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)

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.

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

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)

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)

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)

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)

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)

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)

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.

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.