Skip to main content


We're creating a new version of this page. See preview

  • Commentary
  • Open Access

Developing countries and neglected diseases: challenges and perspectives

International Journal for Equity in Health20076:20

  • Received: 24 February 2007
  • Accepted: 26 November 2007
  • Published:


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.


  • Schistosomiasis
  • Lymphatic Filariasis
  • Cysticercosis
  • Trachoma
  • Ascariasis

1. Introduction

At the dawn of the third millennium, while human rights and health equity are on all international agendas, millions of forgotten people are suffering from a dozen of neglected diseases (NDs). According to The World Health Organization (WHO), NDs are hidden diseases as they affect almost exclusively extremely poor populations living in remote areas beyond the reach of health services [1]. The European Parliament recognised that "to our shame, Neglected Diseases have not received the attention they deserve from EU actions" [2]. Focusing on the "big killers" like HIV/AIDS, malaria and tuberculosis, the Millennium Development Goals (MDG) and other initiatives have generally given very little attention to the most neglected diseases, often mentioned just as "other disease" (Table 1)[3]. Criticizing the "inertia" and the delay taken in the response to the infectious diseases, the humanitarian organization Médecins sans Frontière (MSF) has been continuously attracting the international attention to stimulate more interest in the development and provision of treatments for the most neglected diseases [4]. Meanwhile, beyond mortality figures, NDs continue to cause severe and permanent disabilities and deformities affecting more than a billion people in the world and breeding millions of disability adjusted life years (DALYs) and important economic losses. Indeed, lymphatic filariasis(LF), leishmaniasis, schistosomiasis, Buruli ulcer, cholera, cysticercosis, dracunculiasis (guinea-worm disease), foodborne trematode infections, hydatidosis, soil-transmitted helminthiasis (ascariasis, trichuriasis, hookworm diseases), trachoma, trypanosomiasis (sleeping sickness), onchocerciasis, Chagas disease, dengue and others [Additional file 1] are responsible for impaired childhood growth, mental retardation, blindness, amputation and diverse disability conditions and hence they are impeding human development of many countries of Africa and Latin America (Tables 2 and 3)[1, 58]. The situation being commonly admitted, it remains that urgent and efficient strategies are needed at local, national and international levels in order to reduce the growing burden of these diseases of the poor.
Table 1

The Millennium Project [4]

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

2. Hunger

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

Table 2

The burden of neglected diseases according to WHO Report 2002 [1]



Burden in DALYs

Lymphatic filariasis


5 654 000

Soil-transmitted helminthiasis

12 000

4 706 000



2 357 000



2 329 000


51 000

2 400 000


15 000

1 760 000

Sleeping sickness

48 000

1 600 000



987 000



700 000

Chagas disease

14 000

649 000


6 000

177 000

Buruli ulcer


100 000



100 000

Table 3

The burden of neglected diseases revised estimates (The Lancet) [6]



Burden in DALYs (in million)

Hookworm diseases









Lymphatic filariasis







100 000



150 000 -200 000


Sleeping sickness

100 000





Chagas disease

14 000



6 000


Buruli ulcer




500 000


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" [2].

For the pharmaceutical industry, which carries out the main research and development for new drugs, it is too costly and risky to invest in drugs for neglected diseases occurring essentially in low-income countries where public spending on drugs is less than US$6 (sub-Saharan Africa) compared to around US$ 240 spent in countries of the Organization for Economic Cooperation and Development (OECD) [9]. It is estimated that, less than 10% of the world's biomedical research funds are dedicated to problems dealing with 90% of the world's burden of disease and, of all drugs in development for all neglected diseases in 1999–2000, 18 R&D projects were clinical development, compared to 2100 compounds for all other diseases [1, 2]. Between 1975 and 2004, among the 1556 new molecules of drugs marketed in the world, only 21 were intended for the neglected diseases (8 for malaria, 3 for tuberculosis and only 10 for the whole set of most neglected diseases)[4]. Another study found that, of the 1393 new chemical entities marketed between 1975 and 1999, only 16 were for tropical diseases and tuberculosis, yielding a 13-fold greater chance for a drug to be marketed for central-nervous-system disorders or cancer than for a neglected disease (Table 4) [9].
Table 4

New chemical entities (NCEs) approved between 1975 and 1999 by drug class and relative to disease burden and drug sales [9]

Therapeutic areas

Approved NCEs 1975–1999

Proportion of worldwide sales Year 1999


Drug sales (millions of US$) by DALY

Central nervous system

211 (15·1%)





179 (12·8%)




Cytostatics (neoplasms)

111 (8·0%)




Respiratory (non-infectious)

89 (6·4%)




Anti-infectives and antiparasitics

224 (16·1%)





26 (1·9%)





3 (0·2%)




Tropical diseases (Total)

13 (0·9%)





4 (0·3%)




Other therapeutic categories

579 (41·6%)





1393 (100%)




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, 1012].

