ [1]. Stated briefly, the new doctrine calls for the creation of a new cadre of civilian experts who could jointly pursue diplomacy and international development for purposes of solving global challenges related to health, agriculture and food insecurity, environmental degradation, drugs and organized crime, energy, and climate change [1]. Through joint programs between the US Department of State and its United States Agency for International Development (USAID) and the additional hiring of more than 1,000 Foreign and Civil Service Officers in each organization, and reflecting the results of a new Quadrennial Diplomacy and Development Review, in the coming years the State Department and USAID would now work more closely to enhance global development in the context of diplomacy. The world’s conflict and post-conflict zones and fragile states would represent key targets for international development efforts [1]. In this new doctrine, Secretary Clinton proposes that together the State Department and USAID would establish a premier global civilian service for responding to complex diplomatic and development challenges [1]. Achieving such an ambitious goal would also mandate that USAID look beyond its walls to embrace business, philanthropist, and citizen groups, with dual emphases on partnering with some of the large emerging market economies (EMEs), i.e., China, India, Indonesia, Nigeria, Pakistan, Russia, and South Africa, for joint problem solving, and harnessing selected technologies, such as rapidly expanding cell phone access, for establishing a sustainable and lasting impact [1]. The control and elimination of the world’s major neglected tropical diseases (NTDs) represents a substantive global health and economic challenge, yet one that with a well-coordinated assault in the mode as proposed by Secretary Clinton could become the first major victory for civilian power. The NTDs are the most common infections of the world’s poor, and almost all of the ‘‘bottom billion,’’ i.e., the 1.4 billion people, who live on no money, are infected with one or more NTD [2,3]. In addition to causing a level of global disability that compares with that of HIV/AIDS or malaria, NTDs actually cause poverty through their ability to impair child development, pregnancy outcomes, and agricultural productivity and food security [3]. These diseases also destabilize communities and promote civil and international conflicts [4]. There are a number of reasons why taking on the NTDs would be a worthy early first test for civilian power. It is now possible to control or in some cases eliminate one or more of the seven most common NTDs, i.e., ascariasis, hookworm infection, trichuriasis, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma, through mass drug administration using a ‘‘rapid impact package’’ of drugs that are either donated by the major pharmaceutical companies or available as low cost generics and administered as a part of national control programs [2,3,5]. Mass drug administration for NTDs through rapid impact is one of the lowest cost and cost-efficient mechanisms for both improving maternal child health [6] and lifting the bottom billion out of poverty [3]. The United States government (USG), through its Global Health Initiative (GHI) and USAID’s NTD Program, is already providing financial support for 12 national NTD programs, more than all other countries combined, with additional programs scheduled in the coming years [7]. With assistance from the Department of State, the USAID NTD Program can now reach out to the major EMEs listed above in order to join forces on global NTD control efforts. A USAID–EMEs link makes sense on two fronts: First, it has already been noted that Nigeria has the largest number people infected with the seven NTDs among the sub-Saharan African countries, while South Africa suffers from high rates of some of the soil-transmitted helminth infections and schistosomiasis [8]. Similarly, China, India, Indonesia, and Pakistan have the largest number of ascariasis, trichuriasis, hookworm, lymphatic filariasis, and trachoma cases, as well as other NTDs such as leprosy in Asia [9,10]. Working jointly with experts from USAID and other branches of the USG and GHI, a focused effort on NTDs in the EMEs could ultimately double the total number of at-risk populations receiving rapid impact packages. In addition, China invests billions of dollars in sub-Saharan Africa annually and could also make substantial contributions