Global Health Security and the NTDs, by Peter Hotez

Plos blogs – Peter Hotez, co-Editor in Chief of PLOS NTDs, comments on President Obama’s call for global action to prepare for future disease outbreaks and to treat biological threats as issues of national and global security.

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In a landmark White House summit last week President Barack Obama addressed health ministers from more than 40 countries, in addition to leaders from several international health organizations.  His welcomed message was that highly lethal and widespread epidemics such as the West African Ebola outbreak are more than public health threats.  Instead these devastating infections when they affect or threaten large populations also have dire economic consequences and themselves are highly destabilizing leading to further breakdowns in already fragile systems and infrastructures.  In this sense Ebola is a direct and serious threat to national and global securities.

This is not the first time we have seen epidemics threaten global security. We saw such connections during the SARS pandemic in 2002-03, again with the emergence of avian influenza, and especially during the H1N1 influenza pandemic of 2009.  These outbreaks together with concerns about bioterrorism were underlying reasons why BARDA (The Biomedical Advanced Research and Development Authority) was established within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services (DHHS).

It is important to point out, however, that infectious diseases are threats to global security for reasons that go beyond perceived or actual high profile and lethal epidemics such as Ebola, SARS, and flu.  Previously in PLOS Neglected Tropical Diseases together with former DHHS Secretary and Wisconsin Governor Tommy Thompson I highlighted the widespread and destabilizing effects of the neglected tropical diseases (NTDs).  A key point is that NTDs such as hookworm, schistosomiasis, lymphatic filariasis, river blindness, and trachoma rank among the most common afflictions of the world’s poor and almost every person living in extreme poverty has one or more of these conditions.  As a result we found that these and other NTDs reduce agricultural productivity even to the point where agricultural lands are abandoned.  Thus NTDs promote food insecurity.  Moreover, certain NTDs such as hookworm damage children by adversely affecting their educational performance leading to sharp drops in future wage earning, while promoting ignorance.  They have a huge impact on the health of girls and women and greatly increase bad pregnancy outcomes for both mother and child.

Through such mechanisms, the NTDs may rival more highly visible threats in terms of their ability to destabilize communities.   Aside from the specific NTDs listed above there are also now well established links between some of the vector-borne diseases such as African sleeping sickness, kala-azar, and cutaneous leishmaniasis, and human survival in a conflict or post-conflict setting.  A big question is whether the equation goes both ways, i.e., we know NTDs flourish among destabilized communities, but could it be that NTDs also promote conflict?

In his address to the world’s health ministers, President Obama was right to point out last week that it is important that the global public health community urgently address this current crisis in West Africa, but not let its guard down with respect to other global health threats.  For NTDs this means continuing integrated mass drug administration for intestinal helminth infections, schistosomiasis, LF, river blindness, trachoma, and yaws; multi-drug therapy for leprosy; and elimination/eradication programs for other NTDs including African sleeping sickness and guinea worm.  In parallel, the same roadblocks that have slowed the entry of new Ebola interventions – drugs, diagnostics, and vaccines – into the clinic are similar to those that have thwarted the development of similar control and elimination tools for most of the NTDs.  In the R&D space it is important that we take lessons learned from this Ebola crisis and apply them effectively to produce a new generation of products for the high burden NTDs.

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