Neglected Tropical Diseases and the Austerity Pandemic

Dumdum fever (or visceral leishmaniasis) is caused by a parasite (leishmania) and kills more than half a million people every year. After malaria it’s the world’s deadliest parasitic infection, but little has been done to combat it until very recently.

Dumdum fever is what is known as a Neglected Tropical Disease (NTD). Other NTDs include buruli ulcer, chagas disease, cysticercosis, dengue, dracunculiasis, echinococcosis, endemic reponematoses, helminthiases, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis, trypanosomiasis, and trematode infections.

More than a billion people UN Photo / Sophia Paris are affected by NTDs, yet treatments are rare. On the one hand this is because they are ‘diseases of poverty’, i.e. they mainly affect poor people who can afford neither vaccines nor medical treatments. So there is little incentive for profit-oriented pharmaceutical firms to invest in R&D for treatments.

On the other hand poor-country governments are often fragile states which lack the resources (and often the commitment) to invest in basic amenities which would limit the spread and impact of NTDs, or to provide access to existing medicines. For instance 2.5 billion people still lack proper sanitation and safe water, and 1.5 billion live without electricity.

Continued growth and economic development, coupled with appropriate policies and government investment, is clearly a necessary condition for reducing and eventually eliminating the impact of these diseases. But development takes time, and the benefits of growth are often slow to ‘trickle down’ to the poorest in society.

Moreover, the debilitating effects of these diseases are a contributing factor to poverty. Global intervention is needed to (i) provide access to existing treatments and best practices, but also to (ii) generate, diffuse and use new and more affordable vaccines and other treatments – for many NTDs existing treatments are ‘old, cumbersome to administer, or toxic’ (WHO, 2012:iv).

The World Health WHO NTDsOrganization (WHO) recently announced a Roadmap to deal with NTDs, which is an encouraging step as far as the former (i) is concerned. It aims to control or eradicate most of these NTDs by 2020. The report notes a growing number of contributions by multinational pharmaceutical firms to contribute resources– e.g. donating free medicines – but also notes that more than US$ 2 billion is still needed.

The WHO’s Roadmap also calls for increased R&D for treatments, but doesn’t go into much detail. Hence the question remains, how can we stimulate innovation to control and eradicate NTDs?

In a recent MSM-MGSoG-MERIT Joint Seminar presentation on 16 February 2012, Professor Nicola Dimitri from Maastricht School of Management and the University of Siena argued that from a R&D perspective NTDs are now less neglected than they were before the 2000s.

However much more needs to be done, particularly if the Roadmap’s goals are to be achieved and maintained. Dimitri discussed a number of recent initiatives to stimulate private sector innovation for better treatments.

These initiatives are at the forefront of thinking about public policies, procurement and innovation for socially desirable outcomes, and include push (such as public private partnerships), pull (such as advanced market commitments and priority review vouchers) and hybrid forms of incentives.

Thus (hopefully) in a few years’ time there may be no more ‘neglected’ tropical diseases. The only discordant note was sounded in December 2011 by a G-Finder (Global Funding for Innovation for Neglected Diseases) report which asked ‘is innovation under threat?’ With many rich countries facing high debt burdens and implementing fiscal austerity measures, funding for innovation has been declining.

The report documents that funding for innovation on neglected diseases was slashed by over US$ 100 million in 2010, mostly in European countries. For instance Sweden cut its funding for NTD innovation by 43 per cent, the Netherlands by 39 per cent, Denmark 49 per cent, Spain 30 per cent, Germany 12 per cent and Norway by 20 per cent.  A neglected consequence of the austerity pandemic in Europe is thus the further neglect of NTDs.

Wim Naudé, Professorial Fellow at UNU-MERIT and the Maastricht Graduate School of Governance

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