Exclusive Commentary

Practicing Tropical Medicine in Extreme Poverty America

Professor Peter Hotez, Baylor College of Medicine, Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, and James A. Baker III Institute for Public Policy, Rice University - Posted January 28, 2013


In 2001, the World Health Organization’s Commission on Macroeconomics and Health, led by Dr. Jeffrey Sachs, released a report focused on the “big three” diseases – HIV/AIDS, tuberculosis, and malaria – as well as other important global health conditions, including childhood infections, maternal and perinatal conditions, and tobacco-related illnesses. The report suggested there was a significant link between poverty and disease, and illustrated how global health challenges in low- and middle-income countries actually perpetuate poverty. 

Since the report was issued, newer information has revealed that a little known group of neglected tropical diseases (NTDs) also contribute to disease-induced poverty in these countries. NTDs are a group of parasitic and bacterial infections that infect more than one billion people worldwide. They cause blindness, disabilities, and disfigurements that can trap infected people in a cycle of poverty and limit their ability to attend work and school, or even care for their families.

The type of poverty associated with NTDs is thought of as a challenge exclusive to places such as Haiti, India, or countries in sub-Saharan Africa, but this perception is wrong. Research shows that the extremely poor in America also suffer from these diseases, and at alarming rates.

The U.S. Census reports that approximately 20 million Americans live in extreme poverty, and The University of Michigan’s National Poverty Center found that a subset of those individuals actually live on less than $2 per day. Based on this report, we decided to investigate the prevalence of NTDs in the United States and found that these seemingly exotic and distant diseases affect far more Americans than one might think.

In total, roughly 5 million Americans were estimated to suffer from at least one NTD. In inner cities, they mostly affect populations living in impoverished, dilapidated communities, and they also have a disproportionate impact on minority populations.

Poor living conditions found in many low-income communities greatly contribute to NTD infections, including Chagas disease, dengue fever, and cysticercosis, toxocariasis, and other worm infections. Chagas and cysticercosis can be particularly dangerous because they are linked to heart disease and epilepsy, which can be fatal.

Despite recent articles in the PLoS Neglected Tropical Diseases, New York Times, newspapers in Texas, JAMA, and British Medical Journal, few Americans realize that NTDs impact such a large segment of the population. But through health worker education, advocacy, and public health policy efforts, the public health community is working to raise awareness about these diseases and establish improved methods to treat and prevent them.

At the Sabin Vaccine Institute, we took steps to fight NTDs by moving our product development partnership to Houston, Texas, as part of a new affiliation with Baylor College of Medicine and Texas Children’s Hospital. The National School of Tropical Medicine at Baylor College was also established in 2011 to educate medical students about NTD diagnosis and treatment. Our team also founded the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, which houses a state-of-the-art 10,000 square-foot product development laboratory.

Federal agencies have also begun to tackle the pressing problem of NTDs. The National Institutes of Health, the Centers for Disease Control, and the Walter Reed Army Institute of Research are all working on NTD research and development initiatives.   

These are great steps forward in the effort to treat and prevent NTDs, not only in the United States, but all over the world. Despite this progress, there’s a lot left to be done if we want to solve this problem.

In addition to treatment clinics and health worker education, one promising avenue could include forming a federal inter-agency government task force that brings together experts from health, housing, the environment, and other sectors to address the multiple complexities that link poverty with NTDs in the United States. This process could unite the expertise of federal agencies, such as the National Institutes of Health and its parent, the Department of Health and Human Services, that work every day to address the needs of low-income Americans.

In order to help the Americans who suffer from these diseases, NTDs can no longer be thought of simply as a developing-world problem. With dedicated research, we can begin to fight these diseases and improve life conditions for low-income families. 

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Professor Peter Hotez MD PhD is president of the Sabin Vaccine Institute, dean of the National School of Tropical Medicine at Baylor College of Medicine, director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, and the fellow in Disease and Poverty at the James A. Baker III Institute for Public Policy at Rice University.

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