Cover photo: Malawi, 2010. Courtesy Elizabeth Jordan.

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      Library of Congress Cataloging-in-Publication Data

      Hotez, Peter J.

      Forgotten people, forgotten diseases : the neglected tropical diseases and their impact on global health and development / Peter J. Hotez. — 2nd ed.

      p. ; cm.

      Includes bibliographical references and index.

      ISBN 978-1-55581-874-6 (print) — ISBN 978-1-68367-348-4 (e-book)

      I. American Society for Microbiology. II. Title.

      [DNLM: 1. Parasitic Diseases—prevention & control. 2. Developing Countries—economics.

      3. Neglected Diseases—prevention & control. 4. Tropical Medicine. 5. World Health. WC 695]

      RC961

      362.196′9883—dc23

      2013001419

      doi:10.1128/ISBN978-1-55581-875-3

      Printed in the United States of America

      10 9 8 7 6 5 4 3 2 1

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      Dedicated to my youngest daughter,

      Rachel Kate Hotez,

      who teaches me every day about disabilities

      To my parents, Edward and Jean Hotez

      To the memory of my brother,

      Richard Eric Hotes, M.D.

      To Mort and Chris Hyman

      and the Hyman family

      And to the Bill & Melinda Gates Foundation

      and the National Institutes of Health,

      U.S. Department of Health and Human Services,

      for the opportunity to devote my life

      to the Neglected Tropical Diseases

      Foreword to the Second Edition

      Dr. Peter Hotez seems a lot like your friendly local doctor when you first meet him. He has these fine, circular glasses, a wide thin smile, and wears hand-tied bow ties with his lab coat. You expect him to pull out a popsicle stick at any moment, squash down your tongue, and implore you to say “Ah.” But Dr. Hotez practices so much more than community medicine. His patients span the globe, and he aspires to bring his mix of human compassion and quality health care to the world’s most vulnerable people, those stricken by the double plague of interrelated poverty and illness.

      One way he’s doing this is by educating people about the links between poverty and disease. Dr. Hotez tell us that neglected tropical diseases (NTDs) are not only the most common afflictions of the world’s poor but can actually cause poverty, by keeping chronic sufferers from being able to work, study, or care for their families. That includes impoverished farmers with elephantiasis, trachoma, or river blindness, which cost billions of dollars annually in lost agricultural productivity. Also, children stricken by hookworm and other intestinal worm infections that reduce intelligence and the cognitive and reasoning abilities they need to study and eventually work. NTDs are also the most common disease to affect girls and women in developing countries, like schistosomiasis, which renders them more susceptible to acquiring AIDS, or diseases like elephantiasis, leishmaniasis, and Buruli ulcer that disfigure and bring shame and stigma and hinder plans for marriage or children.

      NTDs are pervasive in poor communities, in developing countries like Africa and Haiti, but even more disturbingly among the poor living in large middle-income nations—the BRICS countries of Brazil, India, and China for example. I can tell you from my own reporting and travels that disease is also destroying the aspirations of the poor and racial and ethnic minorities in pockets of extreme rural and urban poverty in the United States. Chagas disease, a cause of severe heart disease and death, is widespread in Texas and other southern states both among people and animals. The medicines we have available to treat Chagas disease are too toxic to be given to pregnant women, even though tens of thousands of women in North America suffer from Chagas disease during their pregnancy and several thousand give birth to infected newborns. But there are at least five other NTDs affecting millions of people in the U.S.—most of whom live way below the U.S. poverty line, voiceless and forgotten. NTDs can occur among immigrants, but there is increasing evidence that it is also homegrown. This is a domestic crisis, not an import.

      Like Dr. Hotez, I have struggled with how to best get the word out about our need to address NTDs and their link to poverty. Now he has provided us all with a remarkable tool, a book for people without an extensive scientific or medical background. Forgotten People, Forgotten Diseases is an excellent “one-stop” primer about NTDs. The book highlights the most common and devastating NTDs across the world and describes how they simultaneously cause disease and poverty. It also highlights recent global efforts to control, or in some cases to forever eliminate, these diseases using mass treatments with drugs being donated by major pharmaceutical companies and delivered through a network of health ministries, teachers, and community drug distributors. Today hundreds of millions of people in low- and middle-income countries are being treated annually for their NTDs.

      Forgotten People, Forgotten Diseases also demonstrates how nonprofit product development partnerships (PDPs) are developing new medicines and vaccines for NTDs and how these PDPs are changing conventional notions of business models to develop pharmaceutical products for the world’s poor. The playbook for how to make new NTD medicines and vaccines is being written now, and possibly over the next decade we might have a dozen or more new interventions