Neglected Tropical Diseases: Latin America and the Caribbean’s Silent Killer
By: Sarah Cassidy-Seyoum, Research Associate at the Council on Hemispheric Affairs
Neglected tropical diseases (NTDs) are a collection of chronic, bacterial, parasitic, and viral diseases that have remained largely unnoticed and uncured by the global community.[1] NTDs affect the lives of more than 1.5 billion people worldwide and cause, on average, the death of more than 500,000 people each year, most of whom live in extreme poverty. [2] In fact, NTDs have a strong hand in the vicious cycle of poverty, in which the impoverished are more susceptible to disease, and the diseased are more likely to become impoverished.
Understandably, the diseases that have garnered the most international attention are HIV/AIDS and malaria. However, these are not the only diseases that devastate populations around the world. As the name suggests, NTDs most frequently affect tropical regions in Latin America and the Caribbean (LAC), Asia, and Africa. In LAC, more than 200 million people are at risk of contracting multiple NTDs.[3] NTDs have burdened this region for centuries, hindering its ability to develop and compete on the global stage. As such, these diseases need to be a topic of discussion and a target for action. While there have been initiatives to eradicate NTDs from LAC, the presence of these diseases in the region demands more attention. Additionally, treatment projects for NTDs need more funding if the LAC countries are going to continue on a genuine path towards eradicating poverty and becoming fully developed nations.
To understand the impact of NTDs, social scientists have implemented a way to measure the extent to which a disease harms an individual. Such a measure is called a DALY (disease burden), a disability adjusted life year.[4] One DALY, for example, represents the loss of one year of healthy life due to disease or disability. The DALY statistic is used to capture “the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.”[5]
In the case of NTDs, the disease burden in the LAC region is high, especially in Brazil. Overall, when looking at the disease burden of the top seven NTDs (ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, trachoma, and onchocerciasis) compared to other prevalent diseases, there is not a drastic difference. Worldwide, HIV/AIDS has a disease burden of 84.5 million; the top seven NTDs have a burden of 56.6 million; malaria and tuberculosis (TB) follow at 46.5 and 34.7 million, respectively.[6] One study estimates that Brazil alone has a disease burden from NTDs amounting to approximately 20 million.[7] Though NTDs have a significant disease burden, international organizations do not allocate nearly as much funding to NTDs as to malaria and TB.[8] This is a reality that needs to change.
Although these diseases were essentially overlooked until the United Nations Millennium Summit in 2000, there have been recent efforts to address them and their effects. In 2000, the United Nations set Millennium Development Goals (MDGs) that would make the world a better, safer, and more equal place. Such objectives included eradicating poverty and hunger, achieving universal primary education, promoting gender equality and women’s empowerment, reducing child mortality rates, improving maternal health, and combating HIV/AIDS, malaria, and other diseases. Even though the elimination of NTDs would help to achieve more than one of these goals, NTDs were merely a side note in the list of MDGs, simply included under the generalization of “other diseases.” Unfortunately, in light of the HIV/AIDS and malaria epidemics, the United Nations did not give NTDs sufficient attention. Still, public experts have given these diseases more attention over time, recognizing the significance of treating NTDs.
LAC nations increasingly understand the implications of NTDs and have subsequently become leaders in treating them. Treatments have proven effective through the use of domestic programs, as well as through the Inter-American Development Bank (IDB).[9] The IDB has joined the Pan American Health Organization and the SABIN Vaccine Institute in a collaborative effort to initiate numerous projects combating NTDs. In 2011, these groups launched projects in Bolivia, Honduras, and the Dominican Republic. Similarly, in 2012, the IDB’s initiative started supporting projects in Brazil, Guyana, Guatemala, Haiti, Honduras, and Mexico.[10] These initiatives are a start, but far more needs to be done.
