Blue Marble Health: An Innovative Plan to Fight Diseases of the Poor Amid Wealth

This month I am proud to partner with JHU Press for the release of my newest single-author book. 

‘Blue Marble Health’ describes a new and emerging paradigm for the poverty-related infectious diseases based on my observations and analyses as a physician-scientist who develops vaccines for neglected tropical diseases. Ever since I was an MD-PhD student during the 1980s at Rockefeller and Cornell Universities I dreamed of developing vaccines for parasitic infections such as hookworm infection, schistosomiasis, Chagas disease, and leishmaniasis.  Some thirty years later these vaccines are entering the clinic.  Over that period I have traveled to almost every continent where I have interacted both with scientists from tropical disease-endemic countries and vulnerable populations affected by neglected tropical diseases.  Along the way I have been fortunate to meet with many government officials and thought leaders committed to solving global health problems. 

My book reflects a sea change (a notable transformation) I have observed since the launch of the Millennium Development Goals more than 15 years ago.  Using available data from the World Health Organization and other primary sources, and building on a series of papers I wrote for PLOS (the Public Library of Science) I find that today most of the world’s neglected diseases, broadly defined to include the 17 neglected tropical diseases in addition to tuberculosis and other conditions related to extreme poverty, are paradoxically found in wealthy economies.  Indeed the group of 20 (G20) countries, together with Nigeria (with an economy larger than several G20 nations) account for most of the world’s neglected diseases, such as helminth infections, Chagas disease, leishmaniasis, dengue fever, tuberculosis, and many others. 

Thus, ‘Blue Marble Health’ challenges current norms of global health that compare developed to developing countries, by finding that almost all national economies are expanding but leaving behind groups of the vulnerable poor who suffer from neglected diseases. 

The first part of ‘Blue Marble Health’ takes the reader through each of the G20 nations to point out how certain neglected diseases concentrate in areas of extreme poverty.  For example, China’s eastern provinces and cities have exhibited tremendous economic growth since I started working there more than 20 years ago, but today that growth leaves behind tens of millions of people in southwestern provinces such as Guizhou, Yunnan, and Sichuan provinces where poverty and neglected diseases remain widespread.  Similar situations can be found in other massively-populated Asian G20 nations such as India and Indonesia.  In the Americas, most of the world’s Chagas disease is found in Latin America’s three largest economies – Argentina, Brazil, and Mexico, while Brazil alone accounts for most of the cases of many specific neglected tropical diseases including schistosomiasis, dengue, Zika, and leishmaniasis.  Even high income countries in North America and Europe have hidden pockets of poverty and disease. One of the most provocative chapters in my book explains why an estimated 12 million Americans living in the United States suffer from at least one neglected tropical disease, diseases which are now commonly found in the American South.

The second part of the book focuses on some of the policy implications of ‘Blue Marble Health’ by calling on G20 leaders to focus on their own vulnerable and poor populations.  Doing so, could rid the world of most neglected diseases. 

There are two components. 

We need to increase treatment coverage for neglected diseases for which essential medicines are already available.  For example 99% of people living with Chagas disease are denied access to diagnosis and treatment, while most people in G20 countries or Nigeria are still not receiving access to mass drug administration for their soil-transmitted helminth infections, schistosomiasis, or lymphatic filariasis, among other diseases.   Equally important, with a few notable exceptions the G20 nations are not stepping up to provide their populations access to innovation by promoting research for the development of new drugs, diagnostics, and vaccines for their own neglected diseases.  ‘Blue Marble Health’ explores the exciting opportunities for G20 leaders to eliminate most of the world’s neglected diseases over the next two decades.

In a May 2016 editorial entitled ‘As Rich Nations Turn Their Backs’ the New York Times Editorial Board lamented how global leaders have so far refused to address refugee crises in the Middle East, North Africa, and South Asia  ‘Blue Marble Health’ highlights how these failings extend to the billions of people who remain trapped in poverty because of their neglected diseases.   

Peter J Hotez, MD, PhD is the Dean of the National School of Tropical Medicine at Baylor College of Medicine where he is also Texas Children’s Hospital Endowed Chair of Tropical Pediatrics and Professor of Pediatrics and Molecular Virology and Microbiology.  He heads the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. His book, Blue Marble Health, is available now.