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164 13 Future Directions Each of the major G20 nations and Nigeria is now contributing to the high global disease burden from the neglected tropical diseases, as well as HIV/AIDS, TB, malaria, and the noncommunicable diseases. With regard to the NTDs, these same nations must assume greater roles and responsibilities in leading control and elimination efforts. The G20 and Nigeria can effect major changes both within their borders and internationally. If fully realized, the global burden of the major NTDs can be reduced by one-­ half in the case of the helminth infections and by two-­ thirds or more for some of the other vector-­ borne NTDs and leprosy. According to the Global Burden of Disease Study 2013, the 17 major NTDs and malaria together accounted for 20.1 million years lived with disability (YLDs) and 997,000 deaths [1, 2], so by addressing these blue marble health issues, the G20 nations and Nigeria could prevent millions of years lived with disability and hundreds of thousands of deaths. Yet another aspect of blue marble health is the rise in comorbid conditions between the NTDs, the big three diseases, and the NCDs. The specific suggestions for creating a blue marble health framework have been detailed throughout this book. Some of the major policy and other recommendations include steps to promote mass drug administration within national borders and to expand research and development efforts to create new drugs, diagnostics, and vaccines, while pursuing overall goals directed at strengthening health systems. China. China has been a trendsetter and pioneer in the battle against NTDs, having been the first large nation to eliminate LF through MDA and having made great strides since its 1949 revolution in nearly eliminating Hotez.indb 164 6/22/16 11:03 AM Future Directions 165 schistosomiasis from the Yangtze River valley. China now needs to expand these efforts to control intestinal helminth infections in its southwestern region and malaria near the Burma border, and then to begin chipping away at a worrisome problem with liver and lung fluke infections. Simultaneously , China can do much more to export its expertise and experience in parasite and NTD control, especially to Africa, where it currently invests billions of dollars in the extraction of minerals and fossil fuels. China also has tremendous but underused capacity for innovation. China may be the world’s largest producer of vaccines, and like India is now exporting low-­ cost affordable vaccines [3]. But it needs to do more to develop new NTD vaccines beyond its success with a vaccine for Japanese encephalitis. Also on the R&D front, China has to commit resources to establish a well-­ financed global health innovation technology fund similar to Japan’s GHIT initiative. Such a fund would be transformative. Japan and South Korea. These two Asian nations also have a great post– World War II history of eliminating their NTDs (although aided in part by aggressive economic development and urbanization during that era), and like China could offer advice and expertise on MDA and health system strengthening to impoverished areas of Africa and Asia. Japan has now established a successful GHIT Fund to spur NTD innovations in partnership with its industrial and academic institutions; South Korea can do the same. Indonesia and India. MDA for Indonesia’s major NTDs, including LF, intestinal helminth infections, and yaws, faces logistical challenges because of the nation’s vast and complicated island geography. In addition, Indonesia has decentralized its health-­ care system, leading to fragmentation of drug delivery, and the political will required to confront its internal NTD problem remains in question. Indonesia has the ability to develop vaccines, and this skill needs to be better exploited in the service of innovative treatment and control measures to counter NTDs. Similar political and social factors have previously been responsible for inconsistent or inadequate delivery of MDA in India. Malaria has emerged as a major killer in India and South Asia. However, India is becoming more ambitious in tackling LF, as MDA drug coverage now exceeds the 50% mark, and the government has also created National Deworming Days for intestinal helminth infections in children and adolescents. These national efforts represent good starts, but India must continue on this trajectory, while also redoubling efforts to implement case detection and treatment for kala-­ azar and, if possible, scaling Hotez.indb 165 6/22/16 11:03 AM 166 Blue Marble Health up indigenous production of liposomal amphotericin B. India could also play a greater role in ensuring that its South...


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