Responding to the HIV/AIDS pandemic and tackling so-called neglected tropical diseases are the focus of the November/December 2009 edition of Health Affairs, released today. The articles, by leading global health experts from around the world, show that although these challenges differ dramatically, rising to meet them could save millions of lives.

Health Affairs will highlight the issue’s content on neglected diseases at a briefing today in Washington D.C. Another briefing next week will focus on the material on HIV/AIDS, including a study, described in a New York Times article, which warns that increasing prevalence of HIV infection coupled with the current global economic slowdown portends a drastic funding shortfall for addressing the HIV/AIDS pandemic in both the short and long run. By the year 2031, when the pandemic enters its 50th year, funding needed for developing countries could reach $35 billion annually — three times the current level, warn Robert Hecht, managing director of the Results for Development Institute in Washington, D.C., and coauthors. Even then, more than 1 million people will be newly infected each year; some 33 million people worldwide are infected currently.

The Challenge of Neglected Tropical Diseases

Approximately 1 billion people, mostly in the developing world, die or are sickened by a class of infectious diseases often referred to as “neglected” tropical diseases. Today, more than 30 diseases caused by worms, protozoa, bacteria, fungi, or viruses afflict the poorest people in the poorest countries, and collectively cause as much burden as does malaria or AIDS. Global health researchers argue these conditions are demonstrably treatable and can even be eliminated without a large investment of dollars.

A cluster of papers and perspectives in Health Affairs focuses on strategies and policies for fighting neglected diseases. Publication of the cluster was supported by Global Health Progress, an initiative of Pharmaceutical Research and Manufacturers of America (PhRMA). In the series:

• Health Affairs deputy editor Philip Musgrove and coauthor Peter Hotez argue that concerted efforts — from mass drug administration to nondrug interventions — could conquer many neglected diseases. Research, they say, is needed on four fronts: for diseases where no cheap, effective drugs exist; for backup drugs as protection against development of resistance; for vaccines wherever feasible; and for better understanding of nonbiological obstacles to effective delivery. “Neglected diseases affect millions of lives, yet can be treated or eliminated at a relatively small cost,” says Musgrove. “It’s time for the world to act.
• To date, global efforts to control tropical diseases have relied on mass drug administration. But this “magic bullet” approach in most cases will not be sufficient to stay ahead of constantly evolving microbes and parasites, according to Princeton University’s Adel Mahmoud and former National Institutes of Health director Elias Zerhouni. They support a comprehensive approach that includes a combined set of scientific, socioeconomic, educational, environmental, and workforce strategies. 
• Kenneth Gustavsen of Merck and Co. Inc. and Christy Hanson of the United States Agency for International Development see public-private partnerships as key to fighting neglected diseases, including collaborative efforts among global pharmaceutical and biotech companies and other stakeholders. Continued success of these partnerships, they say, depends on having a supportive policy environment.
• Similarly, Genzyme Corporation’s James A. Geraghty also calls for expanding the biotech industry’s involvement in fighting neglected diseases, arguing that companies have a responsibility to help in disease control. Policy changes that could attract more companies to do such work include federal income tax credits, as proposed in a paper by Gerard Anderson. At a modest cost, these could help usher in a new generation of treatment options for neglected diseases.
• Researchers Sarah E. Frew, Victor Y. Liu, and Peter A. Singer of the McLaughlin-Rotman Centre for Global Health (MRC) in Toronto, Ontario, write that health biotech firms in the global South are spurring growth in these economies by developing and selling vaccines, diagnostics, and therapeutics to local markets. These efforts should be accelerated through a business plan to support and grow sources of affordable innovation for neglected tropical diseases, the authors say.

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