By Jennifer R. Herricks, Ph.D.
Did you know that a group of infections known as neglected tropical diseases, or NTDs, afflict the people of Texas, even in big cities like Houston? Neither did I, until I began my postdoctoral work studying disease and poverty. I learned that these diseases affect people’s ability to work, learn and be productive, and that this burden falls disproportionately on the poorest Texans who have the least resources to deal with the repercussions.
This motivates me to do what I can to help our neighbors that suffer from these significant, yet understudied, conditions. One way we can all help is by talking with policymakers because they have the ability to make potentially lasting change. This April I had the perfect opportunity to share what I know about NTDs with Texas lawmakers. I describe that experience below, and I hope it inspires others to get involved with the political process when important issues are at stake.
During Texas’ current legislative session, Rep. Sarah Davis introduced House Bill 2055 regarding the establishment of a sentinel surveillance program for emerging and neglected tropical disease. On April 21 the Texas House Committee on Public Health contemplated the bill, and I was there with Anna Dragsbaek, president and CEO of The Immunization Partnership, to provide testimony. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, provided written testimony.
Like most people, when the committee heard the term “neglected tropical diseases,” they thought about rare diseases that exist only in exotic locations. However, these diseases are not rare — affecting 1.4 billion people globally — and despite the word “tropical,” they can occur anywhere — especially in areas of extreme poverty — including the United States. And while diseases like chikungunya, dengue fever, Chagas disease and cysticercosis may sound exotic, they are very close to home. The combination of a mild climate, the presence of insect vectors and animal reservoirs, and high rates of poverty make Texas and the surrounding states a “hot zone” for NTDs.
In 2011 the National School of Tropical Medicine at Baylor College of Medicine established a Tropical Medicine Clinic at Ben Taub Hospital in the Texas Medical Center. Each week physicians at this Houston clinic see patients with one or more NTDs.
The question naturally arises, as it did in the public health hearing: How many Texans suffer from NTDs? The most recent estimate is that 12 million Americans live with at least one NTD. But, as we testified, a precise burden of NTDs in the U.S., and in the state of Texas it is difficult to attain for several reasons. Perhaps the most important is a lack of awareness about NTDs, even among the medical community. Due to this lack of awareness, many patients are undiagnosed or misdiagnosed and cases often go unreported.
Many of these diseases are chronic and debilitating. Neurocysticercosis can cause epilepsy; toxoplasmosis and toxocariasis can cause blindness and developmental defects in children; Chagas disease can cause fatal cardiomyopathy; trichomoniasis is associated with infertility and poor birth outcomes. Recent work has also linked NTDs to other conditions, such as asthma, mental illness and an increased susceptibility to HIV infection.
In addition, there are financial costs associated with NTDs. The economic burden of Chagas disease in the U.S. is projected to be almost $1 billion, and neurocysticercosis is estimated to cost $17 million in the state of California alone.
The good news is that these terrible consequences can be avoided if the right public health interventions are put in place. To do this efficiently and effectively, we need to have more accurate data about the true burden of these diseases in our communities. HB 2055 would enable the state of Texas to determine better disease estimates to meet this goal. Implementation would be simple, as this program can be rolled into existing disease surveillance mechanisms without additional costs.
These arguments were laid out before the Texas House Public Health Committee without opposition, and the bill recently passed the House, but there is still a long way to go. It must pass in the Senate before it can be sent to the governor. All of this must happen before the end of the Texas legislative session on June 1, or we have to start our efforts again during the next session in 2017. Knowing that the legislature is very busy, it is important to keep them engaged on this issue so that it is not simply put to the side.
Hearing from constituents can motivate elected officials to take action. For my part I am doing everything I can to let the Texas legislature know that HB 2055 is important to me and why it should be important to them and to all Texans. While it may not always be possible for me to go to Austin to tell them in person, I know I can reach them by phone, mail, e-mail, even twitter! I hope other Texans will also see the imperative need for HB 2055 and take action by talking to their elected officials. Together we can create the political will to tackle NTDs and other important issues in our towns, our state and our country.
Jennifer R. Herricks, Ph.D., is a postdoctoral fellow in disease and poverty at the National School of Tropical Medicine at Baylor College of Medicine and Rice University’s Baker Institute for Public Policy.