By Peter J. Hotez, Miriam Alvarado, María-Gloria Basáñez, Ian Bolliger, Rupert Bourne, Michel Boussinesq, Simon J. Brooker, Ami Shah Brown, Geoffrey Buckle, Christine M. Budke, Hélène Carabin, Luc E. Coffeng, Eric M. Fèvre, Thomas Fürst, Yara A. Halasa, Rashmi Jasrasaria, Nicole E. Johns, Jennifer Keiser, Charles H. King, Rafael Lozano, Michele E. Murdoch, Simon O'Hanlon, Sébastien D. S. Pion, Rachel L. Pullan, Kapa D. Ramaiah, Thomas Roberts, Donald S. Shepard, Jennifer L. Smith, Wilma A. Stolk, Eduardo A. Undurraga, Jürg Utzinger, Mengru Wang, Christopher J. L. Murray and Mohsen Naghavi
The publication of the Global Burden of Disease Study 2010 (GBD 2010) and the accompanying collection of Lancet articles in December 2012 provided the most comprehensive attempt to quantify the burden of almost 300 diseases, injuries, and risk factors, including neglected tropical diseases (NTDs) [1]–[3]. The disability-adjusted life year (DALY), the metric used in the GBD 2010, is a tool which may be used to assess and compare the relative impact of a number of diseases locally and globally [4]–[6]. Table 1 lists the major NTDs as defined by the World Health Organization (WHO) [7] and their estimated DALYs [1]. With a few exceptions, most of the NTDs currently listed by the WHO [7] or those on the expanded list from PLOS Neglected Tropical Diseases [8] are disablers rather than killers, so the DALY estimates represent one of the few metrics available that could fully embrace the chronic effects of these infections.
Even DALYs, however, do not tell the complete story of the harmful effects from NTDs. Some of the specific and potential shortcomings of GBD 2010 have been highlighted elsewhere [9]. Furthermore, DALYs measure only direct health loss and, for example, do not consider the economic impact of the NTDs that results from detrimental effects on school attendance and child development, agriculture (especially from zoonotic NTDs), and overall economic productivity [10], [11]. Nor do DALYs account for direct costs of treatment, surveillance, and prevention measures. Yet, economic impact has emerged as an essential feature of the NTDs, which may trap people in a cycle of poverty and disease [10]–[12]. Additional aspects not considered by the DALY metrics are the important elements of social stigma for many of the NTDs and the spillover effects to family and community members [13], [14], loss of tourism [15], and health system overload (e.g., during dengue outbreaks). Ultimately NTD control and elimination efforts could produce social and economic benefits not necessarily reflected in the DALY metrics, especially among the most affected poor communities [11].
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