What harm is caused by this neglect?
The examples of harm from this double neglect are many. Possibly due to their chronic nature (e.g. many NTDs do not lead to high acute mortality, but to chronic, debilitating disease), and geographical distance from high-income countries to populations with NTDs, NTDs are perceived as infrequent and their complications and long-term sequelae of little consequence. However, even if many NTDs are not acutely deadly, (e.g. Chagas disease, cutaneous leishmaniasis, soil-transmitted nematodes) they have large impacts on individual well-being and capabilities, local economies and health systems, and have direct bearing on human flourishing (e.g. as measured by the key metric the United Nations Human Development Index)).3,4 On the other hand, some NTDs also have high mortality, particularly concentrated in neglected populations; for example, the mortality and morbidity burdens for malaria, TB meningitis and disseminated TB are centered in children, and Ebola is almost uniformly fatal both to pregnant women and to their neonates, if left untreated.5 A large portion of individuals worldwide who die each year from diarrhoeal disease are children, particularly with underlying malnutrition.6,7 It is well documented that there are often altered physiological factors that can affect drug pharmacokinetics, leading in many cases to related safety and efficacy concerns in vulnerable populations, such as those with prevalent co-morbidities–obese adults, pregnant women and young children, particularly those with malnutrition.8-10