Cheap to cure but expensive to treat

 What if you could treat a poor person in Africa to cure or prevent seven horrible afflictions – river blindness, hookworm, elephantiasis, trachoma, snail fever and two other parasitic worm diseases – for only 50 cents? Better yet, what if the drug industry could be compelled to give more than a billion of the planet’s poorest people worldwide life-saving and curative drugs for free? Well, you can and they were. These parasites don’t afflict the poor because the worms have a special love for low-income people. Poverty, lack of access to clean water, food or health services is why these people get these diseases.

Yaws is one of a group of 17 neglected tropical diseases (NTDs) that affect 1.5 billion people, among them the world's poorest. They maim or blind people, are often debilitating and sometimes fatal.

"The NTDs are a huge global health priority, and that's really motivated donors and endemic countries to pull together," Helen Hamilton, NTD policy advisor at Sightsavers and chair of the UK Coalition against NTDs said in an interview.

Because most NTDs affect only certain geographical areas, experts say that given the right resources many of them can cease to be a public health risk. Of the 3.5 million cases of Guinea worm infections a decade ago, for instance, there are now just 120 cases globally, showing just how close the world is to eradicating it.

Yaws affects mainly children and causes unsightly skin ulcers and painful bone infections that can make walking difficult. In some rare cases it can eat away people's noses. At least 50 million people were affected by the bacterial infection in the 1950s. When the WHO launched mass treatment campaigns with penicillin vaccines, the number of cases plummeted by 95 percent by the end of the 1960s, according to David Mabey, an expert in yaws and professor at the London School of Hygiene and Tropical Medicine. "But then it fell off the agenda.” Yaws is known to be prevalent in 12 countries in areas where people have little access to healthcare, mainly in West and Central Africa, Asia and the Pacific Islands.

It should be easy to eradicate, because scientists have found that a single dose of the relatively cheap drug azithromycin, given orally, is as effective as the penicillin injections of old. Not enough money is spent on getting drugs and tools to the people who need them, David Molyneux, professor at Liverpool School of Tropical Medicine, said in an interview. Less than 1 percent of official international development aid for health is spent on NTDs, Molyneux said. Malaria, tuberculosis and AIDS attract much of the funds. Bednets, insecticides and free or very cheap drugs can help curb many of the diseases. "We're dealing with something here where ... we can have a profound health impact with very cheap tools," he said.

The global health community needs an estimated $750 million annually to meet the World Health Organization’s 2020 road map for the preventive treatment and care of neglected tropical diseases. It is relatively cheap, when compared with the billions of dollars needed to address other health issues like HIV and AIDS, to which U.S. President Barack Obama allocated $6.2 billion under his 2015 budget request.

According to Dirk Engels, head of WHO’s NTD department. In fact, he said, there’s currently just about $300 million in foreign aid funding available to tackle these diseases — not even half of the required sum. And given the current financial climate, especially in traditional donor countries, Engels, who is also the lead author of a new WHO report on NTDs, isn’t so optimistic that foreign aid can bridge that gap. Ebola has shown that when there is real urgency, something can be done (by foreign donors and pharmaceutical companies)," he said. "But it's also shown that maybe we shouldn't wait until it is urgent." Critically needed interventions are often sidelined as donors focus too much on the end result. Intestinal worm infection is an example. A chronic problem in poor countries, particularly in areas where there are poor sanitation practices and facilities, intestinal worm infection can easily be cured by taking the right medicine. WHO made it a target to reach at least 75 percent of poor schoolchildren with this pill by 2010, and yet, five years past the target and with 600 million deworming tablets available for free, only 300 million are being delivered and just 30 percent of the estimated target population being reached.

The drug company Merck, for example, has for 25 years been donating for free a drug, ivermectin, to treat Africans against the parasitic worms that cause elephantiasis and river blindness (the drug is mostly sold in the West for treating canine heartworm infections). “Most firms were willing to donate the drugs but they didn’t want to be on the hook for anything else,” Julie Jacobson, a physician and program officer at the Bill & Melinda Gates Foundation said. The drug companies agreed to get the donated meds to the countries but other needs such as coordinating the donations in country, incorporating them effectively into broader health programs, monitoring for safety and compliance and so on were to be the responsibility of others.

YLDs – years lived with a disability  YLLs – years of life lost