Gandhi's Hookworms

The spread of neglected tropical diseases haven't just created a health crisis in the developing world -- they have spurred conflicts in some of the most unstable places on the planet.

BY PETER J. HOTEZ | JANUARY 21, 2010

Toward the end of his life, Mohandas Gandhi suffered from a hookworm infection. This disease, caused by blood-feeding worms in his intestine, is associated with severe anemia, lethargy, and fatigue. The fact that Gandhi's vigorous efforts to wage peace in India may have been slowed because of hookworms is only one of the more dramatic examples of the deep connection between medical health and the promotion of international peace and security.

Today almost all of the 1.4 billion people who live below the World Bank's poverty line are infected with hookworms or related parasites. Taken together, there are seven high-prevalence Neglected Tropical Diseases (NTDs) that particularly afflict low- and middle-income countries: six parasitic worm infections, which each afflict up to 1 billion people, and a bacterial infection known as blinding trachoma, which infects 60 to 80 million people.

In addition to their disproportionate impact on the poor, NTDs differ from the type of infections common in the developed world because, in the absence of treatment, they can persist for years or decades. NTDs produce chronic and disabling effects on child development and farm worker productivity, and they increase the risks of pregnancy. In doing so, these infections actually trap people in poverty -- chronic hookworm infections in childhood reduce cognition, school performance, and future wage-earning potential by 40 percent or more.

India loses almost $1 billion annually in worker productivity because of elephantiasis, which is caused by filarial worms in the lymphatic system and genitals. Africa suffers similar economic losses from elephantiasis -- as well as river blindness caused by larval worms in the eyes and skin, and schistosomiasis from worm eggs in the intestines, liver, bladder, or female genitals.

The people at highest risk for acquiring these NTDs also live in areas of greatest concern to the global security interests of the United States. As much as one half of the world's poor who suffer from NTDs live in the nations that comprise the Organization of the Islamic Conference, including Yemen, Sudan, Somalia, and Afghanistan. Almost as many live in pockets of poverty in middle-income countries that either hold and maintain nuclear weapons stockpiles or aspire to produce them, including India, Pakistan, China, Iran, and North Korea. In these countries, people are not only trapped in poverty because of their health conditions, they are also trapped in conflict.

ESSAM -AL-SUDANI/AFP/Getty Images

 

Peter J. Hotez is distinguished research professor and chair of the Department of Microbiology, Immunology and Tropical Medicine at George Washington University. He is also president of the Sabin Vaccine Institute.