Peter Hotez December 13th, 2010
We now know that one of the key reasons the “bottom billion,” the 1.4 billion people living on less than $1.25 per day, remain trapped in perpetual poverty is because they are infected with a group of chronic, debilitating, and mostly parasitic infections known as neglected tropical diseases, or NTDs. The NTD elephantiasis disfigures the limbs and genitals of more than 100 million adults living in Africa, Haiti, and South Asia, where this incapacitating disease prevents people from working. India loses almost $1 billion annually as a result of the disease. The situation is similar for river blindness, an NTD found mostly in sub-Saharan Africa, and chronic hookworm infection, a disease that affects 600 million people worldwide, causing severe growth and development delays in children that can reduce future wage earnings by 40 percent.
For the last three years, I have used a global public health lens to discover the hidden burden of neglected infections of poverty in the United States, which closely resemble the impact of NTDs in the world’s poorest countries. These neglected infections are not rare. They represent some of the most prevalent diseases among the 40 million Americans who live in poverty.
There are a number of powerful social and economic forces preventing millions of people from realizing the American dream. These neglected infections may signify another equally potent poverty trap for our nation’s bottom 40 million.
Indeed, America’s neglected infections of poverty may be the most important diseases you have never heard of—diseases of high prevalence that occur largely among the poorest people, especially people of color, who live in areas of the country that are largely forgotten and seldom visited.
In a 2008 article in the open access online journal Public Library of Science Neglected Tropical Diseases, I provided estimates for the number of mostly African Americans, Hispanics, and Native Americans who live in extreme poverty and suffer from parasitic infections. Cysticercosis, a brain parasitic infection, is now the leading cause of epilepsy among Hispanics in the United States, and as many as 1 million Hispanic Americans suffer from Chagas disease, a major cause of chronic heart defects.
It’s important to point out that this is not a problem resulting from immigration. The root cause is poverty first and foremost, with the chronic issues associated with it, including inadequate sanitation, poor quality housing, malnutrition, and lack of access to health care, especially for pregnant women and children.
Today, up to 3 million African Americans living in poverty in this country have a parasitic worm infection known as toxocariasis, a disease associated with asthma and developmental delays, while 1 million African-American women have another parasitic infection of their genital tract known as trichomoniasis, which has been identified as an important co-factor in the HIV/AIDS epidemic in this country. The rates of these two parasitic infections are similar in the United States and Nigeria. Another neglected disease, congenital cytomegalovirus infection, is a major reason African-American children are born with intellectual and hearing deficits.
If this level of parasitic infections occurred among whites in the suburbs, it would never be tolerated. But because the neglected infections mostly affect people of color living in poverty in places such as the Mississippi Delta, post-Katrina Louisiana, the border with Mexico, and inner cities, they remain forgotten diseases among forgotten people.
Together, with several of my scientific research colleagues, we have taken an interdisciplinary approach to begin chipping away at this burden of disease and neglect in the United States. In our Washington, D.C., research laboratories, where we are developing new vaccines for NTDs, we are now working to develop an easy-to-use diagnostic kit for toxocariasis. In collaboration with the Center for Disease Control and Prevention, this kit may one day be used to determine the role of toxocariasis as a cause of asthma and developmental delays in America’s inner cities. Indeed, there is an urgent need to apply modern biotechnology to all of the neglected infections of poverty.
Second, together with the CDC, we have worked with Georgia Congressman Hank Johnson Jr. to launch a new bill, H.R. 5986, the “Neglected Infections of Impoverished Americans Act of 2010.” Recently passed in the House, the bill would require the U.S. Health and Human Services Secretary Kathleen Sebelius to report to Congress on the current state of these diseases. We urgently need active surveillance for these conditions in order to more accurately estimate the full extent of the neglected infections of poverty, as well as to fully determine how they are transmitted and how they trap our nation’s minority populations in poverty.
This fall, I spoke for the first time on neglected infections of poverty to the Institute of Medicine’s Forum on Microbial Threats. Although best known for its work on emerging threats such as influenza, SARS, and potential bioterrorist attacks, both the Institute of Medicine and I felt it was important that we begin turning our attention to what may represent some of the most important and glaring health disparities in our nation.
Peter Hotez, M.D., Ph.D., is distinguished research professor at The George Washington University and president of Sabin Vaccine Institute in Washington, D.C. This year he serves as president of the American Society of Tropical Medicine and Hygiene.