Saturday, 27 November 2010

By focussing exclusively on HIV/AIDS, malaria and TB, Western governments and NGOs have neglected other easily treatable and curable diseases

Micah Challenge is a global coalition of Christians holding governments to account for their promise to halve extreme poverty by 2015.

It is establishing a global movement to encourage deeper Christian commitment to the poor, and to speak out to leaders to act with justice and its specific focus is the Millennium Development Goals.

The Millennium Development Goals (MDGs) are eight international development goals that all 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015.

They include eradicating extreme poverty, reducing child mortality rates, fighting disease epidemics such as AIDS, and developing a global partnership for development.

The aim of the MDGs is to encourage development by improving social and economic conditions in the world's poorest countries.

The eight MDGs were developed out of the eight chapters of the United Nations Millennium Declaration, signed in September 2000. There are eight goals with 21 targets, and a series of measurable indicators for each target.

Goal 6 is to ‘Combat HIV/AIDS, malaria, and other diseases’ and its three associated targets are as follows:

Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

There are five measurable indicators for target 6C but every single one of them relates to tuberculosis and malaria and none to ‘other diseases’.

So in other words, whilst MDG 6 aims to ‘combat HIV/AIDS, malaria, and other diseases’ the exclusive focus of its associated ‘targets’ and ‘measurable indicators’ is actually HIV/AIDS, malaria and TB. To emphasise the point the United Nations webpage on the MDGs highlights just these three diseases.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing institution that invests the world’s money to save lives. To date, it has committed US$19.3 billion in 144 countries to support large-scale prevention, treatment and care programs against the three diseases.

It claims as a result, through Global Fund-supported programs, to have saved 5.7 million lives, and put over 2.8 million people on AIDS treatment, 7 million people on anti TUBERCULOSIS treatment, and distributed 122 million insecticide-treated nets for MALARIA prevention.

This is perhaps not at all surprising given the support of wealthy donors and celebrities like Bill and Melinda Gates, Warren Buffet and Carla Bruni. But at the same time virtually no progress has been made on ‘other diseases’. If you don’t identify your target there is little chance of hitting it.

So what are these other diseases? And who is championing their cause?

You, like me, may have missed a series of articles in the Guardian highlighting research that is answering just this question, and giving a platform to the British doctor who has been almost a lone voice in trying to attract the world’s attention to this issue.

In 2005 David Molyneux of the Liverpool School of Tropical Medicine said ‘We urge policy makers and health economists to recognise that although HIV, TB and malaria are the most serious problems facing health planners, other diseases exist that can be addressed at realistic cost with effective interventions. Controlling Africa's neglected diseases is one of the more convincing ways to make poverty history.’

As it seems that no one has listened he has now said it again.

The neglected diseases, which include schistosomiasis, river blindness, ascariasis, elephantiasis and trachoma, affect more than 750 million people and kill at least 500,000 every year.

Treating all of these illnesses with a cocktail of four readily available drugs would cost less than 50 cents (28p) a person a year. Furthermore dealing with the forgotten diseases would reduce susceptibility to malaria and help to make socio-economic improvements for those in poverty, as well as save lives.

Molyneux and his fellow researchers are not saying that we should turn our back on HIV/AIDS, TB and Malaria. Far from it! What he is saying is that they must not be our exclusive focus:

‘We urge policy makers and health economists to recognise that although HIV, TB and malaria are the most serious problems facing health planners, other diseases exist that can be addressed at realistic cost with effective interventions. Controlling Africa's neglected diseases is one of the more convincing ways to make poverty history.’

Reaching everyone in Africa who needed treating would cost $200m a year, a mere fraction of the $15bn a year being spent on malaria, HIV and TB.

However, the plight of these people is being neglected because resources are being monopolised in developing countries by HIV, malaria and TB – even though these diseases infect a much smaller fraction of their populations.

These ‘other diseases’ are being missed because of distorted health policy goals.

‘This is not the fault of pharmaceutical companies,’ says Molyneux. ‘They have made available billions of doses of key drugs. Our problem is that we are not providing the impetus or the means for getting these drugs to disease sufferers. People at policy level think that only malaria, TB and HIV exist in the third world. This is not true. Neglected tropical diseases as a whole – like sleeping sickness or bilharzia – cause more of a burden than these big-name diseases but are being ignored.’

Most major pharmaceutical companies have pledged to provide, at no cost, billions of doses of the drugs needed to combat these diseases. But many G8 governments have failed to provide the means or impetus to get those drugs to the people who need them, a failure which Molyneux says is a major one.

‘If we can't deliver free drugs to poor people, I don't think there is much else we can do in international health’, he said.

Matthew’s Gospel tells (4:23) us that ‘Jesus went throughout Galilee, teaching in their synagogues, proclaiming the good news of the kingdom, and healing every disease and sickness among the people.’

Surely if Jesus himself didn’t focus on just some diseases, but dealt with all, then as his people we must do the same.

I pray that it will not be said of us as a generation of Christian doctors, that whilst making an impact on HIV/AIDS, TB and Malaria we turned a blind eye to ‘other diseases’ like schistosomiasis, river blindness, ascariasis, elephantiasis and trachoma.

The neglected diseases (with numbers affected in sub-Saharan Africa)

Ascariasis Most common human worm infection (173 million)
Schistosomiasis Also called bilharzia. Flatworm infection (166 million)
Elephantiasis Worm infection of lymph system (46 million)
Trachoma Leading infectious cause of preventable blindness (33 million)
River blindness Parasite. Symptoms include eye lesions (18 million)


  1. Very good points well made.

    The MDGs, while a good start miss many important diseases and often support a vertical approach which is not the best for sustainable improvements in health. While the global fund to fight malaria, TB and AIDs is a good thing, it neglects so many other diseases and may remove accountability from governments in those countries worst affected. Diarrhoea and pneumonia are also well up there in terms of mortality, especially among children, but there is no global fund to stop these diseases! Also accidents cause millions of deaths in low income countries too but are unheard of. The trouble is these diseases are the result of other social determinants of health like sanitation and clean water and cannot be really solved by technological medical interventions like vaccinations or ARVs. Sanitation was only added on to the MDGs as an afterthought when everyone realised how important it was to have a clean toilet. The trouble is, the solution to so many of these problems is development and poverty reduction, and until that happens, we will still see millions of people dying.

    Another thing is the relative reductions the MDGs call for. It is a lot easier for Mexico to reduce its U5 mortality rate by two thirds (a reduction of 30 children per 1000 from 1990 to 2015) than Niger to reduce its rate by a two thirds from 305 in 1990 to 100 in 2015.

    But the MDGs are doing some good, and it is beneficial to have a focus.
    Maybe we are just focusing slightly in the wrong direction.

  2. It's probably a bit unfair to imply criticism of Bill Gates for supporting the "big three" when the Gates Foundation is one of the world's biggest funders of research into neglected tropical diseases.

    That said, I sometimes quip that HIV is the first Western disease to hit Africa. What I mean is, whereas in much of sub-Saharan Africa many people's view of medicine is something you take for a few days when you fall ill, HIV is pretty much the first chronic long term condition for widespread treatment to be attempted across much of Africa, whereas in the West we take for granted our daily cocktail of statins, aspirins and goodness knows what else that we start in our thirties or forties and continue every day until we die. That requires a shift in mindsets - both at the patient level in understanding the need to take medications consistently and lifelong - and at the infrastructure level to ensure continuous supply and delivery, often in places where there are no roads. As said above, if we can't even provide an annual dose of four free medicines to these people, what hope is there for running an effective healthcare service?

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