Neglected Tropical Diseases: the rise of a global health issue

Summary

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Podcast Summary: Neglected Tropical Diseases – The Rise of a Global Health Issue

Podcast: LSE: Public Lectures and Events
Date: December 10, 2020
Hosts/Presenters: Regina Guzman, Katie Bullman, Polly Haley
Featured Guests: Yael Velleman (SCI Foundation), Ken Shadlin (LSE)

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Overview

This episode explores how neglected tropical diseases (NTDs) became a prominent issue on the international global health agenda—particularly within the World Health Organization (WHO). The discussion analyzes the academic theories of power and social constructivism, the practical realities of NTDs, and the political and economic forces that enable certain global health priorities to "go viral." Real-world voices from advocacy and academia are interwoven to show how framing, lobbying, donor influence, and poverty discourses have shaped the rise of NTDs as a major global health concern.

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Structure & Key Sections

1. Academic Theories Explaining Global Health Agendas
2. Background: What Are Neglected Tropical Diseases (NTDs)?
3. Why and How Did NTDs Gain International Attention?
4. Critical Reflections & Conclusions

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1. Academic Theories Explaining Global Health Agendas

Key Points:

• The spread of ideas in international development is heavily influenced by how institutions use and exercise power.
• The WHO derives its power from member states, but its agenda is shaped by global politics and knowledge produced in the social sciences. (02:13)
• Two central theories:
  • Steven Lukes’ Three Dimensions of Power:
    • Decision-making power (policy, political action)
    • Non-decision-making power (agenda setting)
    • Ideological power (norms and ideas influencing thought) (02:47)
  • Constructivism: International organizations like WHO can institutionalize ideas that legitimize political action and set global norms. (03:43–04:12)

Notable Quote:

“A global health issue may have less to do with how important it is in any objective sense than how supporters of the issue come to understand and portray its importance.”
— Jeremy Schiffman (04:48)

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2. Background: What Are Neglected Tropical Diseases (NTDs)?

Key Points:

• NTDs encompass about 20 diseases—some grouped, some individual—caused by various pathogens (viruses, bacteria, protozoa, parasites). (07:03)
• What unites them is “neglect”: they disproportionately affect poor, marginalized populations with little political voice or access to basic services.
• The concept was created to mobilize attention and resources for diseases that “tend to affect other people somewhere else, not here, that usually no one else worries about.” — Yael Velleman (07:03)
• Almost 2 billion people are affected across 149 countries, costing developing economies billions in lost productivity. Treatments often exist but are inaccessible. (08:33)

Notable Quote:

“What they do have in common… is this issue of neglect. So they are issues that are neglected, but they also affect what you’d call neglected populations... And often these people will have less of a political voice because they are marginalized populations.”
— Yael Velleman (07:03)

Important Stats:

• 58% of populations in low-income countries require treatment for NTDs. (05:35)
• In 2015, nearly 1 billion people received some form of treatment. (10:31)
• Cost to treat a person:
  • $0.50 for NTDs
  • $200 for HIV/AIDS
    (10:31)
• Pharmaceutical companies (e.g., GlaxoSmithKline) donate a billion treatments per year to African children. (10:31)

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3. Why and How Did NTDs Gain International Attention?

Key Points:

• NTDs were largely ignored until recognition of their economic burden coincided with international development shifts, such as the Millennium Development Goals (MDGs) and, more powerfully, the Sustainable Development Goals (SDGs). (08:58)
• Inclusion in SDGs gave explicit legitimacy and made the fight against NTDs central to poverty eradication.
• Mass Drug Administration (MDA) emerged as a popular intervention: drugs are given annually to entire communities, regardless of infection status.
  • MDA is easy to count (“Supplying 1 million drugs... is easy to quantify and sell to donors.” — Regina Guzman, 08:58)
  • But it addresses symptoms (parasitic infection) but not causes (poverty, sanitation, etc.)
• The “poverty reduction” and “econometric” frames have been crucial:
  • Investment in NTDs provides measurable, cost-effective outcomes—a priority for new philanthropic donors and development agencies.
  • NTD prevalence serves as a “useful proxy for poverty” and is helpful for donors who need clear impact metrics. (12:18)
• Major philanthropy, especially the Bill & Melinda Gates Foundation, has reshaped priorities and funding, driving a focus on evidence-based, quantifiable interventions. (15:00)

Notable Quotes:

