The U.S. Government and Global Neglected Tropical Disease Efforts

Key Facts

• Neglected tropical diseases (NTDs) are a set of infectious diseases grouped together due to their often chronic, disfiguring, and stigmatizing impact; their close association with poverty; and their geographic overlap.
• While there are numerous NTDs in the world, the World Health Organization (WHO) has highlighted over 20 that particularly impact poor, politically marginalized populations; cause significant morbidity and/or mortality; are neglected by research; and can be controlled using effective methods.
• In recent years, the U.S. government (U.S.) has affirmed its support for global NTD goals, including eradicating, eliminating, and controlling several NTDs.
• The U.S. has become more involved in global NTDs since launching its first NTD program in 2006 at the U.S. Agency for International Development (USAID) with a focus on five NTDs that are among the most prevalent NTDs globally but can be controlled and even eliminated with low-cost and effective interventions.
• Total U.S. funding for NTDs increased from $15 million in FY 2006, which was the first year Congress appropriated funds for NTDs, to approximately $115 million in FY 2024.

Global Situation

NTDs have garnered greater attention from the U.S. government and other global donors over the past nearly 20 years, spurred on by growing recognition of their potential threat to the achievement of the Millennium Development Goals (MDGs) and their successor, the Sustainable Development Goals (SDGs). In addition, the development and expansion of an integrated NTD treatment approach capitalized on the availability of safe and effective treatments for the most prevalent NTDs.

NTDs are among the top 12 major communicable disease causes of ill health globally, behind lower respiratory infections, diarrheal diseases, tuberculosis, malaria, and HIV, among others.¹ NTDs are grouped together due to their often chronic, disfiguring, and stigmatizing impact; their close association with poverty; and their geographic overlap.

Impact

NTDs have low mortality but high morbidity rates. Approximately one-fifth of the world’s population (1.6 billion people) require NTD interventions (both preventive and curative). Each year, approximately 200,000 people die as a result. Infection with a NTD may result in severe disability, disfigurement, blindness, and malnutrition, and individuals are often infected with multiple NTDs simultaneously. The health impact of NTDs negatively affects economic development, hampers educational achievement and cognitive development, and reduces agricultural productivity and food security.

NTDs span the globe; in 2021, 179 countries reported at least one case of NTDs. However, the majority of the NTD burden is concentrated in low- and middle-income countries in Africa, Asia, and Latin America. People living in areas lacking access to clean water, health services, and adequate housing and sanitation, in both rural and urban settings, are among the most impacted by NTDs. Women and children in particular are most at risk of infection, since they are more exposed to NTDs and more often face barriers to accessing treatment, particularly those living in remote areas.

Major NTDs

While there are numerous NTDs in the world, the World Health Organization (WHO) has highlighted 21 that particularly impact poor, politically marginalized populations; cause significant morbidity and/or mortality; are neglected by research; and can be controlled using effective methods.²

Five “tool-ready” NTDs, those that can be controlled and even eliminated due to the availability of low-cost and effective interventions, are among the most prevalent NTDs (see Table 1). This subset of NTDs is increasingly the focus of donor efforts, including USAID’s NTD Program.

Interventions

A number of strategies have been successful in controlling and, in some areas, even eliminating certain NTDs. Although many interventions are relatively inexpensive, challenges persist in delivering tools and services to the most at-risk populations.

The recommended strategy for NTD elimination is an integrated control approach, often targeting multiple NTDs simultaneously, through mass drug administration (MDA) and other community-level transmission control measures. MDA is the regular distribution of medicines to entire at-risk populations, regardless of infection status. The use of MDA allows programs to reach more people and improve the likelihood of suppressing transmission. Implementation of MDA is often made possible through donations from pharmaceutical companies. In addition to MDA, other measures such as promoting clean water, sanitation, and hygiene (WASH), good veterinary public health, and vector control also play critical roles in addressing the underlying causes of NTDs.

Global Goals

As NTDs began to receive greater attention and global efforts have expanded over the past nearly twenty years, major global NTD goals have been set recently through:

SDG 3: End the Epidemic of NTDs

Adopted in 2015 by all member-states of the United Nations, the Sustainable Development Goals (SDGs) included a target of ending the epidemic of NTDs by 2030 as part of SDG 3 (“ensure healthy lives and promote well-being for all at all ages”). The SDGs are the successor to the Millennium Development Goals (MDGs), which did not include a specific NTD indicator.

