Peter Hotez/George Washington University

Double benefit.
Treating the ascaris worms that had infected this girl may leave her less vulnerable to other diseases.

Two-For-One Special on Diseases

STOCKHOLM--Public health efforts in the developing world are missing out on a bargain, say a group of researchers and health policy leaders. They argue that the ramped-up efforts against the Big Three--HIV/AIDS, tuberculosis, and malaria--will yield far bigger dividends if they are coupled with an attack on so-called neglected diseases such as hookworm, schistosomiasis, and leishmaniasis. Those parasites make their victims more susceptible to the Big Three, say scientists, who add that fighting both categories requires a similar public health infrastructure.

Maladies such as lymphatic filariasis and onchocerciasis take their toll through stunted growth, anemia, and blindness, contributing to widespread developmental and learning delays. Such forgotten infections "are the world's leading cause of growth deficits," yet they would be relatively cheap to treat, says Peter Hotez, a parasitologist at George Washington University in Washington, D.C. In a paper published 30 January in the Public Library of Science Medicine, Hotez and his colleagues argue that treating the 500 million people afflicted with one or more of these neglected diseases would cost just 40 cents per person per year, compared to more than $20 per person per year for fighting malaria. "It's the best buy in public health at the moment," says Alan Fenwick, a schistosomiasis researcher at Imperial College London and an author on the paper.

At the same time, the authors argue, such treatments might boost the ongoing fight against the Big Three. They point to a growing body of evidence that suggests that populations infected with multiple parasites are more susceptible to other diseases--including the big killers. For example, Hotez points to a study in Senegal that found that deworming medicines reduced malaria cases by 90%. And distribution systems for deworming drugs can also distribute antimalarial bed nets, he says.

The team hopes to put its ideas into practice soon. At a meeting here yesterday and today sponsored by the U.N. Millennium Project--an advisory body that aims to reduce poverty, hunger, and disease worldwide--researchers, representatives of donor organizations, pharmaceutical companies, and public health leaders from eight African countries met to devise a "quick impact initiative" that would create national programs to tackle malaria and the neglected diseases together.

Getting drugs where they are most needed is the greatest challenge, says William Lin of Johnson & Johnson. Lin is in charge of his company's effort to donate 50 million doses of mebendazole, used to treat hookworm and other helminths. "I've asked them to ramp up production," he says. "I don't want to be left at the end of the year with stores in the warehouse--and egg on my face."

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