Duck Drop: The neglect is not accidental: the problem with the term ‘neglected tropical disease’

Neglected tropical diseases affect more than 1bn people worldwide – 1 in 8 of all people alive today. However, there is a problem with this phrase, which combines the words ‘neglected’ and ‘tropical’. It implies that there is no correlation here, that they are tropical diseases that happen to be neglected and diseases that only matter in tropical countries. As the Special Rapporteur on leprosy highlighted in the final report of this mandate, the neglect is not accidental; there is an extent to which they are neglected diseases because we think of them as tropical diseases.

This month, TLMI’s communications focus has been on what it means to build a balance of power between actors in the Global North and actors in the Global South. As an organisation, we recognise that progress towards the elimination of leprosy and leprosy-related discrimination will only happen if people in leprosy-endemic countries are essential leaders in our work – something that has not always been true in our 152-year history, but that is a core part of our approach today.

And so, as we consider how we can rectify the challenges of power imbalance created by the past, we should take the Special Rapporteur’s advice and consider whether there is a problem with the phrase ‘neglected tropical diseases.’

The argument can be made that the world’s wealth and power is centralised outside of tropical countries and so when we think of these diseases as ‘tropical’, we relegate them to something of no priority to those with wealth and power in the Global North. The reality, however, is that these diseases are of global concern and for that reason are specifically highlighted within our global Sustainable Development Goals. Thinking of them as ‘tropical diseases’ allows those in the centres of power and wealth to feel they are distant issues, thus increasing their marginalisation and, ultimately, their neglect.

However, there are three reasons that NTDs should be of global priority and not only a tropical issue:

1. They are crucial for global public health: When NTD services are strong in a country, it often means that the overall public health system is strong and that a country is closer to providing Universal Healthcare. The Covid pandemic showed us that strong public health everywhere is a must in our globalised world. Investing in Neglected Tropical Diseases means investing in healthcare globally, making our world more resilient in the face of pandemics and other health threats.
   
   
2. They are a crosscutting human rights issue: The UN Human Rights Council has recently stated in a new resolution that NTDs are a cause and consequences of human rights abuses. When people are faced with systemic poverty and marginalisation, their risk of NTDs is increased. Equally, when a person is diagnosed with an NTD, their risk of poverty and marginalisation increases. As the Special Rapporteur highlights, NTDs account for an estimated 19 million disability-adjusted life years annually, a number that is likely underestimated. For those not versed in public health policy language, that translates to a huge amount of missed economic, cultural, and community potential. In a globalised world, missed potential on a scale as large as this is a problem for everyone.
   
   
3. They are not just a tropical issue: The term ‘tropical’ is a misnomer. As the Special Rapporteur has highlighted, the diseases we refer to as ‘neglected tropical diseases’ are not all tropical and do not only affect tropical countries. If you compare the World Population Review’s map of tropical countries with the WHO’s map of leprosy cases, you see that there is crossover, but it is not total, with many non-tropical countries affected. Brazil and India are only classified as ‘partially tropical’ and yet they account for more than 110k of the total 167k global new cases of leprosy in 2025. Beyond this, climate change is contributing to a migration of vector borne diseases, as mosquitos and other parasites expand into warming countries – in Europe, cases of dengue, Zika and chikungunya are up by 700%. Lastly, migration is common from tropical countries to non-tropical countries, increasing the risk that these ‘tropical’ diseases will impact non-tropical countries. Importantly, that is not a reason to stop migration, it is a reason to end these diseases.

This month, as we consider how to find a greater power balance between the Global North and the Global South, we should pay more attention to how these tropical diseases affect us all.

Dr Premal is our Country Leader in India and he pointed out that research into leprosy medication and treatment has been limited over many decades because the disease affects what he refers to as ‘the wrong strata of person’. He says that we had a Covid pandemic which affected European countries, and suddenly huge amounts of money were invested into finding a vaccine. Meanwhile, leprosy research receives dramatically less funding because it primarily affects those who are often the poorest and on the margins of Asian, African, and South American society - the wrong strata of person. Could you imagine how quickly we would solve NTDs if they affected the 1bn richest people on earth?

This is the crux of what it means that these diseases are neglected. It is not accidental; they do not affect wealthy people in rich countries and so not enough action is taken by those rich, predominantly Global North countries. These diseases are deliberately neglected, which in reality means that the people themselves are neglected. Choosing not to care about these 1bn people is an approach that is distinctly lacking in compassion, but is also short-sighted. Eliminating NTDs is in the best interests of everyone. We have to correct this imbalance between the Global North and Global South if we are to make real progress.

In 2026, we have reached a pivotal moment, with a new UN resolution that identifies neglected tropical diseases as being inextricably linked to human rights abuses. We should seize this moment and write a new narrative that defines these diseases as neglected diseases that impact all of us, not just those of us living far away, in tropical lands. My hope is that we will see the dial shift on this, as all countries contribute towards ending these neglected diseases, with countries in the Global South increasingly taking the lead.