Priorities on dealing with the big 3 infectious diseases - HIV/AIDS, TB, and malaria

Jul 13 2004

The author of a Viewpoint article published online by THE LANCET argues for a renewed public-health effort to tackle so-called ‘neglected diseases’ which continue to have serious impact in less-developed countries.

David Molyneux (Liverpool School of Tropical Medicine, UK) outlines how priorities on dealing with ‘the big 3’ infectious diseases—HIV/AIDS, TB, and malaria—is obstructing public-health initiatives to tackle preventable diseases such as the viral, bacterial, and parasitic infections of the tropics, and acute respiratory infections and diarrhoeal diseases of children. Examples are given of numerous cost-effective treatment programmes for diseases such as onchocerciasis (river blindness) and Chagas’ disease.

Professor Molyneux comments: “The emphasis on the big three killers and the derogatory assignment to the category of “other diseases” of those that can so easily be controlled or even eliminated neglects the proven success of a range of interventions. An investment of a fraction of the annual requirements of the Global Fund would bring long lasting benefit to the millions that still remain disabled, reduce morbidity, and prevent disablement in future generations…If we are to ensure the efficient use of the substantial resources needed to reduce morbidity and mortality associated with HIV/AIDS, tuberculosis, and malaria, then a small investment in proven, cost-effective interventions against “other diseases”—preferably from the Global Fund resources—will bring sustainable public-health benefits, integrate well with and strengthen the health system, reduce disabling conditions, and bring collateral benefits to the health of the poorest nations”.

He concludes: “Policy makers are ignoring scientific and operational evidence that interventions against “other diseases” are effective. By concentrating on so few agents, current policies could perpetuate inequity, disrupt health financing policies, divert human resources from achievable goals, and deny opportunities for impoverished health systems to improve. Current policy also raises ethical issues. Resources are being transferred to interventions against the big three that, realistically, have only a limited chance of success as they are reactive and do not adequately control transmission—a pre-requisite for any public-health impact”.