Jul 29 2004
Millions of the world's poorest people are suffering needlessly from diseases that are being neglected because of the emphasis given to the "big 3" killers, HIV/AIDS, TB and Malaria, says Professor David Molyneux of the Liverpool School of Tropical Medicine.
Writing in THE LANCET, Professor Molyneux outlines how prioritising on dealing with the "big 3" is obstructing public health initiatives to tackle preventable diseases such as viral, bacterial and parasitic infections of the tropics and acute respiratory infections and diarrhoeal diseases of children.
He argues for a renewed public health effort to tackle so called "neglected diseases" which continue to have serious impact in less-developed countries. For example, he argues that conditions like leprosy should receive a bigger share of funding. Such conditions are relatively easy and cheap to treat compared to HIV, he says. Professor Molyneux says that resources are being transferred to interventions against HIV, TB and malaria that have only a limited chance of success.
"I think international organisations tend to set targets that are simply unachievable. If you take HIV, it's going to be extremely difficult to deliver anti-retroviral therapy. The target set by the World Health Organisation is three million (to receive anti-retroviral treatment in Africa) by the end of 2005. That is extremely hard to do," he said. Professor Molyneux believes that money should be directed to tropical diseases in the developing world that are currently under funded yet simple to treat.
"For 25 years there have been several programmes out there for river blindness, Guinea worm etc, all of which have been extremely well controlled with relatively small amounts of money and are cost effective. For the cost of 10 cents in Africa, you can prevent things like river blindness. For less than a dollar a year you can get rid of public health problems forever. If you contrast that with what it costs to provide anti-retroviral treatment for HIV patients, it is probably about 200 dollars per patient per year for the rest of their lives," he said. "But nobody is saying this, nobody is analysing why this is happening. It is inequitable and possibly unethical," he added.
"The emphasis on the big three killers and the derogatory assignment to the category of "other diseases" of those than can so easily be controlled or even eliminated, neglects the proven success of a range of interventions. "An investment of a fraction of the annual requirements of the Global Fund would bring long lasting benefit to the millions that still remain disabled, reduce morbidity and prevent disablement in future generations. If we are to ensure the efficient use of the substantial resources needed to reduce morbidity and mortality associated with HIV/AIDS, tuberculosis and malaria, then a small investment in proven, cost-effective interventions against "other diseases" - preferably from the Global Fund resources - will bring sustainable public-health benefits, integrate well with and strengthen the health system, reduce disabling conditions and bring collateral benefits to the health of the poorest nations."
Professor Molyneux said that part of the problem was poor recognition of the diseases. "These diseases are off the radar screen. They are major public health problems but they do not have names that people identify with because they do not occur in the West. Everybody knows about HIV, tuberculosis and malaria. The West identifies with these."
He concludes: "Policy makers are ignoring scientific and operational evidence that interventions against "other diseases" are effective. By concentrating on so few agents, current policies could perpetuate inequity, disrupt health-financing policies, divert human resources from achievable goals and deny opportunities for impoverished health systems to improve. Current policy raises ethical issues. Resources are being transferred to interventions against the big three that, realistically, have only a limited chance of success as they are reactive and do no adequately control transmission - a pre-requisite for any public-health impact."
Contacts: Professor David Molyneux, Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine +44 (0) 151 708 9393 Ext 2145 or email [email protected]