The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination.

The World Health Organizations and other international health agencies identify a select group of 13 tropical infections as the neglected tropical diseases (NTDs). These diseases, which include leprosy, kala-azar, river blindness, guinea worm, schistosomiasis, hookworm and lymphatic fi lariasis, strike the world’s poorest people living in remote and rural areas of low-income countries in Sub-Saharan Africa, Asia and the Americas. They infl ict suffering by causing life-long disabilities, disfi gurement, reduced economic productivity, and social stigma (WHO, 2003). Unlike better-known global health threats such as HIV-AIDS, malaria, and tuberculosis, the NTDs do not receive enough international attention. Instead, they are neglected diseases among forgotten people found only in the setting of geographic isolation and intense poverty (Molyneux, 2004). Impoverished and marginalized populations with the NTDs represent the lowest priority markets for U.S. and European pharmaceutical manufacturers. The NTDs do not occur in the industrialized world or even among the substantial wealthy and middle-classes in developing countries. They are not a signifi cant health risk for foreign travelers or the military. This is in contrast to the more substantial commercial markets for HIV-AIDS, malaria and tuberculosis (“the big three”). The recent creation of massive funding schemes for the big three, such as The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the U.S. President’s Emergency Plan for AIDS Relief provides additional fi nancial incentives, as well as a certain amount of panache and luster. In contrast, the commercial market for NTD drug