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Ever since junior high school, I have been fascinated by the application of scientific knowledge for solving tropical public health problems of global importance. Starting with an M.D.-Ph.D. dissertation begun in 1980, my adult life has been a quest to develop experimental vaccines for human hookworm infection. Now, after more than 25 years of laboratory investigation and thanks to the support of the Bill & Melinda Gates Foundation, I have the opportunity and good fortune to head a multidisciplinary team that is developing and manufacturing these vaccines and then testing them in an area of Brazil where hookworm is endemic. While reaching this goal has been intensely satisfying at both a professional and personal level, I have also come to realize that completing early-stage development of a new product for a disease such as hookworm has in many ways been the easy part! Hookworm infects approximately 600 million people worldwide, but they almost all live on less than US$2 per day and only in the poorest regions of sub-Saharan Africa, Asia, and the tropical regions of the Americas. Because the people at risk for hookworm infection cannot afford to pay for a vaccine, unless there is greater general awareness about the public health and economic importance of hookworm and other parasitic infections there will never be the political will and large-scale financial investment necessary to ensure the global access of a hookworm vaccine, or indeed any other product for the diseases of poverty. Simultaneously, as it becomes evident to me that vaccine development is a decades-long process, I feel a need to do more in order to reach out to the world’s poor and provide them with better access to the existing treatments for hookworm, even if our currently available antihookworm drugs are imperfect.

Partly as a means to increase access to essential medicines and innovation, I have begun a concerted effort to raise public awareness of hookworm and other parasitic infections and to advocate for the largely voiceless poor people living in remote and rural regions of endemicity. However, it was only after I met three scientific “soul mates,” medical parasitologists who were simultaneously launching their own advocacy efforts, that I felt an important breakthrough was achieved in terms of placing parasitic diseases on the global radar screen. Since 2003 I have engaged in intense colloquy with Professor David H. Molyneux of the Liverpool School of Tropical Medicine (David is also the Director of the Global Alliance to Eliminate Lymphatic Filariasis), Professor Alan Fenwick from Imperial College, London (Alan is also the Director of the Schistosomiasis Control Initiative), and Dr. Lorenzo Savioli from the World Health Organization (as well as some of his close colleagues there, including Drs. Denis Daumerie, Dirk Engels, and Jean Jannin) about some of the common features of all parasitic infections affecting poor people. During these long and detailed but also joyful conversations, which took place in Washington, DC, Atlanta, New York, London, Liverpool, Glasgow, Geneva, Berlin, and Stockholm, we soon realized that the major parasitic infections, as well as some selected bacterial and viral infections, could be thought of in aggregate as a group under the banner of the neglected tropical diseases, or NTDs for short. The NTDs are the most common infections of poor people, and also among the most important in terms of their health and economic impact. In many respects, their burden of disease rivals those of better-known conditions including HIV/AIDS, even though most people have never heard about the NTDs. This lack of recognition continues to surprise us given that the NTDs are ancient conditions that have plagued humankind for centuries (as documented in many of our earliest writings such as Egyptian medical papyri and religious texts, including the Bible), and they represent one of the most important reasons why the populations living in low-income countries of Africa, Asia, and Central and South America remain mired in a vicious cycle of poverty, destitution, and despair. The continued presence of NTDs in North America represents that region’s most striking health disparity and a sad legacy of the Middle Passage, the Atlantic slave trade between the 15th and 19th centuries.

Professor Jeffrey Sachs and Dr. Sonia Ehrlich Sachs of Columbia’s Earth Institute and Dr. Eric Ottesen (then at Emory University) subsequently joined our informal NTD working group, and in a series of policy papers published in PLoS (Public Library of Science) and the New England Journal of Medicine, we were able to articulate the concept of the NTDs and how we can control or eliminate them through a global scale-up of access to essential medicines. These policy documents also provided a rationale for us to establish a new Global Network for NTDs, which is working to coordinate global advocacy and resource mobilization efforts for these conditions.

Forgotten People, Forgotten Diseases summarizes in mostly nontechnical language the major concepts about the NTDs and how they cause human suffering, as well as their global importance and the unique and unusual opportunity we now have to lift the world’s poorest people out of poverty through low-cost and highly cost-effective control measures.

Peter Hotez

Washington, DC