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It is time to recognize a new geopolitical reality: Neglected tropical diseases such as Zika, tuberculosis, Chagas disease, worm infections and dengue fever are not just a problem for poor countries alone. They are now more prevalent in G-20 countries than they are in the rest of the world. That presents a significant health risk, but also an opportunity – because G-20 nations have the knowledge, the money and the means to eradicate these diseases. What is lacking are new political approaches, and the upcoming G-20 summit represents a perfect chance to establish them.

Neglected tropical diseases (NTDs) are often referred to as "poverty-related diseases," which suggests that countries with stronger economies aren't affected. But that impression is misleading: The most confirmed cases of Zika were registered in Brazil, the largest economy in Latin America, followed by Puerto Rico, a United States territory (Pan American Health Organization, 2016). Southern Europe has also been affected: Greece has seen a return of malaria cases while viral infections like dengue, chikungunya and West Nile virus have been found in Portugal, Spain, Italy and southern France. Five years ago, the French island of Corsica registered cases of schistosomiasis, a devastating parasitic worm infection (PLOS Neglected Tropical Diseases: Hotez, 2016), that is normally thought of as affecting only the poorest parts of Africa.

My analysis, based on data both from the World Health Organization (WHO) and the Global Burden of Disease Study (Hotez: Blue Marble Health, John Hopkins University Press, 2016), shows that more than half of all worm infections and tuberculosis cases can now be found in G-20 countries and Nigeria (whose economy exceeds that of several G-20 states). The same holds true for two-thirds of dengue fever, Chagas disease and leishmaniasis cases in addition to three-quarters of leprosy infections (PLOS Neglected Tropical Diseases: Hotez et al, 2013).

12 Million Americans suffer from at least one Tropical Disease

Why is that? Prosperity in emerging economies is often extremely and unequally distributed – as they rise, they leave behind a bottom element of society, the have-nots among the haves. These are the people who are most often affected by poverty-related diseases. And they can frequently be found concentrated in specific regions. Hotspots in northeastrn Brazil, in northern Argentina and in southern Mexico, the three largest economies in Latin America, currently represent the epicenter of tropical diseases in the region of the Americas.

Peter J. Hotez is Dean of the National School of Tropical Medicine, Baylor College of Medicine, in Houston, Texas, where he is also the Texas Children’s Hospital Chair in Tropical Pediatrics, and Baker Institute Fellow in Disease and Poverty at Rice University. © privat

Possibly the starkest example, though, is to be found in the southern United States. Poverty is intensely concentrated along the Gulf Coast in a strip stretching from Texas to Florida. The region constitutes an infectious-diseases hot zone as troublesome as anywhere else in the world. I estimate that 12 million Americans suffer from an NTD, particularly people of color in the South. They are afflicted by parasitic infections such as Chagas disease and toxocariasis, viruses like dengue fever and bacterial infections like murine typhus – and we can now add Zika to this list.

It is important to point out that poverty in G-20 nations is not the exclusive reason for the spread of such diseases. Climate change, urbanization, migration and conflict also help explain their advance in Southern Europe, the Middle East, North Africa and elsewhere (PLoS Neglected Tropical Diseases: Hotez, 2016).

Overseas development assistance alone falls too short

The map highlights where the most poverty-related diseases can be found today. It looks very different from traditional visualizations of global health problems that split the world into a "global north" and "global south." Instead, the map is divided into smaller regions of poverty-related diseases found among the G-20 nations. I have chosen to call my health concept "Blue Marble Health" in reference to the first photos of the Earth from space, taken by the Apollo astronauts during the 1960s and '70s.

Neglected Tropical diseases

Today the G20 countries account for most of the Neglected Tropical Diseases (NTDs). The map shows that NTDs mainly hit poor regions inside economically thriving countries.

It shows that overseas development assistance – traditionally the tool used by rich countries to fight poverty-related diseases – might fall too short nowadays. The G-20 leaders must accept and agree to tackle neglected tropical diseases that today are widespread within their own nations. What must be done in addition? On the one hand, we have to repress vectors that transmit diseases, such as the Aedes aegypti mosquito, which transmits the viruses that cause Zika, yellow fever and dengue. On the other hand, we must apply mass drug administration where people suffer from parasitic infections.

In addition, G-20 countries must take advantage of their large biotechnology capacities. If they cooperate internationally in drug research and development efforts, they could produce a new generation of life-saving pharmaceuticals – both for G-20 countries and for the rest of the world.

G-20 leaders could thus reduce the number of people affected by neglected tropical diseases by up to two-thirds or more. This is an extraordinary opportunity, and one that should be highlighted at the G-20 summit in Hamburg this week.