Neglected diseases, a group of tropical illnesses especially endemic in low-income countries, constitute a major market failure. As such, they need to be controlled by means of appropriate public policies and governmental intervention. These diseases impact almost exclusively populations with very low purchasing power, and therefore private pharmaceutical researchers, developers and manufacturers have little incentive to invest in research and development (R&D), remedies and infrastructure that offer prevention or treatment against them.
- NGOs and private foundations are increasingly increasing funding to address neglected diseases.
- Targets for neglected diseases in the forthcoming UN sustainable development goals would likely favour progress.
- However, political disenfranchisement of affected populations will remain a major stumbling block.
Neglected diseases are both a consequence and a cause of poverty, and will not disappear simply due to development without targeted effort. Rather, their presence significantly hinders economic and social development in societies affected. By the same token, any reduction in the burden imposed by such diseases should produce a significant boost to the productive capacity of some of the world's poorest countries. The World Health Organization (WHO) reckons that it is possible to eliminate several neglected diseases by 2020. Yet in most cases this would require more government support for R&D, especially from donor governments, as well as international cooperation and government moves in affected countries to step up prevention and improve relevant infrastructure.
Neglected diseases constitute a serious global health problem. Indeed, the WHO estimates that more than 1 billion people -- about one-seventh of the world's population -- suffer from one or more of such illnesses. Among their many consequences, they often render HIV/AIDS and tuberculosis more deadly. Though they are most heavily concentrated in low-income regions and countries of Africa and Latin America, they also exert a heavy toll on parts of Asia and the Middle East -- where the range of such diseases is narrower. Some of these diseases are also occasionally found in areas of the United States with high poverty rates.
Social and economic costs
Much of the social and economic costs of neglected diseases are unquantifiable:
- People who suffer from neglected diseases need better nutrition -- more calories and especially more protein --- to stay healthy, and malnutrition accelerates the progression of the disease.
- With fewer adults available to work and an increased number of dependents, famine becomes more likely.
- By reducing life expectancy, these diseases make accumulation and inheritance of material assets, such as cattle and land, as well as of essential farming skills and survival experiences, more difficult.
A quantifiable dimension of the social and economic burden of neglected diseases is their impact on the productivity of individuals, households, communities and countries. For example, according to the WHO, Chagas disease causes a loss of 752,000 working days per year due to premature deaths and 1.2 billion dollars per year in lost productivity in seven Latin American countries.
The impact of neglected diseases is normally minimised with the provision of basic services, including safe sources of drinking water and adequate sanitation and housing. According to the UN, 900 million people lack access to safe drinking-water and 2.5 billion lack access to appropriate sanitation. Simple steps to prevent the spread of neglected diseases have proven to be effective:
Diseases spread by insects
These can be prevented by measures such as using insecticides or hanging nets around beds. Often nets are not a perfect barrier, and are treated with insecticides designed to kill the mosquito before it can find a way through them:
- Insecticide-treated nets are estimated to be twice as effective as untreated nets and increase protection by 70%.
- Despite such effectiveness, only 13% of households in sub-Saharan countries own insecticide-treated nets.
Infections by diseases transmitted by snails and other organisms that live in streams and rice paddies are reduced when people do not bathe in water at high risk of contamination. For some diseases caused by bacteria, an effective prevention measure is to boil water used for drinking, cooking and hand washing.
Reducing neglected diseases significantly will also require new drug development (see INTERNATIONAL: Disease research needs wider scope - February 11, 2009). In some cases, treatment has shown to be effective. For example, drugs have proven able to prevent malaria infections. Yet, even at a price of less than 50 cents a day, anti-malarial drugs remain unaffordable for many poor people. Furthermore, R&D efforts to address these diseases are also very modest compared with other illnesses. Governments have two ways of promoting such R&D initiatives (see INTERNATIONAL: Emerging markets change R&D landscape - March 31, 2011):
This includes the use of state-owned pharmaceutical institutes. A case in point is the Therapeutics for Rare and Neglected Diseases (TRND) programme established by the US National Institutes of Health (NIH), a governmental medical research agency. The 24 million dollar programme combines the expertise and laboratory facilities of NIH with that of outside contractors in specific projects to create new drugs for such diseases.
This includes incentives, such as tax benefits, subsidies or rewards, granted to the private sector. For example, the US Food and Drug Administration (FDA) awards transferable 'priority review vouchers' to companies that obtain approval for new treatments for a neglected disease. The vouchers can later be used to accelerate review of an unrelated drug.
The globalisation of intellectual property rights (IPR) established by the WTO's agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) did not favour access to drugs for neglected diseases, which are rarely patented. Indeed, it may actually have the opposite effect:
- The possibility of patenting profitable drugs in all WTO members for a 20-year term may render investments in drugs for neglected diseases relatively less attractive to private companies, even with governmental rewards.
- Hence, in this case patents aggravate the market failure related to neglected diseases and make its correction more difficult.
International and transnational cooperation is paramount to address neglected diseases because the vast majority of countries with high incidence of such illnesses lack the ability to control them effectively. A successful example of such cooperation is the Drugs for Neglected Diseases Initiative (DNDi) -- a non-profit transnational organisation established in 2003 and composed primarily by public sector partners, which manages R&D networks promoting both South-South and North-South cooperation.
While using existing capacities in countries where neglected diseases are endemic, DNDi seeks to help build additional capacities through technology transfer in the field of drug R&D to treat such diseases:
- To date, the DNDi has successfully delivered a number of treatments in poor countries against diseases such as malaria, sleeping sickness, visceral leishmaniasis and Chagas.
- By December 2010, it had secured 153 million euros (192 million dollars) of the 230 million euros needed by 2014 to achieve its stated objectives of developing 6-8 new treatments and a robust pipeline for people suffering from neglected diseases.
- Oxford Analytica
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