Neglected Tropical Disease Control in the “Post-American World”

We cannot expect the United States and the United Kingdom to shoulder the entire financial burden of global NTD control. The world’s emerging market economies and the nations of the Gulf Cooperation Council must now step up and share this commitment. Writer, columnist, and Newsweek International Editor Fareed Zakaria has coined the term ‘‘the post-American world’’ to refer to a new world order that has unfolded over the last decade [1]. Briefly stated, the United States became the world’s most powerful nation beginning in the 20th century, and since the fall of communism we have lived in a world in which the US is the only superpower. However, the last few years have witnessed what Zakaria calls the ‘‘rise of the rest,’’ referring to massive economic growth in what we ordinarily refer to as developing countries. He points out that 124 countries grew at a rate of 4% or higher in 2006 and 2007 [1]. While much of this growth can be attributed to the so-called BRIC emerging economies, i.e., Brazil, Russia, India, and China, as well as other Asian nations, the economies of at least 30 African countries also increased, and in all, poverty has been falling among 80% of the world’s population, including Indonesia, Kenya, and South Africa [1]. Indeed, with the exception of about 50 truly devastated nations, there has been general global growth throughout the lowand middle-income countries of Africa, Asia, and the Americas [1]. World Bank President Robert Zoellick has echoed similar sentiments. In an April 2010 address, he made the statement that 2009 saw the end of what was known as the ‘‘Third World’’ [2]. According to Mr. Zoelick, Asia’s stock markets now account for a larger share of global market capitalization than those of the United States or Europe. He further states that ‘‘this change is not just about China and India’’ [2]. Instead, what we used to call the developing world’s share of global GDP in purchasing power parity is approaching 50%, while India, Bangladesh, and sub-Saharan Africa, where most of the ‘‘bottom billion’’ (i.e., the world’s poorest people surviving below the World Bank poverty level of US$1.25 per day) live, are each expected to grow by an average of over 6%–7% annually for at least the next five years [2]. Together, the Southeast Asian countries of Vietnam, Thailand, and Malaysia have gone from being a low-income region to becoming a powerful group of middle-income countries with important links to India and China [2]. Some of this economic growth is being fueled by the Middle East, which has become an important source of global capital. Today, the sovereign wealth fund assets of the Gulf Cooperation Council countries, meaning Kuwait, Bahrain, Saudi Arabia, Qatar, United Arab Emirates, and Oman, are estimated to be approximately US$1 trillion [2]. As a result, the influence of the G8, as well as other European countries, is evaporating in favor of a larger group of G20 countries, which includes Brazil, Mexico, China, Korea, Saudi Arabia, India, Indonesia, and South Africa (Figure 1). Not everyone agrees with such global economic assessments, including the anthropologist Thayer Scudder, who points to evidence suggesting the overall decline of global living standards [3]. But if Zakaria and Zoellick are correct, I believe their assessments and predictions of geopolitical and economic transformations in the developing world could soon have important implications for the global control of the neglected tropical diseases (NTDs). The NTDs are the most common infections of the world’s poor, especially the bottom billion [4]. Most are chronic and disabling parasitic infections such as the intestinal helminth infections, schistosomiasis, lymphatic filariasis, food-borne trematode infections, and onchocerciasis, as well as selected bacterial and viral infections such as trachoma and dengue [4,5]. A key feature of the NTDs is their ability to exacerbate poverty by impairing child development, pregnancy outcome, and agricultural worker productivity (evidence reviewed in reference [4]). Another feature of the NTDs is their disproportionate impact on Islamic nations and rogue nuclear states, and therefore the areas of geopolitical interest to the US and Europe [6–9]. In response to the growing awareness of the importance of NTDs as a global health and security threat, the US government, through its Agency for International Development (USAID), and to some extent the British Department for International Development (DFID), have begun to provide up to US$100 million annually for NTD control, with plans to possibly double this amount by 2011 [10]. Additional funds for global parasite control have been provided to the government of Japan through its Hashimoto Initiative [11]. While these dollar amounts pale in comparison to the funds allocated for HIV/AIDS through the President’s Emergency Plan for AIDS Relief, the truth is