Forgotten People, Forgotten Diseases. Peter J. Hotez
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Energy Medical Research Institute, Blavatnik Charitable Trust and Mr. Len Blavatnik, and Dr. Gary Michelson. Nathaniel Wolf was incredibly helpful in the editing and production of this book, while Esther Inman has been an amazing assistant.
Finally, I want to thank my extraordinary close and extended family for all their devotion and incredible support.
Peter J. Hotez
Houston, Texas
Note
1. Hotez PJ. 2012. ASTMH Presidential Address. Four Horsemen of the Apocalypse. Am J Trop Med Hyg 87:3–10.
chapter 1
Introduction to the Neglected
Tropical Diseases: the Ancient
Afflictions of Stigma and Poverty
The age of hypocrisy has been succeeded by that of indifference, which is worse, for indifference corrupts and appeases: it kills the spirit before it kills the body. It has been stated before, it bears repeating: the opposite of love is not hate, but indifference.
ELIE WIESEL, A JEW TODAY, P. 17
It is a trite saying that one half the world knows not how the other lives. Who can say what sores might be healed, what hurts solved, were the doings of each half of the world’s inhabitants understood and appreciated by the other?
MAHATMA GANDHI
Since the beginning of the 21st century, we have seen unfold a new sense of urgency about the plight of the world’s poorest people in developing countries. Today, the average well-educated layperson living in “the North” (North America, Europe, and Japan) is far more aware than ever before about the suffering of the people living in “the South” (the developing countries of sub-Saharan Africa, Asia, and the Americas). Almost certainly, the human catastrophe of HIV/AIDS in sub-Saharan Africa, known as the “plague of the 21st century,” and concerns about possible pandemics from influenza and severe acute respiratory syndrome (SARS) have helped to focus world attention on health problems in developing countries.1
Simultaneously, an unprecedented and extraordinary advocacy effort led by some highly influential international leaders and celebrities has helped to fuel a 21st-century global health movement. Bono, Angelina Jolie, Brad Pitt, George Clooney, Oprah Winfrey, Annie Lennox, Bob Geldof, and other actors, celebrities, and musicians; Bill and Melinda Gates, Warren Buffett, Carlos Slim and his family, and other philanthropists; Jeffrey Sachs; Prime Ministers Tony Blair, Gordon Brown, and David Cameron of the United Kingdom; and Secretary of State Hillary Clinton and Presidents Jimmy Carter, Bill Clinton, George W. Bush, and Barack Obama of the United States have donated their time and energy to advocate for the health of the world’s poorest people. These efforts have captivated world attention and have even infused an element of glamour into solving global health problems. Between 2005 and 2006 alone, Bono, Bill Gates, and Melinda Gates were named Time magazine Persons of the Year; the Time Global Health Summit in New York was branded the “Woodstock of global health”; Brad Pitt narrated a 6-h-long documentary, Rx for Survival, a Global Health Challenge, for PBS; former President Clinton featured global health issues at his annual Clinton Global Initiative; and Bono and Bobby Shriver launched Product RED to support HIV/AIDS, malaria, and tuberculosis relief at the 2006 World Economic Forum in Davos, Switzerland.
As a university professor and now as a dean, I can attest that these activities stimulated an unprecedented level of interest in global health issues from both undergraduates and graduate public health and medical students. These days, almost every week during the academic year, I am visited by one or more young persons who request advice on how they can help solve a health problem in a developing country. I am not the only faculty member to have this experience—today, new university-wide global health institutes are springing up at Duke, Vanderbilt, Harvard, Emory, University of Washington, and elsewhere, as university deans and presidents scramble to keep up with student interest.
Like any movement, the one in global health has been stimulated by a manifesto, which is defined by Webster as “a public declaration of motives and intentions by a government or by a person or group regarded as having some public importance.”1 For the global health movement, we can point to at least three landmark 21st-century policy documents that have effectively served as manifestos.
The first had its origins in January 2000, when then World Health Organization (WHO) Director-General Gro Harlem Brundtland launched the Commission on Macroeconomics and Health (CMH) and appointed the international macroeconomist Jeffrey Sachs to serve as its chair. Jeff and his colleagues were charged with analyzing the impact of health on development. Their Report of the CMH, illustrated with examples of how health investments translate into economic development, elegantly articulated a profound relationship between disease and chronic poverty. As a result, the world’s most influential finance ministers and policymakers began to regard improvements in global health as an important tool for poverty reduction. A second initiative was also launched in 2000 when the General Assembly of the United Nations convened in New York City to adopt a resolution known as the UN Millennium Declaration. The Declaration was a renewed call for sustainable development and for the eradication of poverty, and its core was a set of eight specific Millennium Development Goals (MDGs) along with a set of specific targets for the year 2015. As shown in Table 1.1, three of the goals (MDGs 4, 5, and 6) specifically emphasize health. Finally, the third manifesto was Our Common Interest: Report of the Commission for Africa, commissioned by British Prime Minister Tony Blair to provide specific recommendations on how to accelerate development and reduce poverty in Africa. The report served as an important blueprint for commitments by the Group of Eight (G8) nations at their 2005 summit in Gleneagles, Scotland.
Table 1.1 The MDGs
Unlike many UN and international declarations, which too often are forgotten by the global community almost as soon as they are written, the CMH report, the MDGs, and the Report of the Commission for Africa continue to exert a major influence on global policymakers. Equally important, together with the new advocacy by leaders and celebrities, the global health manifestos have stimulated high-level efforts to invent innovative financial instruments for supporting disease control, including some very substantial funding initiatives from both the G8 nations and some prominent private philanthropic organizations such as the Bill & Melinda Gates Foundation.
MDG 6 (to “combat HIV/AIDS, malaria, and other diseases”) has been a particular target of these new funds, with approximately $10 billion now appropriated annually by the U.S. Congress for HIV/AIDS, malaria, and other diseases through the U.S. Global Health Initiative (www.ghi.gov), which includes the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI). Internationally, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has committed almost $17 billion over the last decade to support interventions against these infections (http://theglobalfund.org), while the Gates Foundation has committed more than $1 billion.2 Practically speaking, these extraordinary new financial commitments mean that unprecedented numbers of poor people in Africa and elsewhere are receiving lifesaving antiretroviral medications for the treatment of HIV/AIDS or drugs and bed nets for the treatment and prevention of malaria. Such interventions are expected to make significant positive changes on the global health landscape over the coming decade.
Unfortunately, with the exception of some important support from the Gates Foundation, the flurry of global health advocacy and resource mobilization occurring over the past few years has, until very recently, largely bypassed the third, “other diseases” component of MDG 6. This neglect is particularly true for a group of exotic-sounding tropical infections that represent a health and socioeconomic problem of extraordinary