Political India: Engaging America

Even as the world welcomed the seven billionth member of the global population this week, medical researchers warned that rapid-growth economies such as India’s still had a high proportion of morbidity with more than 290 million Indians suffering from Neglected Tropical Diseases (NTDs).

In an article on A Disproportionate Burden of NTDs found in India and South Asia, tropical diseases scientists said that although India and South Asia had made significant economic progress, NTDs continued to perpetuate a cycle of poverty among its most disadvantaged populations.

These NTDs include visceral leishmaniasis, also known as “kala-azar,” lymphatic filariasis, which causes elephantiasis, leprosy, dengue fever, rabies and soil transmitted helminth.

Speaking to The Hindu Peter Hotez, an author of the report and President of the Sabin Vaccine Institute in the United States, highlighted the strong link between NTDs and poverty, noting that many cases of NTDs had even occurred in the U.S. wherever poverty had been found.

However the scale of NTD infections in India and South Asia was high, he suggested, noting for example that 12 to 17 per cent of all intestinal worm infections globally occurred in India and were often associated with hookworm, whipworm and the Ascaris worm.

With more than half of the major NTDs attaining endemic proportions in India and South Asia the economic loss attributed to these diseases was significant, Dr. Hotez said, indicating that close to $1 billion per year was lost due to lymphatic filariasis alone.

Dr. Hotez also argued that while the government of India had made rapid strides towards eliminating some NTDs such as leprosy, greater coordination between the government and the network of drug and vaccine producers in the private sector would lend additional momentum to this process.

The need for more coordination notwithstanding, there have been some major success stories in India, and among them is the de-worming drive in Bihar between February and April this year, when over 17 million children were de-wormed.

India has also already demonstrated its capacity to create vaccines, Dr. Hotez said, highlighting the fact that the Serum Institute of India was the first institution globally to create a meningococcal A-vaccine. Similarly Hyderabad-based Shantha Biotechnics Ltd. has launched an oral vaccine for preventing cholera.

While mass drug administration programmes for lymphatic filariasis, worms and leprosy could help completely eliminate these NTDs in India, India ought to focus on developing the next generation of drugs, diagnostics and vaccines for NTDs, Dr. Hotez said.

The presence of a sophisticated biotech industry implied the potential for public-private partnerships the results of which would not only bring benefits to the poor in India but to the poor globally, he added. A good example of international coordination in this regard was a partnership between India, Bangladesh and Nepal in a drive to control leishmaniasis that occurs heavily in the border areas between these nations.

Labels: 7 billion mark, India healthcare, tropical diseases

From The Hindu

A report on Neglected Tropical Diseases released by the World Health Organisation this week has outlined the breathtaking economic cost that developing countries such as India face in coping with diseases such as hookworm infection, lymphatic filariasis and visceral leishmaniasis, commonly known as kala-azar.

In the report WHO Director-General Margaret Chan underscored the linkages between such NTDs and poverty, saying, “Neglected tropical diseases have traditionally ranked low on national and international health agendas.” She added that currently impaired the lives of an estimated 1 billion people, mostly in remote rural areas or urban slums and shantytowns.

According to Dr. Chan, NTDs usually caused massive but hidden and silent suffering, and frequently killed those infected, but not in numbers comparable to the deaths caused by HIV/AIDS, tuberculosis or malaria. She also noted that the presence of these debilitating illnesses also often went unnoticed by health authorities as those affected or at risk generally had “little political voice.”

Speaking to The Hindu, Peter Hotez, President of the Sabin Vaccine Institute and a spokesperson for the Global Network for Neglected Tropical Diseases, corroborated the WHO’s assessment of the current state of NTDs, including the possibility that these diseases frustrated the achievement of health in the Millennium Development Goals.

Touching on the scene in India in particular Dr. Hotez said, “India still remains the epicentre for NTDs,” noting for example that there were currently close to 70 million cases of hookworm infection. This was “of great concern” because childhood infection reduces future wage earning by 40 per cent, according to a 2007 study mentioned in the report.

Given the disproportionately large impact of such NTDs on the lower strata of the population, the vaccines for these NTDs are known as “antipoverty vaccines,” Dr. Hotez explained. He said that the reason such diseases received less official attention was because they “do not kill, but cause high morbidity and economic loss, and this is killing India.”

Citing the case of lymphatic filariasis – also know elephantiasis – Dr. Hotez quoted another study which indicated that India faced “almost a billion dollars loss per year, economically,” from the disease.

While the WHO report said that India had undertaken national efforts to reduce the impact of leishmaniasis and filariasis, Dr. Hotez warned that “for hookworm infection it is too widespread to even consider elimination at this point.” He noted that for this disease there was a need for a vaccine and the Sabin Institute was working on such a vaccine,

In the international arena, Dr. Hotez said, the contributions of European governments and developing country governments did not come anywhere near the major efforts of the U.S. to control NTDs worldwide, with the United Kingdom’s Department for International Development being a notable exception. “Other countries should be doing more to help control NTDs at the global level,” he said.

Labels: health issues, tropical diseases, WHO Director-General Margaret Chan, WHO report

From The Hindu

Neglected tropical diseases such as hookworm infection and lymphatic filariasis together affect over 100 million people in India but have simple, low-cost drug and vaccine treatments that governments need to promote much more, according to Peter Hotez, Distinguished Research Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine, George Washington University.

Speaking to The Hindu after a seminar on “Control of the Neglected Tropical Diseases: Innovative Approaches and Role in U.S. Foreign Policy,” Professor Hotez said that there were approximately 70 million cases of hookworm infection and 30 million cases of lymphatic filariasis, also known as elephantiasis, in India, with the latter costing the country close to $1 billion per year.

To highlight the extent of the disease in India Professor Hotez explained in his paper that toward the end of his life, Mohandas Gandhi suffered from a hookworm infection a disease, caused by blood-feeding worms in the intestine, and associated with severe anaemia, lethargy, and fatigue.

“The fact that Gandhi's vigorous efforts to wage peace in India may have been slowed because of hookworms is only one of the more dramatic examples of the deep connection between medical health and the promotion of international peace and security,” Professor Hotez said.

He also linked the need to combat these diseases with U.S. foreign policy imperatives, pointing out that there was an “extraordinary opportunity” for the U.S. to improve treatment of these infections in Islamic countries such as Pakistan and Syria and also in other states with nuclear interests, such as India, China and North Korea – where neglected tropical diseases had “devastating consequences” for many.

In particular Professor Hotez said that there was much untapped potential for the U.S. to cooperate with India in further developing new drugs and vaccines for hookworm infection and Leishmaniasis, a disease with extremely high infection rates in Bihar.

He said that even in some developing countries the ratio of public expenditure on nuclear projects to neglected tropical diseases was of the order of magnitude of 10,000 to one. He added that even putting aside a small part of this military expenditure towards the treatment of diseases like hookworm would constitute an enormous anti-poverty step.

Labels: Department of Microbiology, George Washington University, lymphatic filariasis, tropical diseases