Building Research and Development Capacity for Neglected Tropical Diseases Impacting Leishmaniasis in the Middle East and North Africa: A Case Study

There is an urgent need to build Research and Development (R&D) capacity for leishmaniasis and other neglected tropical diseases (NTDs) in the Middle East and North Africa. The neglected tropical diseases are a group of 17 viral, bacterial, protozoan, and helminthic infections that often have high morbidity but low mortality, causing disabilities through their impact on child development and education, pregnancy outcomes, and worker productivity [1]. NTDs promote poverty and interfere with economic development. Emerging information indicates that the Middle East and North Africa (MENA) region is highly endemic for several NTDs, with increasing levels of poverty and disease in the region [2]. Today, with the exception of Buruli ulcer, Chagas disease, dracunculiasis, and human African trypanosomiasis, the 13 remaining NTDs are found in MENA countries, with the most prevalent (both on and off the WHO’s list) being dengue virus, rabies, brucellosis, leprosy, trachoma, toxoplasmosis, cutaneous and visceral leishmaniasis, toxoplasmosis, facioliasis, schistosomiasis, and soil-transmitted helminth infections [2,3]. Nations such as Algeria, Iran, Libya, Morocco, Syria, Egypt, and Yemen are impoverished countries with especially high rates of NTDs [4]. Among all, Leishmania is the most important protozoan infection in the MENA region [5]. Rapid urbanization and human migration in this region has led to the spread of the sand fly vector and, consequently, leishmaniasis. Despite establishing national programs for sand fly vector control and leishmaniasis treatment, the disease continues to spread. Almost two-thirds of cutaneous leishmaniasis (CL) cases are reported from Afghanistan, Algeria, Brazil, Colombia, Iran, Syria, and Iraq [6]. Among the different countries of the MENA region, Syria is known to have the highest prevalence of CL (nearly 52,983 cases were reported in 2012). Incidence of visceral leishmaniasis (VL) in MENA is sporadic and has been reported mostly from Iraq (nearly 1,041 cases were reported in 2008), where 90% of cases occur in children under five years of age [6]. Globally, compared to HIV/AIDS, malaria, and tuberculosis, which receive 42.1% of the funds allocated to overseas development assistance for health, NTDs have generally been ignored, receiving only 0.6% of the budget [7]. Studies have also established that financial support for Research and Development for NTDs significantly lags behind AIDS and other betterknown diseases [8]. While global efforts to eliminate some NTDs, such as lymphatic filariasis