Research priorities for neglected infectious diseases in Latin America and the Caribbean region

Abstract

Neglected infectious diseases (NIDs) constitute a group of tropical infections which thrive among impoverished populations of developing countries, mainly tropical, in remote rural areas, urban slums and conflict zones (WHO & Carter Center 2008). They include a range of chronic disabling or more acute infections due to protozoa, helminths, bacteria, viruses or fungi. Globally, NIDs cause an estimated 500,000 deaths each year and inflict severe physical disabilities, jeopardizing child growth and pregnancy outcomes. The aggregate disability-adjusted life year (DALY) tally for NIDs is 56.6 million, which exceeds the tally of malaria (46 million DALY) or tuberculosis (TB) (35 million DALY) (Hotez et al. 2007). By reducing economic productivity, NIDs hinder socioeconomic development in endemic countries and affect the quality of life at all levels. The concept of ‘neglect’ was evoked to signal both market and public sector failure in R&D for drug developement: on the one hand, NIDs affect a large number of people who are unable to pay for access to healthcare, and thus represent an uninteresting market for pharmaceutical companies, on the other hand, NIDs did not (for long) constitute a priority for governments and for funding agencies (Torreele et al 2004. A needs-based pharmaceutical R&D agenda for neglected diseases). When world leaders adopted the Millennium Declaration in September 2000, the fight against "HIV/AIDS, malaria and other diseases" was included as the sixth goal. This resulted in significant global support to combat the three major poverty-related diseases (HIV/AIDS, malaria and TB), whereas NIDs remained largely forgotten. This situation is currently changing, and the international community is increasingly becoming aware of the importance of confronting NIDs. The increased focus on NIDs runs along two tracks of activities. The first is focused on short term improvement of public health by control and elimination of NIDs using currently available tools and methodologies. The second line of activities is research into NIDs in order to develop new or improved products and methodologies for long-term disease control and elimination. Since then, the World Health Assembly (WHA) has established a working group on "needs-driven, essential health R&D", while the OECD countries have given political support to NID research in the Noordwijk agenda in June 2007. In the US, the National Institute of Allergy and Infectious Diseases (NIAID) has intensified its long-standing programme of research in NIDs, while several private charities such as the Bill and Melinda Gates Foundation have also increased their support to NID research.