“If there’s a single issue or group of issues that is fundamentally linked with poverty, it’s neglected tropical diseases... It basically tells you where poor people are, where the people are that need to be better targeted.”
— Yael Velleman (12:18)

“The Gates foundation is playing a role that I don’t think any organization has ever played. Like it’s qualitatively bigger and different than anything anyone... The role of the Gates Foundation and other sort of... philanthropic agencies is, I think, huge.”
— Ken Shadlin (15:00)

Critiques:

• The moral framing of “neglect” forces a response centered on treatment.
• This technical and pharmaceutical approach (vertical programs) risks ignoring root causes and reinforcing cycles of poverty.
• Mass Drug Administration programs have been criticized for innovation failures and not addressing systemic issues. (17:39)

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4. Critical Reflections & Conclusions

Key Points:

• The global rise of NTDs on the WHO agenda is less about epidemiological urgency and more about successful framing; it aligns with policy trends toward poverty reduction and cost-effectiveness.
• Despite extensive MDA campaigns—the world’s largest public health effort—root causes, such as poverty, poor sanitation, lack of education, and weak public sector support, remain insufficiently addressed. (18:45)
• Calls are increasing to shift away from purely technical solutions to more socially oriented and inclusive programs. (18:45)

Power, Ideas, and Global Health:

• WHO and similar agencies serve as decision-makers and norm-setters, translating frames into policy and guiding international priorities.
• Framing and agenda-setting are as powerful as technical solutions in driving global health efforts.

Notable Closing Quote:

“Whoever’s worked on global health issues would know that that moment in the sunshine when your issue gets attention doesn’t last for very long unless you keep at it and continue to make it relevant... There are trends in global health and they come and go.”
— Yael Velleman (20:10)

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Memorable Quotes & Timestamps

• “Institutions use power to push intellectual and policy narratives...” — Polly Haley (02:13)
• “A global health issue may have less to do with how important it is... than how supporters ... portray its importance.” — Jeremy Schiffman (04:48)
• “What they do have in common... is this issue of neglect...” — Yael Velleman (07:03)
• “Supplying 1 million drugs... is really easy to quantify and sell to donors.” — Regina Guzman (08:58)
• “If there's a single issue... fundamentally linked with poverty, it’s neglected tropical diseases...” — Yael Velleman (12:18)
• “The Gates Foundation is playing a role that ... is qualitatively bigger and different...” — Ken Shadlin (15:00)
• “That moment in the sunshine when your issue gets attention doesn’t last for very long unless you keep at it...” — Yael Velleman (20:10)

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Important Segments & Timestamps

• Introduction to power and constructivism theories in global health (02:13–04:44)
• Definition and scope of NTDs, with expert input (06:41–08:33)
• The economics of NTD treatment and pharmaceutical donations (10:31)
• Impact of philanthropic organizations (14:14–15:43)
• Critiques of mass drug administration and technological approaches (17:06–18:45)
• Final reflections on the transient nature of health priorities (20:10)

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Tone & Language

The discussion remains analytical yet accessible, blending academic theory, practitioner insight, and practical critique. The hosts and guests maintain a thoughtful, questioning tone, always tying technical details back to broader issues of power, agenda-setting, and social justice.

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Conclusion

This episode provides a nuanced look at the rise of NTDs as a global health priority, showing how conceptual framing, donor interests, and political dynamics can elevate certain health issues while sidelining others. It challenges listeners to think critically about who sets agendas in global health—and how persistent poverty and inequity demand solutions beyond drugs and statistics.

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Transcript

[Katie Bullman]

This is sighting africa.

[Regina Guzman]

Hi everyone, and welcome to our episode of Sighting Africa. My name is Regina Guzman and with me are my fellow presenters, Katie Bullman.

[Katie Bullman]

Hi, everyone.

[Regina Guzman]

And Polly Haley.

[Polly Haley]

Hi, Ev.

[Regina Guzman]

We're here today to discuss an incredibly important and actually quite relevant question with what's happening in the world today? And that is, what makes an idea, theory or concept go viral and become hegemonic within international development? We hope you enjoy the episode.

[Polly Haley]

When we first received this question, it struck us how enormously broad it was. So we've decided to focus our study down and investigate the dramatic rise of neglected tropical disease campaigns on the World Health Organization, which we'll now refer to as the who. We've been very fortunate to get in contact with some key individuals from agencies and academics working on these topics, which have helped build our understanding and will be featured throughout. Our hypothesis going into this research is that power dynamics and framing will be key.

