	Background

Over the past decade, global health has become a priority in U.S. foreign policy, and U.S. appropriations for health-related efforts have more than tripled. Some observers expect the 112 th Congress to debate the appropriate funding level for ongoing global health programs, to consider ways to make U.S. global health initiatives more effective and efficient, and to encourage other players to become more engaged, particularly countries such as China and India that are receiving assistance from donors to address health challenges while their economies are undergoing considerable growth. NTDs comprise a group of 17 diseases found mostly among the poorest in 149 countries and territories, primarily in areas with unsafe water, inadequate sanitation, and limited health services. Prevalence

The best available estimates indicate that some 2 billion people are at risk of contracting an NTD, of whom more than 1 billion people are afflicted with one or more NTD. Roughly 534,000 are killed by an NTD annually ( Table 1 ). The near eradication of dracunculiasis (guinea worm disease) is one of the most profound cases. The NTD Program continues to be an important part of U.S. global health assistance under the Obama Administration. The President requested $155 million for the NTD Program in FY2011. It costs less than $2 annually to treat each person who needs to be treated for the seven most common NTDs that account for roughly 90% of all illnesses in this group. Also, HIV treatments must be taken daily, while treatments for the seven most common NTDs are usually taken once or twice annually. In that fiscal year, U.S. support for NTDs amounted to less than 1% of the total global health budget. Supporters of expanding the definition also point to the threat some of these diseases could pose to the United States, particularly Chagas disease and dengue. Advocates of a concentrated approach, particularly on the seven most common NTDs, argue that these diseases should be eliminated or eradicated first to build momentum in sustained global health efforts. Other NTDs, like dengue and buruli ulcer, have no known cure. Some proponents call for boosting U.S. funding for consortiums such as the Special Program for Research and Training in Tropical Diseases (TDR) and the Drugs for Neglected Diseases initiative (DND i ), which have played a critical role in identifying innovative NTD tools. Final Discussion

As noted, neglected tropical diseases are diseases that primarily plague the poorest people in the poorest parts of the world. Changes in the environment and population flows, however, make industrialized countries, including the United States, vulnerable to some NTDs as well. Some observers are concerned that mosquitoes capable of spreading dengue fever are gradually spreading across the United States, particularly since there is no vaccine or treatment against this disease. While blood centers are now required to test for Chagas, some health experts surmise that several cases remain undiagnosed in the United States and that Chagas stands as an undetected cause of heart disease and stroke. In addition, travelers from industrialized countries are increasingly contracting NTDs like schistosomiasis while engaged in eco-tourism and other travel "off the beaten track." These cases are usually identified once tourists develop severe, acute infection or other unusual problems.
Over the past decade, global health has become a priority in U.S. foreign policy, and U.S. funding for related efforts has more than tripled. Neglected tropical diseases (NTDs), an important focus of U.S. global health assistance, may come under scrutiny as the 112th Congress debates spending levels for ongoing global health programs. NTDs are a group of 17 diseases that are found primarily among the poorest people in 149 countries and territories. Estimates indicate that some 2 billion people are at risk of contracting an NTD, of whom more than 1 billion people are afflicted with one or more. Roughly 534,000 people are believed to be killed by an NTD annually.
Although these diseases are concentrated among the world's poor, population shifts and climate change increase the vulnerability of the United States to some of these diseases, particularly Chagas disease and dengue. While blood centers test for Chagas, some health experts believe that several cases remain undiagnosed in the United States and that Chagas stands as an undetected cause of heart disease and stroke. Some observers are concerned about scientists' expectations that mosquitoes capable of spreading dengue fever are gradually spreading across the United States, particularly because no vaccine or treatment exists for this disease. In addition, travelers from industrialized countries are increasingly contracting NTDs such as schistosomiasis while engaged in tourism. These cases are usually identified once tourists develop severe, acute infection or other unusual problems.
Proponents support funding research on and treatment for NTDs because it is a cost-effective way of making a significant health impact. Roughly 90% of all NTDs are easy to treat with drugs that cost less than $2 per dose and need to be taken only once or twice annually. This means that all people at risk of contracting an NTD worldwide can be treated for less than $2 billion over the next five years. With consistent treatment and control, several NTDs are being eliminated in various parts of the world, especially in Latin America, and guinea worm disease is on the cusp of eradication, meaning there is no risk of contracting the disease.
Some groups argue that the United States should increase funding for NTD programs to improve global health and advance domestic capacity to detect NTD cases that may arise, particularly for diseases like dengue and Chagas. Other groups maintain that countries like Brazil, China, and India that have received support for eliminating NTDs should play a greater role in addressing the health challenge, particularly as their own economies exhibit strong growth. The 112th Congress may debate funding much of the President's FY2011 budget, which includes $155 million for the NTD Program, as well as upcoming FY2012 budget levels. The 112th Congress will likely weigh calls for greater spending on NTDs with other challenges, such as streamlining foreign and global health assistance to make them more effective and efficient, particularly in light of efforts to reduce federal spending. This report will be updated as events warrant.