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 [15, 1015].

3. Conclusion

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.

Authors’ Affiliations

UFR Modelling and Data Analysis, Faculty of Sciences-University Mohamed Ier, Oujda, Morocco


  1. WHO: Global defence against the infectious diseases threat. Geneva, World Health Organization, Geneva, WHO/CDS/2003.15. 2003Google Scholar
  2. European Parliament: Report on Major and Neglected Diseases in Developing Countries. 2005, Accessed June 18, 2007., []Google Scholar
  3. Sachs JD, McArthur JW: The Millennium Project: a plan for meeting the Millennium Development Goals. Lancet. 2005, 365: 347-353.View ArticlePubMedGoogle Scholar
  4. Médecins sans Frontières: Drugs for Neglected Diseases. Accessed June 18, 2007., []
  5. Boutayeb A: The double burden of communicable and non-communicable diseases in developing countries. Transaction of the Royal Society of Tropical Medicine and Hygiene. 2006, 100: 191-199. 10.1016/j.trstmh.2005.07.021.View ArticleGoogle Scholar
  6. Daumerie D: Main features of neglected tropical diseases. Accessed June18, 2007., []
  7. Holveck JC, Ehrenberg JP, Ault SK, Rojas R, Vasquez J, Cerquiera MT, Ippolito-Shepherd J, Genovese MA, Periago MR: Prevention, control, and elimination of neglected diseases in Americas: Pathways to integrated, inter-programmatic, inter-sectorial action for health and development. BMC Public Health. 2007, 7: 6-10.1186/1471-2458-7-6.View ArticlePubMedPubMed CentralGoogle Scholar
  8. Franco-Paredes C, Jones D, Rodrigues-Morales AJ, Santos-Preciado JI: Commentary: improving the health of neglected populations in Latin America. BMC Public Health. 2007, 7: 11-10.1186/1471-2458-7-11.View ArticlePubMedPubMed CentralGoogle Scholar
  9. Trouiller P, Olliaro P, Torreele E, Orbinski J, Laing R, Ford N: Drug development for neglected diseases: a deficient market and a public-health policy failure. The Lancet. 2002, 359: 2188-2194. 10.1016/S0140-6736(02)09096-7.View ArticleGoogle Scholar
  10. Molyneux DH: "Neglected" diseases but unrecognised successes-challenges and opportunities for infectious disease control. The Lancet. 2004, 364: 380-383. 10.1016/S0140-6736(04)16728-7.View ArticleGoogle Scholar
  11. Molyneux DH, Hotez PJ, Fenwick A: "Rapid-Impact Interventions": How a Policy of Integrated Control for Africa's Neglected Tropical Diseases Could Benefit the Poor. Plos Med. 2005, 2 (11): e336-10.1371/journal.pmed.0020336.View ArticlePubMedPubMed CentralGoogle Scholar
  12. RTI International: RTI International joins efforts to reduce impact of neglected tropical diseases in developing nations. Accessed June 18, 2007., []
  13. Morel CM: Neglected diseases: under-funded research and inadequate health interventions. EMBO reports. 2003, 4: S35-S38. 10.1038/sj.embor.embor851.View ArticlePubMedPubMed CentralGoogle Scholar
  14. Mashelkar RA: Nation Building through Science and Technology: A Developing World Perspective. 10th Zuckerman Lecture. Innovation Strategy Today. 2005, 1: 16-32.Google Scholar
  15. Morel C, Broun D, Dangi A, Elias C, Gardener C, Gupta RK, Haycock J, Heher T, Hoetz P, Kettler H, Keusch G, Krattiger A, Kreutz F, Lee K, Mahoney R, Mashelkar RA, Min H, Matlin S, Mzimba M, Oehler J, Ridley R, Senanayake P, Thorsteinsdottir H, Singer PA, Yun M: Health Innovation in Developing Countries to Address Diseases of the poor. Innovation Strategy Today. 2005, 1: 1-15.Google Scholar


© Boutayeb; licensee BioMed Central Ltd. 2007

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.