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Diseases we can stop, but don't

The Global Strategy for Women's and Children's Health gives short shrift to the fight against seven major neglected tropical diseases.

December 12, 2010|By Peter Hotez

Some of the world's most glaring health problems affecting impoverished girls and women are also some of the easiest to address. The fact that we consistently fail to do so is puzzling.

Take female genital schistosomiasis. This infection, caused by a parasitic worm, affects at least 200 million people in sub-Saharan Africa, and in as many as 50 million African women, schistosomiasis produces ghastly and acutely painful ulcers of the uterus, cervix and lower genital tract. Women who suffer from the disease are stigmatized, and they are often socially isolated and depressed.

In addition, new data from Zimbabwe and elsewhere show that this extremely common condition is associated with a threefold increase in the likelihood of acquiring HIV/AIDS during sex. Indeed, when you look at a map of where HIV/AIDS occurs in Africa, there is a remarkable overlap with the form of schistosomiasis associated with genital disease.

But this is the most amazing thing about female genital schistosomiasis: It is possible to prevent the genital lesions from developing by treating at-risk girls and women once a year with a medicine known as praziquantel, provided we begin the treatments when they are little girls. The total cost for purchasing and administering the medicine is 32 cents a patient annually. Treating every affected woman and girl would cost less than 1% of what we now pay for daily antiviral therapy through the United States President's Emergency Plan for AIDS Relief.

Few people know very much about schistosomiasis or the other six major neglected tropical diseases, in part because they almost exclusively affect the world's poorest people. Most of them are chronic, long-standing parasitic infections that typically begin in childhood and last the life of the individual, and they have a disproportional effect on women and girls. Addressing them could make a huge difference in the world.

Even less expensive than treating schistosomiasis would be yearly de-worming for hookworm infection. Hookworm is a leading cause of intestinal blood loss in sub-Saharan Africa, affecting almost 200 million people and up to one-third of all pregnant women. The daily blood loss caused by hookworms robs children of iron and prevents them from growing and developing, as well as gaining IQ points and learning in school.

Hookworm is seldom recognized as a reason that the poorest people in Africa cannot escape poverty, but new studies show that chronic hookworm blood loss in childhood produces stunted and mentally disabled adults whose future wage earning is reduced by 40% or more. The blood loss that hookworm causes in about 7 million pregnant women in Africa also puts their children at much greater risk for low birth weight and for dying in infancy or childhood.

Today, it is possible to deliver medicines for the most common neglected tropical diseases — including not just hookworm and schistosomiasis but elephantiasis, river blindness and trachoma — with just one annual dose. Success in combating the diseases can be achieved for less than $1 a patient annually.

There are finally some signs of hope. The World Health Organization has just issued its first-ever report on these neglected tropical diseases. And over the last four years, the U.S. Agency for International Development has begun to provide support for national programs to combat the diseases in at least a dozen African countries. Our organization, the Global Network for Neglected Tropical Diseases, is raising private funds to ultimately target the more than 30 African countries at greatest risk, and research is being conducted into longer-term solutions, including vaccines to treat hookworm and schistosomiasis as a means to forever eliminate these horrific scourges.

This fall, Secretary of State Hillary Rodham Clinton and other world leaders met at the United Nations headquarters in New York to launch the Global Strategy for Women's and Children's Health. Backed by $40 billion in pledges over the next five years, it provides a framework for drastically reducing the number of women and children who would otherwise die over the next four years from complications of pregnancy, sexually transmitted diseases (including HIV/AIDS), malaria and other causes.

These are laudable goals, but we are still falling short. The U.N. summit gave short shrift to funding neglected tropical diseases, which would dramatically improve pregnancy outcomes and child health, and at a tiny fraction of the cost of many of the things being proposed by the Global Strategy.

Controlling and eliminating neglected tropical diseases is one of the most effective and cost-efficient humanitarian interventions available today. It is also the surest way to maximize the impact of the new Global Strategy to address the plight of girls and women.

Peter Hotez is president of the Sabin Vaccine Institute, which hosts the Global Network for Neglected Tropical Diseases. He also chairs the department of microbiology, immunology and tropical medicine at George Washington University's School of Medicine.

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