Neglected Again: ODA Cuts Threaten Global Progress on Tropical Diseases
Neglected tropical diseases (NTDs) continue to plague over a billion people around the world, predominantly affecting vulnerable populations in low-resource settings across Africa, Asia, and Latin America. These diseases — a diverse group of parasitic, bacterial, viral, and fungal infections — include conditions such as lymphatic filariasis, trachoma, onchocerciasis (river blindness), schistosomiasis, and soil-transmitted helminths. Despite being preventable and treatable, they are collectively known as “neglected” due to the persistent lack of attention and resources dedicated to their eradication.
In recent years, momentum had been building around global efforts to eliminate NTDs. As of May 2025, 56 countries had successfully eliminated at least one NTD, signaling substantial progress toward the World Health Organization’s (WHO) goal of 100 countries reaching elimination milestones by 2030. However, this progress is now under serious threat.
A Reversal of Fortune: Impact of Official Development Assistance Cuts
The primary threat comes not from the diseases themselves, but from the sudden and severe reduction in official development assistance (ODA) dedicated to global health — and NTD programmes in particular. The most damaging blow has come from the United States, which abruptly withdrew its funding support for NTD initiatives earlier in 2025. This decision endangers nearly two decades of U.S.-backed global health efforts aimed at NTD elimination.
Early assessments shared with the WHO indicate that this single act of funding withdrawal has already led to the postponement of 47 mass drug administration campaigns that were supposed to reach 143 million people. These campaigns are critical for breaking cycles of transmission and preventing long-term disability and death associated with NTDs. Their delay not only puts people at immediate risk but also jeopardizes global targets. The missed campaigns and associated surveys in 2025 are expected to delay target achievements in at least 10 more countries.
Furthermore, the funding cuts have had a chilling effect on research and innovation. Promising investigations into new diagnostic tools, medicines, and surveillance systems have been halted midstream. Without continued research, global health programmes lose the ability to evolve and respond to emerging health challenges, including new vectors, drug resistance, and changes in disease distribution driven by climate change.
Health System Strain: Disruption Comparable to COVID-19
On April 10, 2025, WHO issued a formal warning highlighting the scope and consequences of these ODA suspensions. More than 70% of WHO country offices surveyed reported disruptions to health services, with NTD programmes among the most severely affected. In many countries, the scale of these service interruptions is being likened to the collapse seen during the height of the COVID-19 pandemic.
Across several affected countries, critical shortages of medicines and health products have emerged, with one-third of nations reporting complete stockouts for essential NTD-related commodities. Additionally, the funding shortfall has triggered widespread layoffs of health and community workers — the very backbone of NTD elimination efforts.
Unless alternative funding or delivery mechanisms are urgently secured, the crisis could deepen further. Over 55 million tablets intended for NTD treatments are now at risk of expiration in Africa alone by the end of 2025. This waste of valuable medical resources not only represents a lost financial investment but also a missed opportunity to prevent disease and suffering.
In the absence of external funding, countries are scrambling to develop stopgap measures. Some have begun integrating NTD treatment campaigns with broader health initiatives, while others are working to reallocate domestic resources. However, these are often insufficient to fully compensate for the scale of services previously sustained by international support.
U.S. Contributions: A History of Leadership at Risk
The scale of potential losses is enormous when considering the history of U.S. engagement in NTD elimination. Over the past two decades, the United States Agency for International Development (USAID) has invested $1.4 billion in NTD programmes, delivering 3.3 billion treatments to over 1.7 billion people in 26 countries. These efforts have directly contributed to the elimination of at least one NTD in 14 countries, including Ghana, Nepal, Mexico, and Togo.
Thanks to USAID’s support, countless infections have been cleared, transmission has been interrupted, and lives have been saved. In 2023 alone, more than 860 million people received treatment for NTDs through large-scale distribution campaigns. Between January 2023 and May 2025, WHO officially recognized 17 countries for eliminating at least one NTD. These victories now hang in the balance as programmes are forced to halt drug distribution, dismantle outreach teams, and reassign health personnel.
A Pattern of Decline: Global Support Falters
The U.S. withdrawal from NTD funding follows a troubling trend of declining global investment in NTDs. During the COVID-19 pandemic, the global health funding landscape shifted dramatically. Resources were redirected toward pandemic response and preparedness, often at the expense of other vital health programmes.
In 2021, the United Kingdom similarly pulled out of its flagship NTD programme, the Ascend initiative, dealing another blow to international NTD efforts. While more recent events — such as renewed pledges made at the Reaching the Last Mile (RLM) Forum in December 2023 — had rekindled some optimism, the overall direction of donor behavior continues to raise concern.
The consequences of sustained underfunding are far-reaching. Climate change, urbanization, and global travel are increasing the spread and severity of vector-borne diseases, with dengue standing as a prominent example. Declared a grade 3 emergency by WHO in 2024, dengue caused over 14 million cases and 10,000 deaths in 107 countries. As dengue expands into new regions, the global need for robust surveillance and treatment systems becomes more urgent — yet the financial resources needed to build these systems are shrinking.
Cost-Effective, High-Impact: The Case for Continued Support
NTD programmes have long been hailed as some of the most cost-effective global health interventions. Their success stems not just from the commitment of national governments and international donors, but also from extensive public-private partnerships. Since 2011, pharmaceutical companies have donated over $12 billion worth of medicines, dramatically lowering the cost of intervention and enabling mass drug administration on an unprecedented scale.
Major pharmaceutical contributors — including Bayer, Chemo Group, Eisai, EMS, Gilead Sciences, GSK, Johnson & Johnson, Merck KGaA, Merck & Co. (MSD), Novartis, Pfizer, and Sanofi — have been critical partners in expanding access to essential treatments. These donations have allowed countries to stretch limited budgets further and treat more people more quickly. Defunding these programmes squanders not just public investment but also private generosity and cross-sector cooperation that has been carefully built over the past two decades.
Preserving Hard-Won Progress
The world is at a critical inflection point in the fight against neglected tropical diseases. After years of hard-fought progress, the sudden contraction of financial support threatens to reverse gains, widen health disparities, and plunge millions back into cycles of disease and poverty. What is needed now is a renewed commitment from the global community — not just to protect past achievements but to fulfill promises made to the world’s most vulnerable populations.
Governments, donors, and private sector partners must urgently rally together to restore funding, stabilize programme operations, and reinvigorate research and innovation. In a world increasingly shaped by health emergencies, it is more important than ever to invest in proven, cost-effective solutions that strengthen global resilience and promote equity.
Neglected tropical diseases may be forgotten in global headlines, but for the billion people they affect, they are a daily reality. It is time to ensure that these diseases — and the people suffering from them — are no longer neglected.
