Calling Attention to tropical diseases on Capitol Hill

Globally, more than 1 billion people, mostly impoverished, suffer from at least one neglected tropical disease (NTD), according to the World Health Organization. 

These infectious diseases have names perhaps as unfamiliar to most Americans as their clinical definitions themselves, including Schistosomiasis (parasitic worms) and Onchocerciasis and filarial infections (river blindness). They often emerge in developing countries as a result of contaminated food and water and limited access to health care.

But in recent years, NTDs have popped up with increasing rigor in the US, from Texas to Florida, and this incidence seemed partly the impetus for a hearing held Thursday in the House of Representatives by the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations.

“In today’s world, diseases can cross borders as easily as those affected by them or the products imported from the United States,” said Chris Smith (R-N.J.), chairman of the subcommittee, in his opening remarks. Americans “cannot afford to assume that what may seem to be an exotic disease only happens to people in other countries,” Smith said.

The hearing brought together leading infectious disease specialists from the National Institute of Allergy and Infectious Diseases (NIAID) and the Food and Drug Administration (FDA) along with those from the Sabin Vaccine Institute, Johnson & Johnson, and the NGO Evidence Action, to discuss the US’ role in eradicating NTDs.

Such infectious diseases are, globally, a “major public health concern,” said FDA chief scientist Jesse Goodman. And they require new developments in prevention, diagnosis, and treatment. He said that an estimated 30 million Americans have rare diseases.

Peter J. Hotez, president of the Sabin Vaccine Institute and dean of the new National School of Tropical Medicine at Baylor College of Medicine, addressed concerns from lawmakers about the relationship between immigration and NTDs. Hotez acknowledged that immigration may be contributing to the incidence of NTDs in the US, but that poverty played a big role.

In his opening remarks, Chairman Smith noted that to date, research and development on NTDs has not been commensurate with the problems they present. He cited a 2012 analysis by the international aid organization MSF that found that although NTDs represent nearly 11 percent of the global burden of disease, only 3.8 percent of newly approved drugs between 2000 and 2011 were designed to address them. And this was improvement over previous decades.

The hearing comes at a time of renewed attention to NTDs. Last year, a group of organizations, including leading drug companies, the Bill & Melinda Gates Foundation, and the governments of the US, UK, and the United Arab Emirates, made a global pledge to meet a WHO goal of controlling or eliminating 10 neglected tropical diseases by 2020.

While a 2013 report from the group found that the new commitment increased focus on NTDs and attracted additional funds in 2012, it also noted that there were outstanding needs including a $300 million annual funding gap through 2020.

More recently, the World Health Assembly (WHA), WHO’s governing body, reiterated its commitment this spring with a new resolution to tackle 17 tropical diseases. WHO’s Director-General Margaret Chan said at the time that those people who have NTDs, especially women and children, are currently “suffering in silence” due to inequality, injustice, and social stigma.

The US is the largest funder for NTDs, according to chief witness Lee Hall, chief of the Parasitology and International Programs Branch at NIAID. USAID programs on NTDs have treated more than 250 million people around the world, according to the agency’s website. 

“The U.S. has clearly shown extraordinary leadership on NTDs, but the U.S. investment needs to continue if the WHA hopes to meet its goals and targets,” Hotez said in testimony presented to the subcommittee.

That need, however, is not reflected in the administration’s current budget proposal. President Obama’s budget plan for fiscal year 2014 outlined $85 million for NTDs under the USAID budget line, around 4 percent less than current 2013 levels.

“If funding for USAID’s NTD Program does not at least match FY 2013 levels, the capacity to deliver these medicines to those who need them most will be significantly reduced and we may see a resurgence of many of these NTDs,” said Hotez in his testimony.

“Ridiculously low-cost” treatments exist for many of the diseases, Hotez said, for about $.50 per person per year. But delivering such treatments is contingent on support for USAID programs, Hotez said.

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