The serious nature of the symptoms of these diseases calls for their immediate treatment and management. Due to the diversity of diseases included in the grouping, NTDs have a wide array of symptoms including blindness, growth delays, anemia, organ damage, increased risk of complications during childbirth, increased risk of endangering the mother’s health, loss of limb function, cardiac failure, arrhythmia, disfigurement, and many more.[11] These symptoms greatly reduce quality of life, especially because those most affected are of the lowest socio-economic class. For instance, indigenous communities and Afro-descendent populations are high-risk groups throughout Latin America.[12] However, a reduced quality of life is not the only consequence of being infected by these diseases as these symptoms also lead to a continuation of the poverty cycle.
HOW DO NTDs CONTRIBUTE TO POVERTY?
Poverty is an issue that drastically afflicts Latin America and the Caribbean. According to the World Bank, 22 percent of the population lives on less than $2 USD per day.[13] The only way out of poverty is through education and, ultimately, being able to acquire economic gains. Simply put, educating oneself and working is the only way to escape poverty. Sadly, this is not an easy task in rural communities that are isolated from the trade market, or in poor urban communities where there are more individuals than employment opportunities. Adding to this burden are the symptoms of NTDs.
A report published by the São Paulo Institute of Tropical Medicine states that, “there is a direct relationship between the prevalence of these diseases and the Human Development Index.”[14] NTDs reduce child development and education, increase the number of poor pregnancy outcomes, and drastically reduce economic productivity.[15] Therefore, children with NTDs tend to be hindered for the rest of their lives. Their chance to progress into a productive adulthood is very slim, as demonstrated in a study done by an economist at the University of Chicago. He found that among Brazil’s indigenous people and citizens of African descent who were affected by hookworm during childhood, there was a 43 percent reduction in future wage earnings.[16] Furthermore, there is an even worse immediate outcome when these diseases affect adults, as they are no longer able to work. NTDs significantly reduce the productivity of countries as a whole, not only causing the suffering of affected individuals, but also hindering the growth and development of entire countries. The IDB estimates that controlling NTDs would result in an economic gain of between 15 and 30 percent.[17]
A country’s economic gain, however, is not the most important benefit that would come out of the management of these diseases. The real triumph would be breaking the cycle of poverty and, hopefully, reducing the large socio-economic divide present in many of the LAC countries. As previously mentioned, the poverty cycle tends to persist when an individual is unhealthy and not able to provide for himself, resulting in the perpetual inability to come out of poverty. The impoverished are forced to live under adverse conditions that are conducive to becoming and remaining sick, in large part due to poor sanitation and a lack of health care. Poverty’s instrumental role in acquiring illnesses is illustrated by the fact that most people who make less than $2.50 USD per day usually have more than one NTD.[18] Therefore, if countries manage to get these diseases under control, and eventually eradicate them, they could break the poverty cycle and foster progress.
BRAZIL CASE STUDY
In Latin America and the Caribbean (LAC), Brazil is unequivocally the most affected by NTDs. Most cases occur in the northern regions of Brazil where poverty is most prevalent.[19] The NTDs that are most common are Chagas’ diseases, leishmaniasis, schistosomiasis, dengue fever, leprosy, onchocerciasis, and lymphatic filariasis (LF).[20]
Brazil also has one of the greatest wealth disparities in the world.[21] This inequality has promoted the prevalence of NTDs. Fortunately, their high frequency has encouraged the Brazilian government to work with local governments and international organizations to address the burden of these diseases. Highlighting Brazil’s investment and spending on NTDs is the work of Department of Science and Technology at the Ministry of Health. In 2008, the agency spent $7,806,694 USD on NTDs and has continued funding ever since.[22] This appropriation has financed a variety of projects aiming to eradicate these diseases; specifically those for which there are already effective treatments. LF is one of these diseases.
