Emily Bean
Forgotten People, Forgotten Diseases, by Peter J. Hotez,
Washington, DC: ASM Press,
2008. 215 pages.
As the title clearly states, Peter J. Hotez’s Forgotten People, Forgotten Diseases addresses the overall lack of attention that the thirteen major neglected tropical diseases (NTDs), ranked by prevalence, are receiving in the world today. Although his account can frequently be methodical and scientific, Hotez thoroughly explains the causes and types of transmission and the social and economic impacts that the major NTDs have on the people who suffer from them. He is successful in emphasizing the link between disease and poverty and raising awareness about the issue of neglect. Due to his science background, however, his solutions tend to ignore the social aspect of the problems.
The thirteen major NTDs are characterized mainly by transmission by other organisms, and they are all worm, protozoan, or bacterial infections. A main theme throughout Hotez’s book is the link between disease and poverty and the “povertypromoting features” of the NTDs (9). Hotez argues that many of the communities affected by the NTDs are in poverty because they cannot reach their economic potential. For example, the soil-transmitted helminth infections such as hookworm, roundworm and whipworm affect more than 1 billion people in the rural, agricultural areas of Asia, India, Latin America, and Africa (5). In addition to the physical sufferings that these diseases inflict on their victims, they also limit their cognitive and learning abilities and as a result, children with these diseases are never given the chance to reach their learning potential (19). Here, Hotez clearly illustrates how these NTDs prevent societies from developing economically because even their youth are being hindered. Combined with the issues of poor housing, poor sanitation and little or no access to medical facilities, one can clearly understand the vicious cycle of disease and poverty in these communities.
Hotez is successful in shedding light on why the NTDs continue to be neglected today. One of the major reasons the diseases are not given more attention is because they are endemic to rural areas of the world. The “out of sight, out of mind” concept is at work here; because the diseases are usually not present in cities where government officials and policy makers reside, they go unnoticed (6). Furthermore, since the diseases are chronic, debilitating conditions that victims can live with for years, they have a low mortality rate. This lack of shocking mortality rates draws attention away from these diseases and directs it at the huge mortality rates of HIV/AIDS, malaria and tuberculosis. In a sense, the NTDs lack a “shock factor” that would attract more attention from the international health community. Even more frustrating, the NTDs are ancient diseases that have been prevalent for centuries. One would think that more research and work would already have been done to eradicate these diseases, given their longevity. Hotez’s discussions only reinforce the harsh fact that the level of attention given to diseases is strongly influenced by their mortality rates and the areas that they are prevalent in.
Hotez is hopeful when discussing what has already been done by governmental and nongovernmental agencies to help eradicate the major NTDs. He discusses what still needs to be done and even calculates the cost of a “rapid impact” drug package that could target multiple NTDs in one distribution. Hotez shows that the administration of this drug package would be significantly less money, by millions of dollars in fact, than the current amount of money being spent by the US annually on malaria control (136). An issue with Hotez’s solutions, however, is that they tend to be very scientific without taking into account the social aspect of the problem. At times, Hotez’s words imply that vaccines and medications will be the golden ticket to eradicating the major NTDs and the poverty associated with them. He even dubs these vaccines “antipoverty vaccines”. This is arguably a dangerous term to use because it implies that vaccines for the NTDs will not only eradicate the diseases themselves, but also the socioeconomic and political problems that contribute to poverty. In fact, it is very possible that a community is in poverty due to political or socioeconomic problems. It is not absolutely certain that disease is the root of poverty, and Hotez is walking a fine line when he uses this “antipoverty vaccine” term.
In the last chapter Hotez strays away from his main theme of disease and poverty and brings up the possible link between disease and conflict. He suggests that disease causes civil conflict, and that the eradication of the major NTDs could be the solution to this as well. In his opinion, international diplomacy can be achieved through the control of these diseases. His points are valid, as it has been shown that poverty certainly is associated with civil unrest. They are, however, brief and underdeveloped, as he has dedicated only the last chapter to this issue and a whole separate book could be written about it. Additionally, his discussion almost gives the sense that he would call the vaccines for these diseases “anti-civil conflict vaccines” as well as “antipoverty vaccines”.
Overall, Hotez’s Forgotten People, Forgotten Diseases successfully raises awareness about the enormous issue of the major NTDs. It is a very convincing book that would be beneficial for anyone in the public health field, as billions of people are suffering from these diseases and this issue deserves much more attention than it is currently receiving. Being a scientist, however, Hotez’s solutions are very methodical and are focused on using medications and vaccines to alleviate the problem. He could benefit from collaboration with a social and behavioral sciences specialist in order to take into account the social and economic factors that contribute to poverty.
