"Neglected" diseases but unrecognised successes--challenges and opportunities for infectious disease control.

Viewpoint The Millennium Development Goals and a plethora of initiatives have focused on the control of HIV/AIDS, tuberculosis, and malaria. However, a large group of diseases has been confined to the " other diseases " category by health policy makers and politicians. These so-called neglected diseases are the viral, bacterial, and parasitic infections of the tropics (often vector borne), together with acute respiratory infections and diarrhoeal diseases of children. Despite the availability of cost-effective, stable, and successful control or elimination interventions, large numbers of the world's poorest people remain afflicted or are at risk from this group of diseases. The focus of health policy makers on HIV/AIDS, tuberculosis, and malaria, as well as emerging or reemerging diseases causes funding for neglected diseases to be overlooked, with deleterious effects on the social and economic wellbeing of the poorest quintile of populations in the least developed and low-to-middle income countries. 1 Several organisations, partnerships, and initiatives have been created to address the big three diseases—UNAIDS, International Aids Vaccine Initiative (IAVI), Roll Back Malaria, and Stop TB culminating in the establishment of The Global Fund to fight AIDS, Tuberculosis and Malaria. The Global Burden of Disease study, the establishment of International Development Targets and Millennium Development Goals, the development of public private partnerships 2 and the Macroeconomics and Health Commission, however, have all emphasised the relationship between disease, poverty, and development. 1 In parallel, financing mechanisms have moved towards sector wide approaches (SWAPs), with emphasis on country ownership and basket funding—ie, funding for broad health sector support rather than for individual projects and disease-specific interventions. I want to emphasise that long-term successes have been achieved for control of a group of disabling, debilitating, " neglected " diseases over the past three decades— Chagas' disease (caused by Trypanosoma cruzi), 3 Guinea worm (Dracunculus medinensis) 4 leprosy (Mycobacterium leprae), 5 lymphatic filariasis (Wuchereria bancrofti and Brugia malayi), 6 onchocerciasis (Onchocerca volvulus), 7 poliomyelitis, 8 and to a lesser degree the schistosomiases and geohelminths in schoolage children (usually 6–14 years). I will also contrast the control programmes, biological features, and funding patterns for HIV/AIDS, tuberculosis, and malaria, and emergent and reemergent killer diseases, with those of the chronic disabling diseases that have in the past had programmes for control, elimination, or eradication. The successes of control programmes for neglected diseases are the result of national government and donor commitment; clear objectives; realistic time frames; use of …