Parasites in Paradise

An essay by Peter J. Hotez, a professor at George Washington University and author of Forgotten People, Forgotten Diseases,  in the New York Times describes U.S. President Obama’s plan to eradicate tropical diseases.

President Obama has started an ambitious global health initiative that will deliver urgently needed medicine and preventative care to hundreds of millions of people in poor countries. Included in the plan are efforts to devote resources to “neglected tropical diseases,” afflictions like hookworm infections, river blindness and elephantiasis that many think have gone the way of smallpox, but which still make up the most common ailments among the world’s bottom billion. When we talk about these diseases, we tend to think of distant places like West Africa and South Asia. As we develop the plan, however, it’s crucial that we remember that they plague communities much closer to home as well.

Just off the beautiful beaches of the Caribbean islands popular with American vacationers live millions who suffer from neglected tropical diseases. In Haiti and the Dominican Republic, more than 600,000 people are infected with lymphatic filariasis, a parasitic infection also known as elephantiasis for the profound disfigurement it produces in the limbs and genitals. In the Dominican Republic, 250,000 people are infected with the blood flukes that cause schistosomiasis, and more than a million in the region have hookworms. Intestinal worms are also common in Jamaica, Barbados and Grenada, where they cause chronic anemia, as well as stunted growth and impaired intellectual development in children. The prevalence of these diseases in the Caribbean is at least in part a tragic consequence of the slave trade. When slavers transported 11 million human captives from West Africa to the New World, they brought parasites and infections that flourished in the horrific conditions of plantation life.

Distressingly, some of these diseases have been found in the United States. Researchers have uncovered similar neglected infections like toxocariasis and trichomoniasis, two parasitic infections, among African-Americans living in poverty, particularly in the South and disadvantaged urban areas. In Baltimore and Detroit, there have been appearances of a bacterial infection known as leptospirosis. Nearly three million African-Americans have toxocariasis, a parasitic worm infection transmitted by dogs that can cause asthma and developmental delays. And thousands of African-American infants are born annually with congenital cytomegalovirus, which can result in hearing loss and severe mental disability.

Of course, African-Americans are not the only ones who suffer from these diseases. Hundreds of thousands of Hispanic Americans are infected with Chagas disease, a parasitic infection that causes heart disease. Cysticercosis, a parasitic brain infection, is a leading cause of epilepsy among this same population. And whites living in poverty are also at risk.

Diseases like these represent one of the world’s — and our nation’s — greatest health disparities. But today, few doctors are familiar with them. This has to change, especially because many of them can be cured or prevented at astonishingly low cost with either inexpensive generic drugs or drugs donated by pharmaceutical companies. For example, diethylcarbmazine, used to control elephantiasis, costs less than one cent per dose, and Merck donates ivermectin for the treatment of river blindness. Typically these drugs are effective with one dose a year.

Mass distributions could control or eliminate most neglected tropical diseases from the Caribbean at an estimated cost of $20 million per year for five years (a total that is roughly equivalent to one dollar for every tourist who visits there each year). The United States Agency for International Development finances great neglected tropical disease control programs in Africa, Asia and Haiti, but money for the rest of the Americas is still short. My organization is working with the Interamerican Development Bank and the World Health Organization to find the funding to deliver urgently needed drugs to those communities that need them.

It would probably cost more to eliminate these diseases in the United States, in part because of our expensive health care system. But they’ve been ignored for so long here — by our government and our medical community — that the full extent of the problem is still unknown. We need to develop programs to track the transmission of these diseases and increase the number of affected people who are diagnosed and treated. We also need to invest in researching new cures and vaccines.

Treating those at home should not come at the expense of the needy abroad, but we cannot ignore the neglected tropical diseases in our midst any longer. This is one vestige of slavery and racism we can do more to erase.

The essay appeared at

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