Projects to eliminate LF not only illustrate the progress Brazil has made in treating NTDs, but also the difficulties in achieving total eradication. LF is a chronic disease that causes elephantiasis, a condition that is associated with the disfigurement of limbs, most commonly the legs. It causes the limb to become two or three times its normal size, preventing easy body movement. That being said, an effective treatment for the disease has been found and there is the potential to fully eradicate LF not only in Brazil and the LAC countries, but also throughout the world.[23] The treatment is called Mass Drug Administration (MDA) and involves a variety of drugs that need to be administered on a consistent basis over an extended period of time. This treatment requires a level of specificity, oversight, discipline, and planning that is not easily attainable.[24]
Even though there is a treatment for LF, and Brazil has numerous projects in most of its municipalities to treat the disease, the country has struggled to eradicate it.[25] One difficulty in eradication efforts is the fact that projects are carried out on the municipal level and are therefore inherently unequal. Some municipalities are able to manage LF better than others. Another issue is that some communities are isolated, making it harder to administer treatment. However, Brazil remains adamant about eradicating LF. In a conference in May 2012, Dr. Barbosa da Silva stated,
We are close to the elimination of LF, and that is why this is such an important step. This disease has to remain a top priority and this is why it is key that it is addressed with an integrated approach in collaboration with primary health care services. It is not just about eradication, but also about sustained surveillance.[26]
Under the circumstances, Brazil knows what it has to do to relieve its poorest citizens from the burden of LF as well as other NTDs. Many public health experts believe that controlling NTDs in Brazil is one of the most promising ways “for lifting the 40 million most poor Brazilians out of poverty,” and the country’s efforts are already off to a great start.[27] Other LAC countries need to follow Brazil’s lead in addressing these diseases and invest accordingly in the proper channels and treatment. In addition, the international health and science community should invest more resource into looking for treatments and vaccines to eradicate this roster of neglected tropical diseases.
A NEED FOR CHANGE
Investing in projects that would result in economic growth and development is vital to all emerging countries. The world needs a deliberate and targeted effort to reduce the cluster of social inequalities. Investing in infrastructure and industries is not enough—improving the health of the population is key to breaking the poverty cycle and embarking on a path towards prosperity.
For years, NTDs have been neglected, falling in the shadow of the international HIV/AIDS and malaria epidemics. NTDs are not quite as harmful and destructive as HIV/AIDS and malaria, but the toll they take is still immense. The effects of these diseases are humanitarian and development crises in certain LAC countries, making their eradication vital. Some of these countries have taken the right steps toward treating the diseases and giving the disadvantaged people a fighting chance of breaking out of the poverty cycle. What Brazil has done in their mission to treat LF and other NTDs is an example of what the rest of the developing world needs to do to manage these diseases. Of course, Brazil has a long way to go before it can achieve complete eradication of all NTDs. Investing in meaningful employment generating projects and conscious government-supported efforts to eliminate NTDs will assist in the reduction and elimination of NTDs. Consequently, the people and governments of LAC would be able to focus on other key elements necessary for attaining further development and reducing socio-economic gaps.
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References
[1] “Neglected Tropical Diseases.” Center for Disease Control and Prevention. June 6, 2011. July 23,2014. http://www.cdc.gov/globalhealth/ntd/.
“The 17 Neglected Tropical Diseases.” World Health Organization. July 23, 2014. http://www.who.int/neglected_diseases/diseases/en/.
[2] “NTD Overview: What are neglected tropical diseases?” THE END FUND. 2014.July 23, 2014.http://www.end.org/whatwedo/ntdoverview.
Anup Shah.“Poverty Facts and Stats.” Global IssuesSocial, Political, Economic and Environmental Issues That Affect Us All. January 7, 2013. July 23, 2014. http://www.globalissues.org/article/26/poverty-facts-and-stats.
[3] “IDB integrates efforts to fight Neglected Tropical Diseases.” Inter-American Development Bank. 2014. July 23, 2014. http://www.iadb.org/en/topics/health/neglected-tropical-diseases-initiative-in-latin-america-and-the-caribbean,6453.html
[4] Nicole Rappin. “Calculating the Cost-Effectiveness of Brilliance: A journey to understand DALYs and the assumptions we make (Part 1).” D-Rev. April 29, 2014. July 25, 2014. http://d-rev.org/2014/04/dalys-cost-effectiveness-analysis-brilliance/.
