Developing countries and neglected diseases: challenges and perspectives
© Boutayeb; licensee BioMed Central Ltd. 2007
Received: 24 February 2007
Accepted: 26 November 2007
Published: 26 November 2007
It is now commonly admitted that the so-called (most) neglected tropical diseases have been given little attention. According to World Health Organization, neglected diseases are hidden diseases as they affect almost exclusively extremely poor populations living in remote areas beyond the reach of health service. The European Parliament recognised that, to our shame, Neglected Diseases have not received the attention they deserve from EU actions. In the Millennium Development Goals they were given very little attention and mentioned just as other disease. Investing in drugs for these diseases is thought to be not marketable or profitable. However, despite their low mortality, neglected diseases are causing severe and permanent disabilities and deformities affecting approximately 1 billion people in the world, yielding more than 20 millions of Disability Adjusted Life Years (56.6 million according to Lancet's revised estimates) and important socio-economic losses. Urgent pragmatic and efficient measures are needed both at international and national levels.
The Millennium Project 
Millennium Development Goals
UN Millennium Project task forces
1. Reduce extreme poverty and hunger by half relative to 1990
1. Poverty and economic development
2. Achieve universal primary education
3. Promote gender equality & empowerment of women
3. Education and gender equality
4. Reduce child mortality by two-third relative to 1990
4. Child and maternal health
5. Improve maternal health, including reducing maternal mortality by three-quarters relative to 1990
5. HIV/AIDS, malaria, tuberculosis, and access to essential medicines
6. Prevent spread of HIV/AIDS, malaria, and other diseases
6. Environmental sustainability
7. Ensure environment sustainability
7. Water and sanitation
8. Develop a global partnership for development
8. Improving the lives of slum dwellers 9. Trade 10. Science, technology, and innovation
The burden of neglected diseases according to WHO Report 2002 
Burden in DALYs
5 654 000
4 706 000
2 357 000
2 329 000
2 400 000
1 760 000
1 600 000
The burden of neglected diseases revised estimates (The Lancet) 
Burden in DALYs (in million)
150 000 -200 000
2. Neglected diseases afflicting marginalised populations: Challenges and perspectives
Neglected Diseases are given low priority because they have low mortality, they occur almost exclusively in poor developing countries and essentially, because they offer negligible marketable and profitable issues. As stressed by the European Parliament Report in 2005, "No research is currently being carried out into the most neglected diseases which mainly affect developing countries...there is a chronic shortage of investment in research and development in poverty-related diseases and in the developing countries themselves to obtain medicines which meet the needs of those countries" .
New chemical entities (NCEs) approved between 1975 and 1999 by drug class and relative to disease burden and drug sales 
Approved NCEs 1975–1999
Proportion of worldwide sales Year 1999
NCEs by DALY
Drug sales (millions of US$) by DALY
Central nervous system
Anti-infectives and antiparasitics
Tropical diseases (Total)
Other therapeutic categories
Despite the dilemma created by the pharmaceutical industry (treatment-profit), the responsibility is shared by other decision makers. At the global level, international solidarity and public-private partnerships are needed to tackle the problems of shortage and lack of treatments, resistance and the need for new drugs and vaccines. More initiatives are needed to support the projects already launched such as Global Alliance for Vaccines and Immunization (GAVI), The Human Hookworm Vaccine initiative (HHVI), the Foundation for Innovative New Diagnostics (FIND), the Drug for Neglected Diseases Initiative (DNDi), The USAID funded program on integrated control of seven of the most prevalent neglected tropical diseases (trachoma, hookworm, ascariasis, trichuriasis, onchocerciasis, schistosomiasis and lymphatic filariasis) and others [1, 2, 10–12].
However, this international strategy is insufficient without the national and local implication. National health decision makers, non governmental organizations (NGOs), research institutions, community groups and individuals must adhere to these global initiatives. Many countries, being heavily indebted, affect less than 1% of the national global budget to health, and few governments are putting science, technology, and innovation at the centre of their strategies and, in the meantime, war and conflicts are financed at the expense of health services. For instance, in 1999, the governments of sub-Saharan Africa dedicated US$7 billion to military spending, whereas, diverting just 15% of this would have raised more than one US$ billion, enough to treat millions of patients affected by neglected diseases[13, 14]. It is also worth stressing that, in the absence of reporting and surveillance, the available statistics on the burden of NDs are sometimes very different as indicated in Tables 2 and 3.
To overcome this odd situation and in order to reduce the burden of neglected diseases afflicting mainly poor populations of developing countries, pragmatic and efficient strategies are urgently needed. Beside large campaigns for education and sensitisation, measures may include advance purchase commitments, tax credits, fee waivers, partial transfer of patent rights, innovation prizes, technology transfer, health innovation and various incentives for investment. These would promote development of drugs and vaccines for neglected diseases by enhancing collaboration with the pharmaceutical industry of developed countries and encouraging research and development for drugs in developing countries [1–5, 10–15].
In many developing countries, millions of people live with less than one dollar a day and on fragile and often remote rural ecosystems, most of them lack access to basic health services and safe drinking water and sanitation (vectors that transmit NDs thrive on these ideal conditions). Trapped in the vicious circle of underdevelopment-poverty-health inequity, these populations constitute exhausted "preys" for "predators" such as HIV/AIDS, malaria, tuberculosis and a multitude of the so-called neglected diseases. The growing attention given to the "Big Three Killers" should not shadow the suffering that neglected diseases are causing to millions of people who can afford, at best, archaic drugs, some of which are toxic, ineffective or difficult to administer.
In the era of science and high technology, while regular meetings are held worldwide to discuss human rights and various forms, causes and consequences of health inequities, it is a shame that poor populations living in developing countries are denied access to adequate and affordable treatment against NDs. Urgent actions are needed to develop new drugs and vaccines that are efficient and accessible. A big challenge is addressed to national and international decision makers but it is worth trying.
The author is very grateful to the Editor-in-Chief and the Editorial board of IJEqH for granting a waiver of the article-processing charge for this paper.
The author wishes also to thank Mrs Saidi Fatima Zohra for the English checking of the last version.
This paper is dedicated to the African children who are suffering from neglected diseases and deprived of adequate treatment.
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