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James Barker, Publishing Executive at F1000, introduces the Neglected Tropical Disease Collection, which brings together all content published on F1000Research related to neglected tropical diseases. James tells us about the prevalence of these diseases and the heavy toll they are taking on global health. Find out how the collection will contribute towards the World Health Organisation’s roadmap and the UN Sustainable Development Goals to control and eliminate these diseases.

What are neglected tropical diseases and why are they neglected?

Neglected tropical diseases (NTDs) are a group of diseases that the occur in the tropical and sub-tropical regions. These diseases are intertwined with poverty, and the more than a billion people affected by NTDs make up some of the poorest and most marginalised communities across the globe. These diseases are prevalent in areas without sanitation, clean water, and healthcare; and where the population lives in close proximity to animals and disease vectors.

These conditions are the result of poverty; however, the diseases themselves can result in further poverty due to infections leaving adults unable to work, and children unable to attend school. Disabilities and disfigurements resulting from the infections leads to stigmatisation and individuals becoming socially isolated. Poverty is therefore both the cause and effect of NTDs.

NTDs are a broad range of diseases including those of bacterial, helminth, protozoal and viral origin. The World Health Organization maintains a list of priority NTDs, which now includes 20 diseases:

• Buruli ulcer
• Chagas disease (American trypanosomiasis)
• Dengue and Chikungunya
• Dracunculiasis (Guinea-worm disease)
• Echinococcosis
• Foodborne trematode infections
• Human African trypanosomiasis (sleeping sickness)
• Leishmaniasis
• Leprosy (Hansen’s disease)
• Lymphatic filariasis (Elephantiasis)
• Mycetoma, chromoblastomycosis and other deep mycoses
• Onchocerciasis (river blindness)
• Rabies
• Scabies and other ectoparasitoses
• Schistosomiasis (Bilharzia)
• Soil-transmitted helminthiases
• Snakebite envenoming
• Taeniasis and cysticercosis
• Trachoma
• Yaws (Endemic treponematoses)

All these diseases can be prevented, treated or both; so why are they still so prevalent?

As with many global health problems this a multifaceted issue, but some of the contributing factors are:

1. The Big Three – Research over the past decades in infectious disease has overwhelming focused on HIV, tuberculosis and malaria, sometimes referred to as the ‘Big Three’, with their inclusion in the Millennium Development Goals contributing to this. NTDs have been marginalised in terms of research, research funding, and public health interventions as a result.
2. Neglected diseases affecting neglected people – Many NTDs occur in marginalised groups such as women, migrants, nomads, and people displaced by conflict, who are unable to draw the attention of, or put pressure on decisionmakers.
3. Death vs disability – Global public health responses tend to focus on deadly diseases such as the ‘Big Three’. While many NTDs can result in death, disability and disfigurement are more common outcomes. Where deaths do occur, they are often proceeded by an asymptomatic phase with a lengthy incubation period, meaning the link between infection and death is not always clear.  
4. Money talks! – NTDs are seen as non-profitable, resulting in a lack of R&D on potential new treatments. A study in the Lancet from 2002 showed that of 1,393 new chemical entities registered in a 25 year period, only 16 were for tropical diseases. They also found a 13-fold increased chance of a drug being brought to market for CNS disorders or cancer than a tropical disease. Given this, the majority of investment on NTD programs has come from public funding or through philanthropic organisations such the Bill and Melinda Gates Foundation.

The response

The concept of NTDs was first introduced in 1977 by Kenneth S. Warren, then referred to as the “great neglected diseases of mankind”. These were a series of parasitic diseases that were lacking attention, which Warren set up a series of labs to focus on. In parallel, the WHO set up the Special Programme for Research and Training in Tropical Diseases (TDR) to study a similar set of diseases with the same aim. Some of the recent work from TDR on NTDs is published in our TDR Gateway, an open access publishing venue set up specifically for TDR-funded researchers.

The concept of NTDs has since grown and now the World Health Organization has developed a series of roadmaps aimed at the elimination of NTDs. The first was published in 2012 and ran to 2020 with an aim to eliminate at least 10 NTDs by 2020. The WHO gathered support from member states, foundations and pharmaceutical companies, with this being formalised in a statement referred to as the London Declaration. While the initial aims of the roadmap were not met by 2020, significant progress was made including:

• 500 million fewer people requiring treatment for NTDs
• 40 countries, territories and areas eliminating at least one NTD
• Dracunculiasis is now close to being eradicated
• Lymphatic filariasis and trachoma eliminated as health problems in 16 and nine countries respectively

The full results are reported in the next published roadmap which will run to 2030. The overarching targets of the new roadmap are:

• 90% reduction in people requiring interventions for NTDs
• 75% fewer NTD-related disability-adjusted life years (DALYs)
• 100 countries having eliminated at least one NTD
• Dracunculiasis and yaws eradicated

The progress seen at the conclusion of the first roadmap demonstrated the progress that can be made when the neglect of these diseases ends, and organisations collaborate towards a common goal.

The Collection

At F1000Research we aim to provide a framework for collaboration through our open access publishing, transparent reporting, and open data policy. Our immediate open access publishing means that content is available for all to read and interpret, which is of particular benefit to low- and middle-income countries where NTDs are most prevalent.

Our transparent reporting ensures that the articles we publish are reproducible. This, coupled with our open peer review provides a blueprint that others can trust to replicate a study’s findings. Furthermore, the open sharing of underlying data has been shown not only to increase citations, but also foster reuse and collaboration.

One of our previous authors, David Mobley from University of California, summarizes it best:

“When we make our work available in a truly reproducible manner, we find that other researchers build on, reuse, and extend the work in ways far beyond what we might have originally imagined. It increases the visibility of our work, and helps science progress better and faster. Everyone wins.”

The Neglected Tropical Disease Collection will not only thematically group articles related to NTDs, but through the F1000Research model described above, will provide an environment to facilitate future reuse and collaboration. Our commitment to the HINARI/AGORA scheme also provides publishing opportunities for researchers living in countries directly affected by NTDs, ensuring the neglect classically experience by these regions is not replicated when reporting research on NTDs. The success of collaboration on NTDs has been demonstrated with the London Declaration and initial WHO road map. It is our hope that the collection can continue this and contribute to the new roadmap leading up to 2030.

The Neglected Tropical Disease Collection is now live and open for submissions. If you have any questions, please get in touch.