Research Article: Which New Approaches to Tackling Neglected Tropical Diseases Show Promise?

Date Published: May 18, 2010

Publisher: Public Library of Science

Author(s): Jerry M. Spiegel, Shafik Dharamsi, Kishor M. Wasan, Annalee Yassi, Burton Singer, Peter J. Hotez, Christy Hanson, Donald A. P. Bundy

Abstract: This PLoS Medicine Debate examines the different approaches that can be taken to tackle neglected tropical diseases (NTDs). Some commentators, like Jerry Spiegel and colleagues from the University of British Columbia, feel there has been too much focus on the biomedical mechanisms and drug development for NTDs, at the expense of attention to the social determinants of disease. Burton Singer argues that this represents another example of the inappropriate “overmedicalization” of contemporary tropical disease control. Peter Hotez and colleagues, in contrast, argue that the best return on investment will continue to be mass drug administration for NTDs.

Partial Text: The past decade has seen a host of new initiatives and funding to address NTDs affecting the world’s poorest people [1]-[4]. But despite this additional funding, the global disease burden remains high [5]. We believe that one of the reasons for this continuing burden is that NTD research has neglected the broad social determinants of disease. We propose a mechanism, a “social offset in research,” to address this neglect.

The recent designation of a set of tropical diseases as “neglected” [27] has given rise to a groundswell of interest in strategies for their control and research on new tools for alleviation of their burden [28]-[30]. Regrettably, this initiative has also served to expose yet another example of the over-medicalization of contemporary tropical disease control strategies. A primary example is the emphasis on drug administration alone to alleviate the burden of schistosomiasis [31]-[33] and the soil-transmitted helminths, of which hookworm is the most prominent [34]. The extant programs focus on deworming already infected people while doing nothing to prevent reworming of the same individuals. These programs amount to establishing a chain of dependence on drugs with no terminal horizon in sight. The problem is that at some point funds for drugs and their programmatic support fade out [35], and the reworming process escalates afresh.

More than one billion people, mostly in the developing world, suffer from one or more of the neglected tropical diseases (NTDs) [44],[45]. These diseases disproportionately impact poor and rural populations who lack access to safe water, adequate sanitation, and essential medicines. Ninety percent of the global burden of NTDs is caused by a group of seven highly prevalent diseases: onchocerciasis, lymphatic filariasis (LF), trachoma, schistosomiasis, and the three major soil-transmitted helminth (STH) infections (hookworm, roundworm, and whipworm) [44],[45]. In terms of both health impact and cost-effectiveness, few other interventions can rival mass drug administration for NTDs, and increasingly this approach is being recognized for its beneficial effects on strengthening health systems, improving economic development, and achieving the Millennium Development Goals [45].



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