[5] “Metrics: Disability-Adjusted Life Year (DALY).” World Health Organization. 2014. August 4, 2014. http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/
[6] Shanthi Kappagoda, John PA Ioannidis. “Prevention and control of neglected tropical diseases: overview of randomized trials, systematic reviews and meta-analyses.” March 13, 2014. July 23, 2014. http://www.who.int/bulletin/volumes/92/5/13-129601/en/
Patricia Gabriel, Rebecca Goulding, Cecily Morgan-Jonker, Shannon Turvey, Jason Nickerson. “Fostering Canadian drug research and development for neglected tropical diseases.” Open Medicine 4, no. 2 (2010). http://www.openmedicine.ca/article/view/344/335.
[7] Peter J. Hotez. “The Giant Anteater in the Room: Brazil’s Neglected Tropical Disease Problem.” PLoS Neglected Tropical Diseases 2, no. 1 (2008): e177. www.plosntds.org.
[8] Stephen J. Swanson, MD, DTM&H Pediatric Infectious Diseases Hennepin County Medical Center University of Minnesota. “Neglected Tropical Diseases.” Taste of Tropical Medicine- Mayo 2009.http://www.mayo.edu/mayo-edu-docs/mayo-school-of-graduate-medical-education-documents/swansonneglectedtropicaldiseases2009.pdf
[9] “IDB integrates efforts to fight Neglected Tropical Diseases.”
[10] “IDB integrates efforts to fight Neglected Tropical Diseases.”
[11]José Angelo L. LINDOSO, Ana Angélica B.P. LINDOSO, “Neglected Tropical Diseases in Brazil.” São Paulo Institute of Tropical Medecine 51, no. 5 (2009): 247-253.
“IDB integrates efforts to fight Neglected Tropical Diseases.”
[12] “IDB integrates efforts to fight Neglected Tropical Diseases.”
[13]Peter J. Hotez
[14]José Angelo L. LINDOSO, Ana Angélica B.P. LINDOSO, “Neglected Tropical Diseases in Brazil.” São Paulo Institute of Tropical Medecine 51, no. 5 (2009): 247-253.
[15] “Global Immunization: Archives.” The Children’s Hospital of Philadelphia. January 2013. July 28, 2014.http://www.chop.edu/service/parents-possessing-accessing-communicating-knowledge-about-vaccines/global-immunization/global-immunization-archives.html
[16] Peter J. Hotez
[17] “IDB integrates efforts to fight Neglected Tropical Diseases.”
[18] “IDB integrates efforts to fight Neglected Tropical Diseases.”
[19]José Angelo L. LINDOSO, Ana Angélica B.P. LINDOSO
[20]José Angelo L. LINDOSO, Ana Angélica B.P. LINDOSO
[21] Peter J. Hotez
[22] Mary Moran.“GLOBAL FUNDING OF NEW PRODUCTS FOR NEGLECTED TROPICAL DISEASES.” National Academy of Sciences. 2011. July 28, 2014. http://www.ncbi.nlm.nih.gov/books/NBK62528/
[23] Albis Francesco Gabrielli, Antonio Montresor, Ruben Satiago Nicholls, and Steven Kenyon Ault. “Progress towards the control and elimination of neglected tropical diseases in Brazil.” Jornal de Pediatria 89, no. 3 (2013): 215-216
[24]Ibid.
[25]Albis Francesco Gabrielli, et. al.
[26] Agustin Caceres. “Lymphatic filariasis, on the spotlight in Brazil.” Global Network: Neglected Tropical Diseases. May 20, 2012. July 25, 2014. http://endtheneglect.org/2012/05/lymphatic-filariasison-the-spotlight-in-brazil/
[27] Peter J. Hotez