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Neglected Infectious Diseases

Strategy Overview

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In Ghana, aggressive public health efforts led to the 2011 eradication of guinea worm disease, which is spread by a water-borne parasite.

our goal:

to reduce the burden of neglected infectious diseases on the world's poorest people through targeted and effective control, elimination, and eradication efforts.

The Challenge

At A Glance

One billion people suffer from one or more neglected infectious diseases—diseases that have historically attracted little investment to develop treatment, prevention, or control methods and that disproportionally affect the world’s poorest and most vulnerable people.

Effective treatment and control methods are available to fight many of these diseases, but significant progress cannot be made without more funding for drug delivery and better diagnostic tools to improve disease mapping and surveillance.

We work with our partners to develop and deliver new tools to address neglected diseases, with a particular focus on diseases that present the greatest opportunity for control, elimination, or eradication.

We also support efforts to accelerate progress through coordinated mass drug administration against multiple diseases, public-health surveillance, and vector control.

Our Neglected Infectious Diseases strategy, updated in 2011, is led by Lance Gordon, director, and is part of the foundation’s Global Health Division.

More than 1 billion people in developing countries suffer from infectious diseases that attract little donor funding, largely because those diseases are rare in wealthier countries. Until recently, investment in treatment and prevention methods has been lacking and access to existing interventions in areas where they are needed has been limited.

These diseases cause serious health problems and significant economic burdens. They can cause anemia and blindness, stunt children’s growth, lead to cognitive impairments, and complicate pregnancies. They also cause hundreds of thousands of deaths each year. People living in extreme poverty often suffer from more than one of these diseases simultaneously, which affects their ability to make a living and move out of poverty. As a major public health burden in dozens of poor countries, neglected infectious diseases are a barrier to the achievement of the UN Millennium Development Goals.

The Opportunity

Safe and effective treatments and control methods are available to fight some neglected infectious diseases. The difficulty is in getting the interventions to where they are most needed: poor and hard-to-reach communities in developing countries where people have little access to healthcare. Despite logistical challenges, efforts to combat some of these diseases have been highly successful in recent years, creating optimism that we can control, eliminate, or even eradicate several of them.

For example, reported cases of dracunculiasis (guinea worm disease) fell to a historic low of 541 in 2012 in just four countries. More than 120 million people are infected with lymphatic filariasis (elephantiasis), a parasitic disease spread by mosquitoes, but 2.7 billion treatments have been delivered since 2000.

Progress against lymphatic filariasis has come largely through a global alliance that has delivered drugs donated by Merck, Eisai, and GlaxoSmithKline. Despite limited economic incentives, these pharmaceutical companies have increased their donations and supported research and development into new tools against neglected diseases. Recent history demonstrates that these diseases can be eradicated when they are the target of strategic, innovative, collaborative, and sustained action.

Growing resolve within the public and private sectors can accelerate progress and lead to larger-scale efforts. In January 2012, a public-private partnership that includes the foundation; 13 pharmaceutical companies; the governments of the United States, United Kingdom, and United Arab Emirates; the World Bank; and other global health organizations announced a coordinated push to control or eliminate 10 neglected tropical diseases by the end of the decade.

Our Strategy

Battling neglected infectious diseases is an important priority of the Bill & Melinda Gates Foundation. We work closely with donor governments and developing countries—who together provide most of the funding to combat these diseases—to ensure that our investments complement other efforts. We concentrate our resources in areas where existing funds are scarce, our support can have catalytic effect, and we are better positioned than others to assume risks. Our strategy reflects where we believe the foundation is best positioned—among a broad spectrum of actors—to help significantly reduce the incidence of neglected infectious diseases.

To date, we have committed more than US$1.02 billion in grants to organizations working to address neglected infectious diseases. Our investments have largely focused on the development of new tools and on ways to deliver them and make them broadly available. Beyond our direct investments, we advocate for increased international funding to support these efforts.

Many infectious diseases could be considered neglected. In deciding what types of investments to make, we consider factors such as the scale and severity of a disease’s impact, the social and economic burdens it imposes on developing countries, and the likelihood that strategic, feasible interventions could control, eliminate, or eradicate it.

