Neglected tropical diseases (NTDs) have become an important part of these efforts. Congressional appropriations for NTDs have grown from $15 million in FY2006 to $100 million in FY2014. Heightened congressional interest in combating NTDs has been reflected not only in higher appropriation levels but also in the development of caucuses on these issues. The 17 NTDs are found mostly among the poorest people in 149 countries and territories ( Figure 1 ), primarily where access to clean water, sanitation, and health services is limited. Global Progress in Combating NTDs

Since WHO coined the phrase "neglected tropical diseases" in 2003, global efforts to address these ailments have accelerated. These pledges included the following:
$785 million (includes preexisting commitments) to strengthen drug distribution and program implementation; 1.4 billion drug treatments annually; access to drug compound libraries to identify new treatments; increased financial support for NTD programs (some of which amended previous commitments to ongoing efforts), such as: commitments by the governments of Bangladesh, Brazil, Mozambique, and Tanzania to devote political and financial resources to combat endemic NTDs. In addition to the above-mentioned diseases, dengue has become a growing global health problem. More than 2.5 billion people are now at risk of infection, close to 40% of the world's population. Key U.S. government players include the U.S. Agency for International Development (USAID), U.S. Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Department of Defense (DOD). On May 8, 2014, the Obama Administration announced that it had administered its one billionth NTD treatment, reaching 465 million people and surpassing one of its goals. In FY2014, Congress appropriated $100 million for NTD programs and the Administration requests $86.5 million for NTD programs in FY2015. Issues for Congress

The international community has made substantial progress in combating select neglected tropical diseases. Some NTDs have been tackled more effectively than others. Guinea worm disease, for example, is on the cusp of eradication and with expanding mass drug administration campaigns, the prevalence of several NTDs is declining, particularly in Latin America. Despite these advancements, WHO cautions in the 2020 Roadmap that these diseases cannot be banished without expanding global access to clean water and sanitation, improving hygiene practices, strengthening local health capacity (veterinary as well as human), and intensifying case detection and management. The United States has played an important role in combating NTDs and will likely be a central player in global efforts to advance the 2020 NTD goals. Some of the discussion includes an analysis of steps the 113 th Congress might consider. Documents by the Administration maintain the NTD Program is part of a complete package of services the United States provides to improve the health of women and children across sectors. These two accounts support a wide range of governance and economic development activities, which do not typically focus on health objectives. The international community is increasingly integrating treatments and services, particularly for multiple diseases that can be treated with one pill. One argument is that disease-specific efforts divert investments from the very public health systems that are needed to support vertical programs.
The term "neglected tropical diseases" (NTDs) was coined by the World Health Organization (WHO) in 2003 to describe a set of diseases that are ancient, worsen poverty, and typically impair health and productivity while carrying low death rates. While the use of the term "NTDs" has helped to raise awareness about these long-standing health challenges, its use risks simplifying a complicated health challenge. Some of the diseases are treatable with drugs that can be administered by lay health workers irrespective of disease status, while others require diagnosis and can be treated only by trained health professionals who have access to appropriate equipment, electrical power, and refrigeration (to store the temperature-sensitive therapies).
Neglected tropical diseases primarily plague the poorest people in developing countries. Changes in the environment and population flows, however, make industrialized countries, including the United States, increasingly vulnerable to some NTDs, particularly dengue haemorrhagic fever, which can cause death and has no cure. Health interventions to address the array of NTDs vary, but a common factor to an enduring solution to these illnesses is economic development. Industrialized countries, including the United States, have controlled these diseases in their territories by combining drug treatment with the construction and use of improved sanitation, modernization of agricultural practices, and utilization of improved water systems.
The international community has made substantial progress in combating select NTDs, though some have been tackled more effectively than others. Guinea worm disease, for example, is on the cusp of eradication. More generally, expanding access to mass drug administration is contributing to decreases in prevalence of several NTDs, particularly across Latin America. Despite these advances, WHO cautions that these diseases cannot be banished without improving global access to clean water and sanitation, strengthening local health capacity (veterinary as well as human), and intensifying case detection and management. Making improvements in these areas will require long-term investments that are complex and may entail facing thorny issues such as addressing corruption, transferring ownership of health programs from donors to recipient countries, and evaluating the impact of political and economic policies on health programs (e.g., international lending requirements).
The United States has played an important role in combating NTDs. Congressional interest in NTDs has been growing. Appropriations for NTD programs have steadily increased from $15 million in FY2006 to $100 million in FY2014. In May 2014, President Barack Obama announced that the U.S. Agency for International Development (USAID) had supported the delivery of the one billionth NTD treatment and had reached nearly half a billion people. The Administration requested $86.5 million to support NTD programs in FY2015. Between FY2006 and FY2012, U.S. funding has supported the delivery of nearly 585 NTD treatments, reaching 258 million people. This report discusses the prevalence of NTDs, U.S. and global actions to address them, and options the 113th Congress might consider. For additional background on NTDs, including photographs and discussions about transmission of NTDs, descriptions of activities to combat NTDs by other agencies, and additional policy issues, see CRS Report R41607, Neglected Tropical Diseases: Background, Responses, and Issues for Congress.