In times of pandemic, who remembers neglected diseases?

Today marks the World Day of Neglected Tropical Diseases, about twenty ailments that few people in Spain know about. Despite the fact that they affect 1,700 million individuals in the world, in many cases they lack diagnosis, treatment and, of course, vaccines. Being present mainly in the poorest regions of the planet, there is little interest from the pharmaceutical industry, whose research and development model is based on profits. The result is that the investment in new diagnoses and treatments for these diseases is dramatically disproportionate to the suffering they cause. Even though medicines exist, they are frequently ineffective or toxic and access to them is never guaranteed.

Over the years, as doctors, we have witnessed how neglected diseases can destroy the lives of patients and affect their families, like that of Kavita, a seven-year-old Nepali girl of the Rai ethnic group. Kavita had had a fever for several months. Her father, a farmer, based the family’s subsistence on what his fields and animals produced, which also generated about 150 euros a year. The payment to the traditional healer, the repeated alms in a tour of temples to win the favors of the goddess Kala, three months of work lost in coming and going for the duration of Kavita’s illness, had made that exemplary father sell the cornfield, the cow, two goats and 45 chickens before finding the Koirala hospital.

Even there, a university center had more stipends before receiving free treatment for the little girl’s illness: leishmaniasis. In total, the expenses exceeded $1,000, she had gone bankrupt and had to start working for someone else. Poverty begets poverty in a pernicious circle.

Visceral leishmaniasis is a parasitic disease transmitted by the bite of an insect, the sandfly. It causes inflammation of the spleen and liver, destroys blood cells and causes a high fever for months. Without treatment, it can lead to death. There is another form of leishmaniasis, cutaneous, which is manifested by ulcers on the skin where the infected sandfly bit. Of this there are a million new cases every year, that is, one every 30 seconds. In South America, these ulcers can become so aggressive that they cause mutilation of the face, disfiguring the patient’s face, with the consequent stigma and mental health problems.

Although the two variants, visceral and cutaneous, are preferentially distributed in low- and middle-income countries in Latin America, the Middle East, Africa and Asia, many high-income countries do not escape their presence, even with a low incidence. Sometimes, due to refugee displacement, malnutrition or environmental disturbance, outbreaks occur. Thus, the ecological imbalance due to human action in the southwest of the Community of Madrid meant that between 2009 and 2016 some 700 people suffered from one of the two forms of leishmaniasis.

In the southwest of the Community of Madrid, some 700 people suffered from one of the two forms of leishmaniasis between 2016 and 2019

The narrow panoply of treatments for leishmaniasis includes some that were discovered nearly a century ago. They are painful to inject, they are toxic, some life-threatening, and they generally have limited efficacy. For affected people and communities, leishmaniasis, like other neglected diseases, represents an insurmountable barrier to a productive and healthy life. For the health systems of the countries that concentrate most of these ailments, overwhelmed and with few resources, they are one more challenge among many others that they have to face to guarantee access to health for their population.

This unacceptable reality, and with the conviction that the fruits of science must be for everyone, has led us as scientists to dedicate our careers –and our lives– to research and development to combat neglected diseases, and in particular in the development of effective and accessible medicines. There are many other social and health sectors in the same cause. Today we celebrate successes and toast to a better future.

It is a long-distance race. Over the years, the generous efforts of many have led to considerable achievements in various tropical diseases. To cite one case, the South Asia Visceral Leishmaniasis Elimination Programstarted in 2005, has managed to reduce the number of patients, estimated at around 200,000 in that year, to less than 2,000 cases in 2020. In contrast to this success, which hopefully will be stable, in east africa We still do not have a treatment that is both simple and effective, which slows down the fight against the disease.

This example, like many others among tropical diseases, has been a great encouragement to continue. The World Health Organization (WHO) has outlined a path to eliminate or control these diseases in its Road Map for 2030 to which the international cooperation programs of donor governments, funding agencies, philanthropic associations, NGOs and the academic world have joined. Also some sectors of the pharmaceutical world. There are reasons for hope, yes. But there is a long way to go to eliminate these diseases, as proposed in Objective 3.3 of the Sustainable Development Goals “by 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, waterborne and other communicable diseases.

Historically, Spain has made an important contribution to the fight against neglected diseases, not only with trained and cooperating scientists in the field, but also with the financing of research and development programs. At a time when a new Cooperation Law is being inaugurated in our country, thus joining the Sustainable Development Goals, we applaud the commitment that Spain wants to regain in the global movement to fight poverty and its diseases.

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