Tuesday, 11 December 2012

Neglected Tropical Diseases: Jostling for Position

Neglected Tropical Diseases and the Post-2015 Global Development Agenda

Part One: Jostling for Position

By E. Michelle Taylor and James Smith

The United Nations Millennium Development Goals (MDGs) expire in 2015. Earlier this month, the high-level panel appointed to discuss the global development agenda post-2015, met for the second time in London. The recommendations made by the panel are likely to prove extremely important for determining the global health budget over the coming decade. Who the winners and the losers will be in the new agenda is not yet known, but certain parties will hope that this time around Neglected Tropical Diseases (NTDs) will gain a special mention.

The MDGs, established in 2000, gave a new prominence to the health issues affecting the poor. However, the spotlight they provided was restricted. MDG 6 - combat HIV/AIDS, malaria and other diseases – sidelined many of the communicable and non-communicable diseases that perpetuate the cycle of poverty. Yet the very act of naming HIV/AIDS and malaria raised their profile immeasurably. It stimulated a reconfiguration of official development assistance for health. Global Health Initiatives such as the Global Fund ushered in an era of vertical aid on an unprecedented scale and diverted resources away from existing health programmes.1 In this climate, advocacy groups were left to argue that it was their disease being referred to in the ambiguous wording ‘other diseases’. In this respect, the case of tuberculosis is instructive; the success of the tuberculosis campaigning was such that it is now widely assumed that it too received a special mention in the MDG 6.Clearly, effective networking and alliance building can blur the boundaries of the MDGs and raise the profiles of diseases.

The 17 NTDs identified by WHO represent some of the MDGs’ ‘other diseases’. Their neglected tag stems from the disparity between the attention and funding they receive (0.6% of official development assistance for health), and their catastrophic impact in terms of disability-adjusted life years.3,4  The case for including them in the post-2015 agenda has been building since their ostensible omission from MDG 6, which served as ‘a call to arms’ for a group of concerned stakeholders who have since contributed to a series of landmark initiatives which have placed NTDs firmly on the international agenda. In 2003, the Drugs for Neglected Diseases Initiative (DNDi) was established; in 2006 the Bill and Melinda Gates Foundation helped set up the Global Network for Neglected Tropical Diseases; in 2012, a number of parties endorsed the London Declaration on Neglected Tropical Diseases, and WHO published its roadmap for action.6,7 

Alongside these landmark events, the NTDs secured unprecedented funding from traditional and non-traditional sources; contributions from philanthropic foundations such as the Gates Foundation have been decisive (Gates is pledging US$363 million over the next 5 years); as have the in-kind donations provided by the pharmaceutical industry (exceeding US$2 billion annually). The galvanising force behind this change in fortune has been new forms of partnership between the public and private sectors (PPP).8

Already the fruits of the PPP approach are being felt, with gains in NTD control providing hope that elimination is a possibility for the many of the diseases.7,9 The success has been such that WHO Secretary General Dr Margaret Chan recently referred to the story of the NTDs in the 21st century as one of ‘rags to riches’.10  In this extraordinary reversal of fortunes, the centrality of branding cannot be downplayed;5,11 where once 17 disparate diseases (caused by different pathogens) were easily ignored, under the rubric of NTDs they have become a clarion call for helping the world’s ‘bottom billion’.

Read Part 2: What Next?


1 Shiffman J. Has donor prioritization of HIV/AIDS displaced aid for other health issues? Health policy and planning. 2008; 23(2): 95-100.

2 Allen T, Parker M. The "other diseases" of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor's parasites. Third world quarterly. 2011; 32(1): 91-117.

3 Liese BH, Schubert L. Official development assistance for health–how neglected are neglected tropical diseases? An analysis of health financing. International Health. 2009; 1(2): 141-7.

4 World Health Organisation. The global burden of disease 2004 update. Geneva: World Health Organisation; 2004.

5 Adams J, Gurney KA, Pendlebury D. Thomson Reuters global research report: neglected tropical diseases. Leeds: Evidence Thomson Reuters; 2012.

6 London declaration on neglected tropical diseases. 2012. http://unitingtocombatntds.org/downloads/press/ntd_event_london_declaration_on_ntds.pdf [Accessed 20th November 2012].

7 World Health Organisation. Accelerating work to overcome the global impact of neglected tropical diseases: a roadmap for implementation. Geneva: World Health Organisation; 2012.

8 Buse K, Walt G. Global public-private partnerships: Part I--A new development in health? Bull World Health Organ. 2000; 78(4): 549-61.

9 Molyneux DH, Malecela MN. Neglected tropical diseases and the millennium development goals: why the "other diseases" matter: reality versus rhetoric. Parasites & vectors. 2011; 4: 234.

10 Chan M. Address to the Sixty-fifth World Health Assembly 21st May 2012. Geneva, Switzerland; 2012.

11 Molyneux DH. The 'Neglected Tropical Diseases': now a brand identity; responsibilities, context and promise. Parasites & vectors. 2012; 5: 23.

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