[Katie Bullman]

This podcast will come to you in four parts. We'll start by having a look at some academic theory which is especially important in understanding how different ideas gain traction within international organisations. Then, in our second section, we'll briefly introduce what neglected tropical diseases are and give a background to them in the World Health Organisation. Thirdly, we will try to apply the initial theoretical section to the case of neglected tropical diseases and explore why this group of diseases has managed to so suddenly gain such a huge amount of traction from the who. Finally, we'll be drawing out some of our key findings and conclusions. So here we go. We hope you enjoy.

[Polly Haley]

Institutions use power to push intellectual and policy narratives. Different institutions gain power in different ways, but in the case of the who, this is derived from their member states. The different management of outputs from the WHO have come from broader global agendas, despite the organisation itself probably being one of the more strategic and autonomous within its policy design. Organisations such as the WHO draw their information from social scientific knowledge and the policies that are produced as a result are shaped and enforced by politics.

[Regina Guzman]

There are two theories about power that are especially relevant to our conversation about neglected tropical diseases today. The first is the theory of three dimensions of power by former LSE professor Steven Lukes. And it claims that power is exercised in three ways decision making power, non decision making power and ideological power. A really quick breakdown of those three dimensions is the following. The decision making power is the public dimension that has to do with policy and with political action. The second, non decision making power, is what sets the political agenda in debates and makes certain issues acceptable or unacceptable in public forums. And then lastly is ideological power, and that's what influences people's thoughts. So this has less to do with action and more about the norms and ideas that influence those actions. The second theory is constructivism, which Katie will expand on a bit more later, but for now I'll just mention that it is about how international institutions like the WHO have the capacity to capture ideas on a systemic level which then get adopted by a range of influential actors that can legitimize political action based on those ideas. So basically, international organizations have the power to diffuse norms and ideas that then get translated into global rules and practices.

[Katie Bullman]

Building on this, there's been a lot of research in the field of global health on how and why certain health problems, groups of diseases and concepts gained traction and attention at an international level. This became particularly apparent in the era of the early 2000s, when HIV AIDS was dominating global health policy making and funding. One influential academic, Jeremy Schiffman, wrote a number of articles on this topic. He argues that social constructivism is is one of the most useful frameworks through which to understand global health decision making. This is a short snippet from his.

[Polly Haley]

2009 article the Rise and fall of.

[Jeremy Schiffman]

A global health issue may have less to do with how important it is in any objective sense than how supporters of the issue come to understand and portray its importance. Specifically, those issues that attract attention may be ones in which policy community members have discovered frames, ways of positioning an issue that resonate with global and national political elites and then established institutions that can sustain these frames. I do not imply that there is no connection between material conditions and issue attention in global health. I do mean to suggest that the connection may be loose, and this is always mediated by social interpretations.

[Polly Haley]

Now to look at our case study. The WHO is responsible for coordinating international public health. Its roles consist of setting norms and standards, articulating policy options, providing technical support to countries, monitoring and assessing health trends, and finally shaping the global health research agenda. Its objective is the attainment by all peoples of the highest possible level of health and it is committed to universal access to health as well as ensuring a high quality of health services to all. We chose the WHO and subsequently neglected Tropical Diseases because the parameters of their work focuses on avoidable diseases and excess mortality that have persisted, as well as treatable infectious diseases that remain a major cause of deaths. This is critically important to development and the key thing I want to mention here is the fact that these are diseases of poverty. They disproportionately affect people of the global south, with around 58% of the populations of low income countries requiring these treatments for neglected tropical diseases.

[Katie Bullman]

What are neglected tropical diseases? So we were really lucky to be able to speak to an expert on this issue, Yael Velleman. She's the director of policy at the SEI foundation, which is a not for profit supporting programs targeting parasitic diseases in sub Saharan Africa. Here's what she has to say about how we should understand neglected tropical diseases.

[Yael Velleman]

So technically speaking, it's a list of varying lengths. So if you go by the WHO definition, there are 20 diseases, some of them are disease groups and some of them are individual diseases. And as you say, they're caused by a variety of pathogens. They could be viruses, bacteria, protozoa, parasites, and they have different manifestations. What they do have in common, though, and the reason that they were grouped into this list is this issue of neglect. So they are issues that are neglected, but they also affect what you'd call neglected populations. So people who live in low income settings, who have relatively poor access to social and health services, to water and sanitation services, good housing, and so on. And often these people will have less of a political voice because they are marginalized populations. So the idea of generating this concept of neglected tropical diseases was to try and drum up support and prioritization for things that tend to affect other people somewhere else, not here that usually no one else worries about.

