Achieving success in the global fight against the "big three" diseases-HIV/AIDS, tuberculosis and malaria, which together account for 5.6 million deaths a year-may well require a concurrent attack on the world's most neglected tropical diseases, says a team of researchers in the international open access journal PLoS Medicine.

The team will present its work at a meeting on malaria and the neglected tropical diseases at the Nobel Forum, Stockholm, on 30-31 January 2006, organized by the UN Millennium Project and hosted by Karolinska Institutet and the Nobel Forum.

The neglected tropical diseases, such as leprosy and sleeping sickness, are disabling infectious diseases (mostly due to parasites) affecting the world's poorest people. The research team-Peter Hotez (Principal Investigator, Human Hookworm Vaccine Initiative), David Molyneux and Eric Ottesen (Global Alliance to Eliminate Lymphatic Filariasis), Alan Fenwick (Schistosomiasis Control Initiative), Jeffrey Sachs (Director of the UN Millennium Project and of the Earth Institute at Columbia University) and Sonia Sachs (Millennium Village Project)-argues that initiatives for tackling the big three would be far more effective if they also included control of the neglected tropical diseases.

"The evidence indicates that coinfection with one or more neglected tropical disease may profoundly affect the outcome of one or more of the big three," says the team. For example, people with HIV infection or TB who are also infected with helminth infections, such as hookworm and schistosomiasis, have a worse prognosis. There is also emerging evidence that people infected with the neglected tropical diseases are more susceptible to becoming infected with the big three.

In addition to these interactions, it is becoming clear that there is extensive geographic overlap between the big three and the neglected tropical diseases. "HIV/AIDS, TB, and malaria occur predominantly in populations who are polyparasitized," say Professor Hotez and colleagues. The public health community, they argue, must therefore begin to integrate neglected disease control with its worldwide efforts to tackle HIV, TB, and malaria.

"The neglected tropical diseases," they say, "must now join the big three to create a 21st century 'gang of four.' For too long, the public health community has been tackling each of these diseases in isolation."

It would cost just 40 cents per person per year-a total of just US$200 million annually-to deliver a package of four drugs to about 500 million Africans, which would control or eliminate seven neglected tropical diseases. "Given the compelling logic and the very modest costs of embracing neglected tropical disease control efforts," say the authors, "it is surprising that those aiming to control the big three have largely ignored these opportunities."

In a linked Perspective article commenting on Professor Hotez and colleagues' paper, Juerg Utzinger and Don de Savigny (Swiss Tropical Institute) say that "it makes sense to integrate interventions for multiple diseases when those interventions share a common technical approach, a common target population, and a collectively high disease burden."


Citation: Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Sachs SE, et al. (2006) Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Med 3(5): e102.

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Professor Peter J. Hotez
Professor and Chairman, Dept. Microbiology and Tropical Medicine
The George Washington University
Tel. 202-994-1768, Cell 202-841-3020, Email: [email protected]

Professor David H. Molyneux
Director , Lymphatic Filariasis Support Centre
Liverpool School of Tropical Medicine
Pembroke Place, Liverpool L3 5QA
Tel +44 (0)151 705 3291, Cell +44 (0)778 099 1824, Fax +44 (0)151 709 0354
Email [email protected]

Professor Alan Fenwick
Director, Schistosomiasis Control Initiative
Dept Infectious Disease Epidemiology
Imperial College, St. Mary's Campus
Norfolk Place, London W2 1PG, UK
Tel +44 (0)20 7594 3418, Cell +44 (0)7811 708313, Email:[email protected]

Related PLoS Medicine Perspective article: Citation: Utzinger J, de Savigny D (2006) Control of
neglected tropical diseases: Integrated chemotherapy and beyond. PLoS Med 3(5): e112.

About PLoS Medicine 
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit

About the Public Library of Science 
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit

About the Nobel Forum Meeting 
The Malaria and Neglected Tropical Diseases Quick Impact Initiative Meeting will be held at the Nobel Forum in Stockholm, on January 30 and 31, 2006. The objective of the meeting is to advance the Malaria Quick-Impact Initiative of the United Nations 2005 World Summit by convening key stakeholders-malaria endemic countries, the donor community, the African leadership, the scientific community, WHO, UNICEF, the World Bank, UNDP, non-governmental organizations and the private sector-and to expand this initiative to include neglected tropical diseases.

About the UN Millennium Project 
The UN Millennium Project is an independent advisory body led by Professor Jeffrey Sachs in his capacity as Special Advisor to the Secretary-General. The Project is tasked with putting forth strategies to meet the Millennium Development Goals (MDGs)-the world's time-bound, quantifiable targets to reduce the grinding poverty, hunger and disease that afflict billions worldwide. The Project also assists governments, particularly those in sub-Saharan Africa, in preparing MDG-based needs assessments and national development strategies. For more information, visit

About the Earth Institute 
The Earth Institute at Columbia University brings together talent from throughout the University to address complex issues facing the planet and its inhabitants, with particular focus on sustainable development and the needs of the world's poor. For more information, visit

About the Millennium Village Project:

About the Human Hookworm Vaccine Initiative:

About the Global Alliance to Eliminate Lymphatic Filariasis:

About the Schistosomiasis Control Initiative:

About the George Washington University Medical Center:

About The George Washington University Medical Center Department of Microbiology, Immunology & Tropical Medicine: