G20 CALL TO ACTION. Introduction. Why the G20 should address global health

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1 G20 CALL TO ACTION Introduction This November, the Group of 20 (G20) will gather in Brisbane, Australia to discuss ways to stimulate economic growth among the world s vulnerable populations. The G20 Summit will review a number of areas that aim to improve people s lives, such as investments in infrastructure, increased job and employment opportunities and financial sector reforms. The Global Network for Neglected Tropical Diseases applauds the G20 s efforts to boost prosperity among the world s poor. However, the world s leading economies must also take concrete steps to address cross-cutting issues of global health and development in order to advance the G20 s overarching goal of spurring sustainable, inclusive growth. With three-quarters of the world s extreme poor now living in middle-income countries, far too many people are not yet experiencing the benefits of economic growth. Instead, they remain trapped in a cycle of poverty and disease that prevents them from contributing to their communities, often perpetuated by easily-treatable neglected tropical diseases (NTDs). We cannot hope to sustain increased economic growth until all people - the real drivers of growth - are freed from the burden of these diseases. Why the G20 should address global health The G20 should join the fight against NTDs as a way to advance its goal to create a sustainable path for current and future generations. i NTDs cause impaired childhood growth and development, poor pregnancy outcomes, blindness, and crippling physical disfigurements and increase the likelihood of contracting HIV, eroding the health and economic future of more than 1.4 billion people worldwide. NTDs undermine the G20 s collective efforts to build human capital, increase employment opportunities, reduce inequality and expand access to agricultural and nutrition initiatives. Specifically, NTDs are closely associated with: 1. Worker Productivity and Wage Earning Potential: Chronic lymphatic filariasis (LF), a disease that causes crippling physical disfigurements, limits worker productivity and can lead to a 15 percent annual loss in personal income.2 Trachoma, which can lead to permanent blindness, is estimated to cause a total potential productivity loss of Page 1 of 5

2 $5.3 billion annually. 3 In Bangladesh, tea plantation workers suffering from intestinal worms earned significantly lower wages and were absent from work more often Gender Inequality, Social Stigma and Susceptibility to HIV: There are important social and economic consequences of the stigma that come along with the disfigurements associated with many NTDs, including LF and trachoma. Women with LF are especially vulnerable to stigma, social isolation, lost jobs and diminished wages, further embedding them in poverty. Additionally, women who suffer from female genital schistosomiasis (FGS) are three times as likely to contract HIV compared to women without FGS Socio-economic status, Anemia and Nutritional Status: Evidence shows that prevalence of anemia is consistently higher in people with low socio-economic status, including in women who have recently given birth. Hookworm has been identified as one the leading causes of anemia 6 and represents a major challenge for pregnant women across Africa, Asia, and Latin America and the Caribbean. Hookworm infections rob vital nutrients from a person s body, causing severe anemia and exacerbating poor nutritional status. As a result, efforts to improve nutrition and maternal and child health are diluted. 7 Better Education, Improved Wage Earnings and Improved Economic Outcomes Ten countries account for 90 percent of the global NTD burden: Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Myanmar, Nigeria, Pakistan, the Philippines and Tanzania. 8 Considering half of these countries are in Asia, the geographic location of the 2014 G20 Summit presents a natural occasion for Australia, as host, and other G20 leaders to examine global health solutions that can dramatically improve the health of people burdened by NTDs and open up economic possibilities across the Asia and Pacific region. While this region has made significant strides against poverty, it has been accompanied by rising inequalities, in part as a result to unequal access to health, education and other public services. 9 As countries in Asia, Africa, and Latin America and the Caribbean move towards closer regional and global economic integration, the control and elimination of NTDs is a smart investment in human development that can help create strong, competitive economies and equitable growth across the globe. The possibilities are exceptional, as illustrated by a number of studies: The world s top economists recognized deworming as one of the most cost-effective investments for policymakers in the 2008 and 2012 Copenhagen Consensus and confirmed that an integrated approach to treating NTDs with nutrition initiatives will help achieve better educational and economic outcomes. 10 Children who are treated for intestinal worms benefit from improved cognitive function and educational outcomes. A study in Kenya demonstrated that treating children for intestinal worms reduced school absenteeism by at least 25 percent. 11 In Ethiopia, the mortality associated with blinding trachoma was significantly reduced in children after treatment. 12 Nearly 600 million people have been treated for LF since the creation of the Global Program to Eliminate Lymphatic Filariasis in 2000, resulting in an economic rate of return estimated at between US $20-30 for every dollar spent on treatment. 13 Remarkable progress has been made against river blindness (onchocercaisis) in Africa through the African Programme for Onchocercais Control (APOC), a public-private partnership, through which development partners distribute ivermectin, a treatment donated for free by Merck. Thank to this program, 25 million hectares of arable land enough to feed 17 million people are now freed up for use by farmers Page 2 of 5

3 Clearly, the benefits of fighting NTDs extend beyond health, underscoring the importance of addressing NTDs simultaneously with poverty reduction and other development initiatives. Recognizing the long-term health and economic impacts of these diseases, the United Nations High-Level Panel report includes NTDs as a priority issue for the post-2015 sustainable development agenda. Simply put, treating NTDs strengthens the capacity of people to lift themselves out of poverty and stretches the positive impact of economic growth and development assistance across multiple sectors. G20 Well Equipped to Expand Social and Economic Opportunities for All The G20 has an opportunity to leverage its collective financial resources and convening power to help build political support and attract new investments to the NTD cause. The G20, which accounts for 90 percent of global gross domestic product and 94 percent of global official development assistance, is exceptionally well-positioned to lead efforts that could dramatically improve the global health landscape. While NTDs are prevalent across the developing world, they are also found in many emerging economies, including several G20 nations. By taking measures to address NTDs in their own countries as well as through their international cooperation efforts, the G20 can dramatically shrink the global NTD burden. Many regional bodies have helped put NTDs at the forefront of policy debates, discussions and forums. For example, with strong leadership from the Philippines, NTDs were included on the agendas of the Senior Officials Meeting on Health Development and the Association of Southeast Asian Nations (ASEAN) Expert Group on Communicable Diseases meetings in 2013, which both recognized NTDs as a regional priority. As a global forum for world leaders, the G20 can build on regional and country level discussions and propel NTDs an issue that impacts all regions onto the global agenda. Looking ahead, the G20 should ensure that it leverages existing public-private partnerships, which are a key element of expanding access to NTD treatments. As a result of these partnerships, nearly all of the treatments required to fight the most common NTDs are donated by pharmaceutical companies. The value of these donations will reach nearly US$ 19 billion by However, less than 40 percent of the global population at risk had access to NTD treatments in G20 leaders have an opportunity to capitalize on the cost savings created by the pharmaceutical industry s drug donations to close this coverage gap. While many donors and other public sector partners are providing financial and technical assistance for distribution, the most pressing problem is a US$220 million annual funding gap that stands in the way of reaching the World Health Organization s (WHO) goals to eradicate, eliminate or control 10 NTDs by Furthermore, as the G20 looks for ways to increase public and private sector investments in infrastructure, it should encourage investments that complement efforts to treat NTDs, including support for projects that improve access to clean water and improved sanitation. Page 3 of 5

4 Call to Action: The Global Network for Neglected Tropical Diseases urges the G20 to take the following actions on NTDs in order to deepen its impact on global development at the 2014 Brisbane Summit: 1. Recognize NTDs as a key underlying constraint to global economic growth. 2. Highlight the importance of NTD control and elimination programs in the G20 Development Working Group agenda and broader G20 policy statements. 3. Call on historic and emerging donors to prioritize the issue of NTD control and elimination in their foreign policy, development and poverty reduction agendas. 4. Call on NTD endemic countries to prioritize NTDs in their national poverty and health plans. 5. Support inclusion of NTD control and elimination efforts in the final post-2015 development agenda. Point of Contact: For more information, please contact Amber Cashwell, Senior Policy Officer for the Global Network for Neglected Tropical Diseases: amber.cashwell@sabin.org. Page 4 of 5

5 Endnotes Saint Petersburg Development Outlook. 2. Ramaiah KD, Das PK, Michael E, Guyatt H. (2006). The economic burden of lymphatic filariasis in India. Parasitology Today; 16: Frick KD, Hanson CL, Jacobson GA (2003). Global burden of trachoma and economics of the disease. American Journal of Tropical Medicine and Hygiene 69: Gilgen DD, Mascie-Taylor CG, Rosetta LL. (2001). Intestinal helminth infections, anemia and labor productivity of female tea pluckers in Bangladesh. Tropical Medicine & International Health. 6(6): Sustaining the drive to overcome the global impact of neglected tropical diseases: Second WHO Report on Neglected Tropical Diseases. (2013). Retrieved from 6. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. (2014). A Systematic Analysis of Global Anemia Burden from 1990 to Blood. 123: Hotez PJ. (2009). Empowering Women and Improving Female Reproductive Health through Control of Neglected Tropical Diseases. PLoS Neglected Tropical Diseases 3(11): World Health Organization lists 10 countries that make up 90 percent of the global NTD burden: Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Pakistan, Myanmar, Nigeria, Philippines and Tanzania. Preventive chemotherapy: planning, requesting medicines, and reporting. (2014). Weekly Epidemiological Record. (8), Retrieved from 9. Zhuang, J., R. Kanbur, and C. Rhee. (2014). Rising Inequality in Asia and Policy Implications. Asian Development Bank Institute Working Paper 463. Tokyo: Asian Development Bank Institute. Retrieved from: Copenhagen Consensus 2012 Expert Panel Findings, Retrieved from Miguel E., Kremer, M. (2001). Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities. Econometrica. 72(1), Porco TC, Gebre T, Ayele B et al. (2009). Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. The Journal of the American Medical Association. 302(9): Chu BK, Hooper PJ, Bradley MH, McFarland DA, Ottesen EA. (2010). The Economic Benefits Resulting from the First 8 Years of the Global Programme to Eliminate Lymphatic Filariasis ( ). PLoS Neglected Tropical Diseases. 4(6): Onchocercaisis, Fact Sheet Number 374. World Health Organization. Retrieved from factsheets/fs374/en/. 15. Delivering on Promises and Driving Progress. (2014). United to Combat NTDs. Retrieved from Page 5 of 5