Rebuilding Global Health Starts With Neglected Diseases

A Growing Public Health Challenge

In rural Alabama, people still test positive for the parasite hookworm. In South Florida and Texas, mosquitoes capable of spreading dengue, Zika, and malaria are starting to thrive. These diseases, once thought of as foreign, are now resettling locally.

Earlier this year, the U.S. quietly ended one of the most effective global health programs, which is generally unknown to the public. For nearly two decades, the Neglected Tropical Diseases (NTD) Program at the U.S. Agency for International Development (USAID) delivered more than three billion treatments and helped more than a dozen low-income countries to eliminate at least one NTD from their population. The program accomplished all this work for less than 1% of the U.S. foreign assistance budget.

Its closure is more than a bureaucratic footnote; it signals a public health emergency.

Why Neglected Tropical Diseases Still Matter

NTDs are a group of 20 chronic and debilitating infections that cause anemia, cognitive impairments, growth failures, blindness, limb and genital disfigurement, and profound social stigma. Through USAID and other donor support, the world was on the verge of eliminating some NTDs entirely. Now, we risk watching them resurge, especially in vulnerable communities, both abroad and here at home.

NTDs are often thought of as diseases only occurring in low-income countries. This framing, however, is outdated. People worldwide are seeing NTDs rising in wealthy G20 countries, driven by climate change, rapid urbanization, and intensifying inequity. What affects a village in northern Nigeria may soon affect a county in the Mississippi Delta. Such realities should remind global leadership, policymakers, and the public how preventing and combating NTDs are in the best interests of all nations.

So, how did the NTD Program’s end occur?

A Fragile Success Story Unravels

The NTD movement was born in the early 2000s, in the shadow of the global fight against HIV, tuberculosis, and malaria. NTDs, despite afflicting over a billion people, were largely ignored. A coalition of scientists, advocates, and policymakers changed that, building programs that bundled treatments and delivered them at scale, often using donated medicines from pharmaceutical companies. These programs cost as little as $0.50 per person annually and were widely celebrated as some of the most cost-effective public health investments ever made.

But the funding model was always fragile. First, the U.K. slashed its aid program in 2021. Now, the U.S. has followed suit. The ripple effects will be immediate: mass treatment campaigns will stall; medicines will go unused; and, children will go untreated. Diseases once on the verge of elimination could return.

Rather than nostalgia, this moment calls for reinvention.

Rebuilding the Neglected Tropical Diseases Ecosystem

A bold reimagining of the global NTD ecosystem through health diplomacy and scientific development is needed. The following recommendations offer practical first steps to launch this work:

1. Broaden the base of responsibility: Wealthy countries in the G20, especially large middle-income countries such as Argentina, Brazil, India, or South Africa, should strengthen and fund efforts to address NTDs. These countries currently carry a notable portion of the global NTD burden yet contribute little to NTD control. Ending NTDs ensures health security, not just goodwill.
    
2. Invent new tools based on regional needs: Mass drug distribution has helped millions, but it was never perfect. It often misses mobile or marginalized communities and can rely on medicines that are suboptimal, especially for diseases such as hookworm or Chagas. Thus, reinfection is common. Ethical concerns about treating uninfected individuals also persist. What is needed now are new vaccines, diagnostics, and long-lasting treatments developed and manufactured by and for the regions most affected.
   
   That future is already beginning to take shape. In both Rwanda and South Africa, new biotech companies are developing some of the first mRNA vaccines made indigenously and for diseases of regional importance. Though not focused on NTDs, these models offer a glimpse into a future where innovation is rooted in regional leadership, not just philanthropy.
    
3. Confront older and potentially outdated donor-recipient models in global health: The fight against NTDs cannot be run solely from Washington, D.C. or Geneva. Countries with high rates of NTD infections should be not only recipients of aid, but also leaders in shaping, financing, and delivering solutions. Pooled funding models, tiered by GDP and driven by regional health priorities, could ensure shared responsibility and ownership.

Global Health and Shared Responsibility

The end of the USAID’s NTD Program is a significant setback. Finding ways to restore, at least, some of these funds is paramount toward building a more enduring program: A decentralized, equitable, and science-driven ecosystem that treats NTDs not as someone else’s problem, but as a shared challenge. Even for the U.S.

A longer and more detailed version of this commentary was published in Microbes and Infection on July 19, 2025.

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