The yin and yang of leishmaniasis control

The relevance of neglected tropical diseases (NTDs) to global poverty and political instability has ignited interest in this group of diseases with the emergence of terms and concepts such as ‘One Health’ and ‘Leaving no one behind’ [1]. Importantly, this led to the materialization of concrete programs and initiatives aiming at control, elimination or even eradication of some NTDs, most notable being the World Health Organization (WHO) Roadmap to overcome the global burden of NTDs (www.who.int/neglected_diseases/NTD_roadmap_2012_fullversion. pdf) and the London Declaration on NTDs (http://unitingtocombatntds.org/). Leishmaniasis is a vector-borne NTD transmitted by the bite of infected phlebotomine sand flies. It afflicts an estimated 900,000–1.3 million people annually and is responsible for up to 30,000 deaths each year (http://www.who.int/mediacentre/factsheets). At present, leishmaniasis is undergoing a tug of war between natural phenomena and man-made conditions that facilitate the spread of disease, and our efforts to control it through rapid advances in knowledge, technology and communication. Here, I put forward some of the major interrelated yet opposing forces that are likely to shape the future of leishmaniasis control.