[Katie Bullman]

To add to Yael's introduction to net neglected tropical diseases, I want to stress their massive scope. This group of diseases affects nearly 2 billion people in 149 different countries, costing developing economies billions of dollars in lost productivity each year. Astonishingly, though, in many cases there are readily available drugs which could treat the diseases, yet they aren't easily accessible to people living in these areas.

[Regina Guzman]

As Katie mentioned, and as the name implies, neglected tropical diseases were largely overlooked up until the 2000s, when global health organizations began paying attention to the economic burden associated with these diseases. The first turning point came with the Millennium Development Goals, as neglected tropical diseases get included in global health goal number three, as other diseases to address alongside hiv, aids, malaria, polio and tb. But in a way, the real win came with the reformulation of those goals into the Sustainable Development Goals. When neglected tropical diseases get explicitly mentioned as an epidemic to be dealt with in order to tackle poverty. That, together with the rise of econometrics and international development, gave way to a boom in mass Drug Administration campaigns in which drugs neglected tropical diseases, get blanketly administered once a year to endemic communities, Regardless of who is infected and who isn't. Mass Drug Administration programs are really Easy to measure. For example, supplying 1 million drugs to a community in Niger is really easy to quantify and sell to donors. And another thing to note is that drugs supplied through Mass Drug Administration only address the long term effects of parasitic infections. They don't prevent infections or deal with any of the underlying causes for why people get these parasites in the first place. To add a bit more context to that, let's listen to a few interesting statistics.

[Jeremy Schiffman]

Sub Saharan Africa has the Highest prevalence of 9 neglected tropical diseases where rates of infection are as high as 90% in exposed areas. In 2015, nearly 1 billion people received treatment for at least one neglected tropical disease. Comparatively, it costs $200 a year to treat one person with HIV AIDS, whereas it's only $0.50 to treat one for neglected tropical disease. Neglected tropical disease drugs are very cheap and easy to manufacture, so pharmaceutical companies donate the drugs for free. And as an example of the scope of this, Glasgow smithkline donates a billion treatments per year to treat school age children in Africa.

[Polly Haley]

In regard to why international health institutions such as the WHO have responded to neglected tropical diseases in the way that they have, and the reason this has gained such traction can be attributed to social and political explanations. Put simply, this is the idea that issues that get funding and attention are the ones where policymakers have been able to frame the issue in a way that resonates with both global and national political elites. Institutions are therefore set up in a way that reflects this. The post MDG period was a time of focus towards the issue of poverty reduction. Major organisations operating in this field were able to tap into this poverty reduction discourse, among them those representing neglected tropical diseases. These diseases have been closely linked to the poverty cycle, reducing the productivity of the workforce through excess morbidity and mortality. This is Yael from the SCI foundation again talking about how econometric and poverty reduction frames have proved essential to advancing NTDs in the international agenda.

[Yael Velleman]

The main global agenda is around poverty elimination and is around prosperity and economic development. And if there's a single issue or group of issues that is fundamentally linked with poverty, it's neglected tropical diseases, not only because they contribute to this cycle of poverty and neglect, but also because if you look at NTD prevalence, if you look at where the need is and also look at where there are multiple diseases in the same populations, it basically tells you where poor people are, where the people are that need to be better targeted, better reached by services. So it's a very, very useful proxy for poverty. And I think that that is very easy for people to get their heads around, but also very useful when you're trying to measure what your impact is and why you're as a donor spending where you're spending. If you can have a single indicator that says this is why I need to spend here, then that's a very useful thing for any kind of funder, whether it's government or donor.

[Polly Haley]

As a result of this framing, there has been a huge amount of lobbying that has proved to be highly successful. Subsequently, pharmaceuticals have been donating millions of drugs for free. The reasons for this have been political and economic, such as the expansion of markets for biomedicine or brand promotion.

[Katie Bullman]

Another really important factor to consider within these framing debates is the importance of the power dynamics within international organisation, which includes an examination of who controls knowledge production about global health and development at large. Since the 2000s, the rise of philanthro capitalism has been drastically changing the shape of global health politics interventions. The Bill and Melinda Gates foundation is the largest and most influential of these philanthropic organisations. According to the foundation, they have donated US$50 billion since inception, the majority of this being fueled into global health campaigning, which has given them huge influence at the who. We spoke to institutional theory and health development expert Ken Shadlin on the biggest changes taking place within global health in the past 20 years. And here is what he had to say on this issue.

