Peter Hotez, MD, PhD, FAAP

The health issues of the "bottom billion" of the world's people are parasitic diseases that ensure that poverty will continue from one generation to the next, unless some inexpensive solutions are quickly implemented.

Peter Hotez, MD, PhD, FAAP, told the audience at the October 20 plenary more about these issues in "The Impact of Parasitic Infections on the Health of Children in Developing Areas of the World." Dr Hotez is professor and chairman of the department of microbiology, immunology and tropical medicine at George Washington University, and president of the Sabin Vaccine Institute.

The "bottom billion" is the one-seventh of the world's population that lives on no money, he said. These families are subsistence farmers and urban slum dwellers.

"There's an element of hopelessness among the bottom billion because it's not just being poor, it's the fact that not only will they live in poverty, but their children will live in poverty, and their children's children will live in poverty," Dr Hotez said.

The United Nations Millennium Development Goals were created to break this cycle of poverty, and the goal related to health and infectious diseases is being implemented for HIV/AIDS and malaria. However, the clause about "other infectious diseases" is often overlooked.

"Particularly for AIDS and malaria, there's been this groundswell of support," Dr Hotez said. "But it's not easy to get global health policy makers, much less the Bonos and Angelina Jolies of the world, excited about something called ‘other diseases'."

However, these "other diseases" are diseases we can do something about that will affect the lives of children in a simple way that we can't with AIDS and malaria, he said.

The "neglected tropical diseases" are the most common infections of the world's poor, and they are not only diseases of poverty, they ensure that people stay in poverty, Dr Hotez said. For example, 807 million people are infected with ascariasis (roundworm), which flattens children's growth curves, causes malnutrition that lowers IQ and performance in school, and ensures that the cycle of poverty continues. Many of the world's poor are infected with more than one tropical disease.

"They are particularly devastating in children," he said. "In just about any rural area in the poorer nations of the world, 100 percent of the children between 8 and 12 are infected with roundworm."

These diseases are chronic, not acute, and affect the entire life of the person infected. "These diseases don't kill, so it's hard to compare them to AIDS or malaria," Dr Hotez said. This quality also makes them relatively invisible to the rest of the world's attention.

Dr Holtz noted that for many of these diseases, the distribution of Rapid Impact Packages of drugs eradicate selected diseases in an entire area.

"These seven drugs cost 50 cents per person per year," he said. Donations from drug companies and other agencies have kept costs low, and there have been pockets of success in many areas.

However, drug resistance is a looming problem, making the development of vaccines a critical venture. What is needed to meet that need, Dr Hotez said, is a "guaranteed, money-losing company — creating vaccines for people who can't pay for them."

"They're really anti-poverty vaccines," he said.