We are currently targeting 18 neglected infectious diseases. Because each disease is different, we vary our strategic approach accordingly.

Areas of Focus

High-Opportunity Targets

Most of our funding goes toward addressing nine diseases that present the greatest opportunity for control, elimination, or eradication. With several of these diseases, large-scale interventions have made good progress but more needs to be done. We support the development and delivery of new drugs, vaccines, diagnostics, vector-control tools, and program approaches, tailoring our investments to each disease.

Our investments focus on the development of new treatments, tools, and control measures and on ways to make them broadly available.

One high-opportunity target is onchocerciasis (river blindness), which is caused by a parasitic worm transmitted to humans by black fly bites. Some 18 million people are infected, primarily in Africa, but mass distribution of the donated drug ivermectin has helped to eliminate the disease in many parts of Africa and South America.

Ivermectin kills only worm larvae, however, leaving adult worms unaffected and allowing them to produce more larvae that can spread disease. This means that people infected with the disease must repeat drug treatment annually or even twice a year for a decade or more. Another challenge is that millions of people in West Africa are infected by eye worm, also known as loa loa, which makes them unable to tolerate ivermectin and leaves them with no effective treatment for river blindness.

We are working to help eliminate onchocerciasis with current drugs where that is possible. We also support efforts to develop new treatments that could be more effective and more widely used. These include new methods of controlling disease transmission and a new drug that would attack adult worms and could be used safely where eye worm is prevalent.

Another target disease is dengue, a mosquito-borne viral illness. Its incidence has increased 30-fold worldwide since the 1960s, and an estimated 50 million people are infected each year. There is no effective treatment, and current methods of controlling transmission are costly and often ineffective because they are used too late.

Dengue is a high-opportunity target because several potential vaccines are in development. We are supporting preparations to deploy a safe and affordable vaccine when it becomes available. Meanwhile, we are investing in the development of novel mosquito-control methods to prevent outbreaks. We are also funding work on new ways to detect or even predict dengue outbreaks early enough for transmission controls to succeed.

The other high-opportunity diseases that we target are Japanese encephalitis, human papillomavirus (HPV), visceral leishmaniasis (black fever), hookworm disease, dracunculiasis (guinea worm), lymphatic filariasis (elephantiasis), and human African trypanosomiasis (sleeping sickness).

Integrated Efforts

We support efforts to develop new ways to attack multiple infectious diseases at the same time, in a coordinated and integrated fashion. These efforts include three main areas of focus:

  • A Médecins Sans Frontières (Doctors Without Borders) screening and treatment site for neglected tropical diseases in rural Uganda.

    Mass drug administration. In areas where several infectious diseases are prevalent and can be treated with the same drugs or a similar schedule of drug treatments, we support efforts to coordinate the various components of large-scale drug administration programs, such as obtaining commitments to donate drugs.
  • Public-health surveillance. In fighting infectious diseases, good data is crucial—such as data on where a disease is prevalent in humans and in the mosquitoes, flies, worms, or other vectors that transmit it. Such data is lacking for many neglected diseases. We are seeking solutions such as shared approaches to sample collection and processing, data aggregation, and the design of efficient surveillance systems.
  • Vector control. Most neglected infectious diseases are caused or spread by insects or worms, which are costly and difficult to control. But control measures are similar for all of these vectors, so better cross-disease coordination would improve the efficiency and effectiveness of the various vector-control efforts. We support the development of a framework for cross-disease coordination to improve the coverage and impact of vector-control measures.

Transitional Diseases

We are currently winding down our work on three diseases: rabies, trachoma, and cysticercosis (tapeworm infection). Several of our partners are leading efforts to combat these diseases, using available treatments and tools. Our final investments are aiding their work.

New Diseases

To improve prospects for curbing six newly targeted diseases—ascaris, trichuris, hookworm, schistosomiasis, Buruli ulcer, and Chagas disease—we are investing in research to better understand their transmission patterns and what tools or interventions are needed to fight them.

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