[Ken Shadlin]

I think that the biggest thing has been the emergence, this is hardly original, but the emergence of big philanthropic players on the scene. So I mean the Gates foundation is playing a role that I don't think any organization has ever played. Like it's qualitatively bigger and different than anything anyone. So I think, and they're not alone, there's all sorts of other philanthropic organizations, there's all these product development partnerships, vaccines, alliances, all these things. But the role of the Gates foundation and other sort of, they're not private companies, they're sort of philanthropic agencies is I think, huge.

[Katie Bullman]

These donors therefore have changed the international agenda owing to their focus on a business common sense attitude to development policy. As Yale highlighted earlier, this approach has facilitated a focus upon evidence based decision making grounded in econometric and quantitative data.

[Regina Guzman]

It should be no surprise therefore, that econometric frames have been heavily employed by the actors and institutions representing neglected tropical diseases to facilitate the meteoric rise on the agenda. One academic, David Canning, for example, argues that investing in neglected tropical diseases is the most cost effective way to use scarce health budgets. The changing nature of power within the WHO and the growing importance of econometric analysis thus enabled neglected tropical diseases to capture attention on the global scale. And second, I just want to highlight how the word neglect itself serves as a really powerful frame. Having a group of diseases termed neglected tropical diseases makes the issue a clearly moralistic one. So then the only possible approach to this neglect is treatment. The word neglect is intrinsically loaded with ethical issues about a group of diseases that disproportionately affects the world's poorest population, which was well outlined by Yael from the SCI foundation early on.

[Polly Haley]

The focus on technological solutions for specific diseases has been quite heavily criticized, a central concern being the vertical programs that have been pursued by the WHO to combat the big three diseases, which are hiv, aids, malaria and tb, that have resulted in the expense of other priorities. Until now with the growing focus on NTDs. As discussed throughout the podcast so far, during our discussion with Professor Shadlin, these are the major issues that he recognizes within NTD treatment campaigns.

[Ken Shadlin]

So a lot of the things that make the Mass Drug Administration programs that they have very prominently critiqued, I think are related to innovation problems. Which gets us back to the very first question. These are neglected diseases and if we had better drugs for these diseases, and by better, I mean better, more convenient formulations. A lot of the MDA problems, Mass Drug Administration problems that they write about, I'm not saying they would go away. I would think they would be different and they would be less so. That's why I think all these things are kind of related.

[Katie Bullman]

So we've taken a very brief look into the case of neglected tropical diseases and their rise on the global agenda and through the WHO in the past 10 years. Neglect of tropical diseases are a hugely interesting and highly political topic which we've only been able to touch the surface of. However, our ultimate argument is that neglect of tropical diseases have been framed in such a way that which has resonated with policy makers in the WHO and fit into existing agendas, including poverty reduction and econometric decision making.

[Polly Haley]

Although Mass Drug Administration has become the world's largest public health initiative, these campaigns have actually done very little to address issues of systemic poverty, which has been the environment in which neglected tropical diseases have been able to prosper. There are issues such as reinfection, lack of education regarding the diseases and their treatments or fears, and rumours around side effects and the real purposes of the drugs. There have been calls for the creation of strong public sectors as well as an increase in targeting of the most vulnerable populations. There has been a change in focus to the social welfare of people to.

[Regina Guzman]

Wrap things up and to ground the conversation back in the dimensions of power that we discussed earlier. I just want to say that ideas are at the core of public health communication, and organizations like the WHO act as the decision making powers that set the guidelines and standards for policy. These standards then get adopted by political elites who can translate the ideas into political action. And finally there's the ideological dimension to power, and that's really strong. Frames set not only policy, but the way we understand issues and norms. We'd like to finish with this thought from Yael about what we can learn about the broader ebb and flow of global health agendas which have formed the basis of this discussion and apply now to the current COVID 19 cris anyone.

[Yael Velleman]

Who'S ever worked on global health issues would know that that moment in the sunshine when your issue gets attention doesn't last for very long unless you keep at it and you continue to make it relevant. If there's anything happening at the moment to show us that, it's the current outbreak, there are trends in global health and they come and go.

[Regina Guzman]

That concludes our episode. Thanks to all those who have contributed to this podcast, including Yale Velleman, Ken Shadlin, and Laura Mann. They've kindly supported us during our research and informed our knowledge. All references for those cited and used during our study will be included in our summary.

[Polly Haley]

Sam.