Background on Neglected Tropical Diseases
Around 2018, Diango Tounkara in Mali began experiencing vision difficulties. She was subsequently diagnosed with trachoma, identified as the leading infectious cause of blindness. Trachoma, caused by the bacterium Chlamydia trachomatis, results in eyelid swelling and scarring. This condition can lead to eyelashes turning inward, causing continuous abrasion of the cornea and subsequent vision loss. Tounkara received antibiotic treatment and surgery in 2022 through a program funded by the United States Agency for International Development (USAID).
For approximately two decades, Tounkara's work involved distributing drugs in local communities for the treatment and prevention of neglected tropical diseases (NTDs), a role supported by USAID. Mali reported the elimination of trachoma in 2023 and is progressing toward eliminating lymphatic filariasis and other NTDs.
USAID Funding Changes and Program Impact
In January, the Trump administration ceased funding for USAID's neglected tropical diseases program. This decision resulted in job losses, including Tounkara's position. According to Mamadou Coulibaly, who coordinates several NTD elimination programs for Mali's Ministry of Health, the cessation of financing has halted program activities, encompassing both disease elimination efforts and post-treatment monitoring.
Diagnostic testing kits, previously funded by USAID for monitoring disease status, remain unused due to a lack of personnel to administer them and are scheduled to expire in February. Mali has initiated efforts to secure domestic resources and alternative international financing but anticipates these will be insufficient, as U.S. funding previously constituted approximately 90% of the NTD program budget in Mali. Concerns have been raised that this situation could contribute to the resurgence of eliminated diseases in Mali and other countries that had partnered with USAID.
NTDs are recognized for their potential to cause significant disability and affect national development, particularly in regions with fewer resources. This funding reduction is anticipated to reverse some of the progress achieved.
Understanding Neglected Tropical Diseases
Neglected tropical diseases comprise 21 conditions, including onchocerciasis (river blindness), schistosomiasis (a snail-borne infection causing fever and diarrhea), and cysticercosis (caused by tapeworms that can infect the brain). These diseases affect over 1 billion individuals globally and can lead to profound disability. Historically, NTDs have received less attention and financial support in global health initiatives compared to diseases with higher mortality rates, such as HIV or malaria, partly due to their non-lethal nature and prevalence among marginalized populations.
Program Establishment and Achievements
In the early 2000s, researchers developed a strategy that led to the formation of USAID's NTD program. The program officially launched in 2006 with bipartisan support and an initial budget of $15 million. Its operational model relies on pharmaceutical companies donating necessary drugs, with USAID supporting their distribution and post-treatment monitoring in affected countries.
Since the program's inception, pharmaceutical companies have donated over $31 billion in medicines, predicated on the U.S. supporting their delivery. Local personnel in affected countries were central to drug distribution efforts. Over a period of under two decades, the USAID NTD program, utilizing approximately $1 billion in taxpayer funds, treated 1.7 billion people and contributed to the elimination of at least one NTD in 14 countries. Emily Wainwright, who previously led the USAID NTD program's strategy, noted that disease elimination was initially considered an ambitious goal. Angela Weaver, Vice President of neglected tropical diseases at Helen Keller Intl, indicated that the approach could treat NTDs for less than 50 cents per person.
Funding Gaps and Future Outlook
The NTD program's budget was $114 million last year. Countries that depended on this funding are now seeking alternative resources. Reductions in foreign aid have also affected other disease programs, including those for HIV and malaria, requiring countries to make resource allocation decisions. Non-profit organizations are seeking additional financial contributions to address these gaps.
There was speculation regarding a potential resumption of funding through the U.S. State Department. However, the Trump administration's 40-page America First Global Health Strategy, released in September, did not include neglected tropical diseases.