WHO Roadmap for NTDs 2021-2030

The Roadmap outlines targets and strategies for global NTD control, elimination, and eradication efforts from 2021 through 2030. Among its goals are the eradication (permanent reduction of a disease’s worldwide incidence to zero with no risk of reintroduction) of dracunculiasis (Guinea worm disease) and yaws and the elimination (interruption of transmission in a defined geographical area(s), marked by a reduction of incidence to zero with a minimal risk of reintroduction) of human African trypanosomiasis (gambiense), leprosy, and onchocerciasis by 2030. In addition to the Roadmap’s eradication and elimination targets, it also lays out overall targets including 90% reduction in the number of people requiring interventions for NTDs, a 75% reduction in DALYs related to NTDs, and at least 100 countries eliminating at least one NTD.

Kigali Declaration on Neglected Tropical Diseases

In 2022, the Kigali Declaration, endorsed by key public and private stakeholders, laid out global NTD goals (affirming those in the SDGs and Roadmap) and commitments. It aims to improve partner efforts to coordinate and collaborate across their respective efforts in order to help eliminate NTDs. Among its goals are the elimination of at least one NTD in 100 countries and reduction of people requiring NTD interventions by 90% by 2030. These goals are in alignment with some of the WHO Roadmap goals. The Kigali Declaration is the successor to the London Declaration on NTDs (2012-2020).

U.S. Government Efforts

Over the past nearly twenty years, U.S. attention to and funding for NTDs have increased markedly. Historically, the U.S. government’s response to NTDs was relatively limited, focusing largely on research and surveillance conducted by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Department of Defense (DoD). In 2006, Congress first appropriated funds to the U.S. Agency for International Development (USAID) for integrated NTD control, after which the agency launched its NTD Program. In 2008, the U.S. announced expanded NTD efforts, building on USAID’s NTD Program. In 2012, the U.S. signed onto the London Declaration, and shortly afterward, the U.S. adopted a longer term global health goal of protecting communities from infectious diseases and highlighted the important role of NTD efforts in achieving this goal.

Organization

USAID serves as the lead implementing agency for U.S. NTD efforts. Several other agencies, including NIH, CDC, DoD, and the U.S. Food and Drug Administration (FDA), are also involved in responding to NTDs worldwide. Collectively, U.S. activities have helped reach more than 30 countries.³

USAID

USAID’s NTD Program targets five “tool-ready” NTDs (see Table 1). Having scaled up from five countries in 2006, it now spans 26 countries, mostly in sub-Saharan Africa and Southeast Asia, and has one regional program, which reaches an additional eight countries in the Americas. Using interventions such as MDA, the U.S. supports endemic countries in scaling up and developing their capacity to manage NTD control programs. The program’s goals are to control and eliminate diseases, strengthen the NTD scientific and program evidence, support sustainable country-led programs, and expand partnerships with key stakeholders.

Other U.S. Efforts

Other agencies, including NIH, CDC, and DoD, support NTD control efforts through implementation assistance of NTD interventions, technical assistance to help develop guidelines for NTD control and improve monitoring systems, and research and development (R&D) activities focused on developing new NTD tools and encouraging the adoption of existing NTD tools. These efforts include a focus on the USAID-targeted NTDs, as well as others (such as dengue, and neglected tropical fungal diseases including mycetoma, chromoblastomycosis, and sporotrichosis, among others). In addition to these efforts, the FDA administers the congressionally-authorized Tropical Disease Priority Review Voucher Program, which provides for a voucher to a developer that is awarded at the time of approval for a product meant to prevent or treat an eligible NTD. The voucher, which can subsequently be redeemed for a priority review of an application for another product, is designed as an incentive for the private sector to invest in new NTD drug development. A number of vouchers have already been awarded by the FDA.

Multilateral and Other Efforts

U.S. NTD efforts are coordinated with a number of international partners (like WHO and private sector entities), regional strategies (like the Regional Strategic Framework for sustaining, accelerating, and innovating to end neglected tropical diseases in the South-East Asia Region, 2024-2030), and funding mechanisms (like the END Fund). For example, the pharmaceutical industry donates several NTD drugs to many of the countries that also receive USAID NTD support; USAID has estimated the value of these donations in U.S.-supported countries at approximately $29.9 billion since 2007.

Funding

Congress first appropriated funding for NTDs in FY 2006, and while total U.S. funding for NTDs has risen overall since then (from $15 million in FY 2006 to approximately $115 million in FY 2024), funding was flat at around $100 million for several years (see Figure for most recent funding data). The Biden Administration has requested level funding for NTDs for FY 2025. U.S. funding for NTDs is provided through the Global Health Programs account at USAID.