Texas Children’s calls attention to “perfect storm” of poverty, conflict, and NTDs in CAR


Peter Hotez, president of the Sabin Vaccine Institute and Texas Children’s Hospital Endowed Chair in Tropical Pediatrics, put the spotlight on neglected tropical diseases (NTDs) in the Central African Republic (CAR) through a recent op-ed piece in the Huffington Post. With just more than five million people, CAR is considered one of the most remote and economically devastated countries in Africa – and according to Hotez, its brewing brutal civil war could mean an overwhelming increase in disability and death caused by NTDs if action isn’t taken quickly.

“NTDs and poverty reinforce each other through mechanisms that involve reductions in workforce, food insecurity and the health of girls and women. Less well known, but equally important social forces, in promoting NTDs, are war and conflict,” said Hotez. “CAR has a fragile health system to begin with. If we now superimpose conflict and war, it could result in near or complete collapse and inability to provide treatments.”

CAR is one of Africa’s largest sources of endemic and hyperendemic NTDs, and the numbers are staggering. Approximately 1.5 million children require periodic deworming for their intestinal helminth infections, of whom more than 500,000 also need regular treatment for schistosomiasis. Hotez explains that while all of the most common NTDs, such as intestinal worms and schistosomiasis, are of concern in CAR, there also is reason to be especially worried about NTDs transmitted by insect vectors such as kala azar and African sleeping sickness. According to the World Health Organization (WHO), CAR is one of four African countries annually reporting more than 100 cases of the Gambian form of sleeping sickness, which usually leads to death in two to three years.

Currently, neither the United States nor the United Kingdom governments support NTD control and elimination programs in CAR, and there is very little private philanthropic money focused on NTDs going to support such measures. The END Fund, a private philanthropic fund dedicated to combatting NTDs, was one exception and supported NTD control efforts in CAR in 2012. But due to the impact that violence and instability had on the ability for program partners to move forward with mapping and mass drug administration (MDA) activities, the END Fund had to place support to CAR on hold.

“NTD control often falls off the priority list when conflict arises as agencies and governments focus on providing food, shelter and security to affected populations,” said Hotez. “As MDA often mobilizes thousands of health workers to treat millions of people at risk of NTDs in a short period of time, the activities can be dangerous in times of conflict.”

While the majority of health organizations in the U.S. don’t seem focused on NTDs in CAR yet, Texas Children’s is highly aware of the situation there, stressing how important it is that the people of CAR receive access to essential NTD medicines.

“Texas Children’s Hospital is emerging as the first truly global children’s hospital – we take care of the world’s children,” said Hotez. “This is an absolutely unique vision pioneered by Dr. Mark Kline and Mark Wallace, but also extends to Drs. Michael Belfort and Chuck Fraser who are committed to women’s health and surgical issues in resource-poor settings.”

To ensure that NTDs are not further neglected during times of crisis in CAR, Hotez calls for engagement from health agencies with expertise in complex emergencies and a willingness to ensure NTD control efforts remain a priority.

He also is working tirelessly to develop vaccines that can be administered in places like CAR to help eliminate the spread of NTDs. The Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development are pioneering the development of a human hookworm vaccine and schistosomiasis vaccine. They also have a new vaccine for leishmaniasis under development.

“At Texas Children’s, we are very concerned about the suffering of children everywhere,” said Hotez. “We’re making vaccines for the world’s poor.”