The end of 2014 saw the release of the Global Burden of Disease Study 2013 (GBD 2013), in which 240 causes of death were studied through a systematic analysis. Among the important findings were that globally, parasitic diseases caused more than one million deaths in the year 2013.
Since the founding of PLOS Neglected Tropical Diseases more than six years ago, I have written about the interface between disease and geopolitics. The neglected tropical diseases (NTDs) are the world’s most common infections of people living in poverty. Where they are widespread in affected communities and nations, NTDs can be highly destabilizing and ultimately may promote conflict and affect international and foreign policy. Many of the published papers in this area were recently re-organized in a PLOS “Geopolitics of Neglected Tropical Diseases” collection that was posted on our website in the fall of 2012, coinciding with the start of our sixth anniversary. From this information, a number of new and interesting findings emerged about the populations who are most vulnerable to the NTDs, including the extreme poor who live in the large, middle-income countries and even some wealthy countries (such as the United States) that comprise the Group of Twenty (G20) countries, as well as selected Aboriginal populations. Together, the PLOS “Geopolitics of Neglected Tropical Diseases” collection and the G20 analyses identified more than a dozen areas of the world that repeatedly show up as ones where NTDs disproportionately affect the poorest people living at the margins. Here, I summarize what I view as ten of the worst global “hotspots” where NTDs predominate. They represent regions of the world that will require special emphasis for NTD control and elimination if we still aspire to meet Millennium Development Goals (MDGs) and targets by 2015; they are regions that may need to be highlighted again as we consider post-MDG aspirations and new Sustainable Development Goals (SDGs).
The recent commitment of the Obama administration to establish the Global Health Initiative, which is expected to increase to over US$100 million annually for neglected tropical disease (NTD) control, provides the most significant investment and opportunity for the global control of NTDs to date. These investments, together with commitments by the British Department for International Development, the World Bank, and several key private philanthropies, including the Bill & Melinda Gates Foundation, must be guided by a strong evidence-based approach. First, the problem, and the resources required to tackle it, need to be clearly quantified. Second, mass drug administration (MDA) should be optimally targeted to communities with the highest prevalence of infection and presumed greatest morbidity.
The new Grand Challenges in CNCDs initiative is an ambitious effort to raise public awareness of these conditions in the developing world, enhance economic, legal, and environmental policies, modify risk factors, mitigate the health impacts of poverty and urbanization, engage the community, and reorient health systems away from treatment towards prevention. Wherever the NTDs geographically overlap with the CNCDs, there is a need to assess the contribution of the former, and to recognize that when it comes to NTDs, the distinction between noncommunicable and communicable diseases can be murky.
As a basis for prioritizing the allocation of financial and other resources targeted for international development, the strong preference of the global community’s policy makers and donors is to rely on numbers. Metrics such as DALYS (disability-adjusted life years—the number of healthy life years lost either from death or disability) or DALYs averted per dollar provide highly useful information about the cost-effectiveness of health interventions in different settings. In turn, the cost-effectiveness of a program is considered fundamental to its merit or its need for redesign. In this regard, one of the important achievements of this decade is the publication of the Second Edition of the Disease Control Priorities in Developing Countries. DCP-2 is a landmark document for informing fundamental policy considerations, selecting and scaling up effective interventions, and identifying opportunities for ongoing research.