“Rapid-Impact Interventions”: How a Policy of Integrated Control for Africa’s Neglected Tropical Diseases Could Benefit the Poor

O ver the past two decades there have been signifi cant achievements in the control of a handful of important human tropical infections [1].These achievements include the substantive reductions in the prevalence and incidence of the so-called neglected diseases such as lymphatic fi lariasis, onchocerciasis, guinea worm, leprosy, and trachoma (Box 1) [2].Each of these neglected diseases is a poverty-promoting and often stigmatizing condition occurring primarily in rural areas of low-income countries (Box 2) [3].They are ancient affl ictions, described in the Bible and other ancient texts, which have burdened humanity for millennia [3].But now, as a result of aggressive regional vertical interventions, there is a possibility that some neglected tropical infections could be eventually controlled to the point of elimination in some areas of endemicity [2-8].In the case of guinea worm infection, disease eradication might also soon be possible [9]. Neglected by Policy Makers and DonorsSomewhat surprisingly, policy makers and public health offi cials have largely ignored the extraordinary successes in these vertical programmes for neglected disease control and elimination.We believe that there are two main reasons for this lack of attention.The fi rst is that the international health community, including donors, have given the highest priority to the “big three”-HIV/AIDS, tuberculosis (TB), and malaria-with the result that other infections of poverty garner less attention.The second is that donors and policy makers take a dim view of the overall value of vertical programmes that are not directed at the big three.With regards to the big three, donors, international agencies, nongovernmental development agencies, and governments have responded through focused attention on vertical initiatives by creating UNAIDS (http:⁄⁄www.unaids. org) and within WHO, Stop TB (http:⁄⁄www.stoptb.org)and Roll Back Malaria (http:⁄⁄www.rollbackmalaria.org).These developments stimulated the establishment of the Global Fund to Fight AIDS, TB and Malaria (http:⁄⁄www.