Early in its first year, the Trump administration proposed drastic cuts to U.S. foreign aid, with reports that USAID might ultimately disappear or fold into the State Department. Such actions have launched a vigorous dialogue regarding America’s role in overseas development funding.



But missing from the debate and discussion on USAID’s future is the story of a little known yet highly ambitious Neglected Tropical Disease (NTD) Program created at USAID in 2006. Created in response to congressional concerns about global health and development, the NTD Program may now represent one of the most cost-effective means ever devised to lift people out of poverty, while simultaneously building good will towards the United States.

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Of special interest to the Trump administration is how the program uniquely partners with industry and leverages industry dollars, with spectacular results that might soon also translate to improvements in the health of Americans.









The NTDs are not as well-known as other global health conditions, such as AIDS or malaria, but they are probably the most common illnesses of people who live in extreme poverty. Today, the World Bank estimates that approximately 760 million people live below the poverty level of $1.90 per day with almost everyone affected by at least one NTD such as hookworm and other intestinal worms, schistosomiasis, elephantiasis, river blindness, and blinding trachoma.

Many are infected simultaneously with several of those diseases. These NTDs are not generally killer diseases, but instead produce long-term and disabling effects leading to diminished productivity and intellectual functioning. In this way the NTDs have actually been shown as a cause (not just a consequence) of poverty in African, Asian, and Latin American countries, and recently one of us has shown that NTDs such as hookworm still also occur in the poorest areas of the Southern U.S.



More than twelve years ago we worked with the World Health Organization to propose that seven of the most common NTDs highlighted above could be treated and sometimes even prevented through mass treatment with a package of essential medicines provided free-of-charge by the major pharmaceutical companies for national programs targeting the NTDs.

Because of these drug donations, and the facts that the drugs themselves were extremely safe and could be administered by a school teacher or community health worker, and because only a single dose annually was required, we proposed that the medicines could be delivered for only about 40 cents per person annually.

Over time, such an intervention would reduce the number of people infected with NTDs, and in the case of elephantiasis, river blindness, and trachoma could even lead to their global elimination. Free from their disabilities, a generation of people previously affected by NTDs could lift themselves out of poverty for the first time.



In 2006, the U.S. Congress appropriated a modest $15 million to create the USAID NTD Program — after one year an estimated 36.8 million treatments were delivered. The dollar amounts increased gradually before they plateaued at around $100 million.

Ten years later more than 2 billion treatments had been delivered to an estimated 935 million people in USAID-supported NTD programs in 33 developing countries. According to the Global Burden of Disease Study 2016, an initiative supported by the Bill & Melinda Gates Foundation to measure health impact, we have now seen a 30-40 percent reduction in the years lived with disability from most of the NTDs targeted for mass treatment. Indeed the elimination of elephantiasis, river blindness, and trachoma is now more than a pipe dream — it’s an achieved or achievable goal.



Equally impressive is how USAID funding was effectively leveraged. It’s estimated that through the USAID NTD Program, industry provided $15.7 billion in donated drugs to the USAID-supported countries. This number equates to $26 dollars in donated medicines from industry for every $1 spent by USAID.



Based on these successes one of us is now working with Reps. Chris Smith Christopher (Chris) Henry SmithChina sanctioning Rubio, Cruz in retaliatory move over Hong Kong China sanctions Cruz, Rubio, others over Xinjiang legislation New Jersey incumbents steamroll progressive challengers in primaries MORE (R-N.J.) and Sen. Cory Booker Cory Anthony BookerDHS opens probe into allegations at Georgia ICE facility Democratic lawmakers call for an investigation into allegations of medical neglect at Georgia ICE facility Black Voters Matter Fund deploying voter outreach caravans in 12 states to drive turnout MORE (D-N.J.) to achieve similar victories with NTDs in the U.S. that until recently were mostly hidden and unknown among the poor .



Today, the USAID NTD Program represents the very best in American ingenuity and thrift. It shows how a modest amount of American taxpayer money can be leveraged into a game-changing assault on poverty in the world’s poorest countries, as well as here at home.



Eric Ottesen M.D. is with the Task Force for Global Health and RTI International. Peter Hotez M.D. PhD is professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.