Clinton-Sebelius-Obama Apologies for Guatemala Are Just the First Step

Last Friday Secretary of State Hillary Rodham Clinton and Health and Human Services Secretary Kathleen Sebelius issued a joint apology for United States Government led experiments conducted during the 1940s in which incarcerated Guatemalans were deliberately infected with syphilis and other sexually transmitted diseases. President Obama also telephoned Guatemalan President Alvaro Colom to issue his personal apology.

It is all too easy to dismiss such heinous acts as crimes committed in the distant past, having little relevance to U.S.-Latin American relations today. However, last week's revelations about the unethical experiments conducted in Guatemala City's Central Penitentiary afford an opportunity to highlight some of this hemisphere's greatest health disparities and how we can wipe them out through low-cost solutions.

A 2008 study of parasitic infections in Latin America, published in the Public Library of Science Neglected Tropical Diseases, revealed several stunning statistics. Despite the fact that Guatemala is a relatively small country with a population of only 12 million people, it has the third largest number of some intestinal worm and blinding trachoma infections in the Western Hemisphere, behind only Brazil and Mexico. Indeed, Central America as a whole exhibits some of the highest rates of intestinal worm infections anywhere. The intestinal worm infections belong to a larger group of conditions known as the neglected tropical diseases or "NTDs." NTDs are now recognized as one of the most potent inducers of poverty. In addition to intestinal worm infections, Chagas disease is a leading cause of serious heart disease in Central America. Chagas disease is a parasitic infection transmitted by a biting assassin bug, which bears some resemblance to a cockroach and lives in poor quality dwellings found throughout the poorest areas of Latin America.

Today, the United States Agency for International Development (USAID) is supporting NTD control programs in 14 countries, including 11 in Africa, two in Asia, and one in Haiti. In addition, USAID is supporting efforts to eliminate two other NTDs in the Western Hemisphere - lymphatic filariasis and river blindness. Such an effort could also be used to leverage support from private donors in order to reach all children living in poverty. Committing to national NTD activities is one mechanism the U.S. Government could employ to offset the damage done so many years ago.

In 2006, the Global Network for Neglected Tropical Diseases (Global Network) was established to raise awareness and funds for deworming programs and other NTD-control practices. With support from the Bill & Melinda Gates Foundation, in 2008 the Global Network, in collaboration with the Inter-American Development Bank and the Pan American Health Organization, established a regional initiative to address NTD control in the poorest countries of Latin America, including Guatemala. The partnership aims to harmonize and integrate NTD efforts by working in collaboration with health care systems and other sectoral initiatives, such as education and improvements in water and sanitation. Through our Latin America and the Caribbean NTD Initiative, we look forward to seeing U.S. Government efforts expand to include the other most common NTDs, beginning in Guatemala.

Having tens of millions of people chronically infected with parasitic worms has now been shown to result in devastating consequences not only to the region's health but also its economic development. Children living in squalor and deep poverty typically harbor worms in their intestines for years. Over time, the worms cause malnutrition and stunt physical growth and intellectual and cognitive development. As a result, children with worms struggle in school, suppressing future wage earnings and trapping poor children in a cycle of poverty.

Extremely low cost solutions are available for controlling the most common NTDs throughout Latin America. Through yearly mass deworming with medicines donated by the major drug companies or those purchased as low-cost generics, it is possible to drastically reduce the number of intestinal worms in the children of Guatemala and elsewhere. This approach has been shown to improve childhood growth and development, school performance and attendance, and may even lift children out of devastating poverty.

Local, national and regional political will and leadership is also needed if we, together, are to meet the target of eliminating lymphatic filariasis, river blindness and trachoma, from the region by 2015. Building on the region's strong history of implementing successful programs to defeat polio, measles and rubella, Latin America and the Caribbean are now well poised to address NTDs. In addition, a recent commitment by Johnson & Johnson to donate the necessary drugs needed to treat children allows us to ensure reach and help the most marginalized and vulnerable populations.

Simultaneously, there is a need for mechanisms to support innovations such as new treatments and NTD vaccines in Latin America. This year, Brazil's National Development Bank (BNDES) created a fund for such innovation so that together the U.S. and Brazil could work together to help support a new generation of life-saving NTD pharmaceuticals.

The timely apologies issued at the highest levels of the U.S. Government are welcomed. Now they should be backed up with action across the hemisphere to control or in some cases eliminate the region's NTDs.

Peter Hotez MD PhD is President of the Sabin Vaccine Institute, which hosts the Global Network for Neglected Tropical Diseases