How innovation, incentives and infrastructure can combat neglected tropical diseases and ensure “Health for All”

In an age in which so much in the news seems overwhelming, there is a surefire way of staying both optimistic and informed: reading about the steady onwards march of medical science. In just a few generations, this progress has transformed the quality and length of human life, creating a world in which global infant deaths have dropped by more than two-thirds since 1950, antibiotics and vaccines have saved countless lives and prevented chronic disabilities, and average global life expectancy now exceeds 70 years.

Yet the prevalence of many communicable diseases remains persistently high, particularly among impoverished populations. Notably, neglected tropical diseases (NTDs) remain a global scourge, affecting over 1 billion people, and causing around 120,000 deaths annually. The WHO describes NTDs as a “disease of neglected populations”, and they disproportionately affect sub-Saharan Africa, where 90% of the burden of the most common NTDs occurs. NTDs exacerbate malnutrition and cause chronic illness, disability, and death, perpetuating cycles of poverty by undermining education and productivity. Patients are often subject to stigma and ostracization, compounding all other impacts: many NTD survivors report feeling ashamed of their illnesses, and describe their battles with profound social exclusion and depression. Some, especially those who have been scarred or disfigured, even recount wishing they had not survived. Meanwhile, at a societal level, NTDs strain fragile healthcare systems and cost developing communities billions of US dollars in direct health costs and lost productivity, hindering economic growth.

Overcoming NTDs is therefore critical to reducing the global public health burden, achieving health equity, and meeting the Sustainable Development Goals (SDGs), especially SDG 3: “Ensure healthy lives and promote well-being for all at all ages”.

We believe we can achieve this through a combination of innovation, incentivization and investment in infrastructure. Here is how.

Innovations offer powerful new solutions to the millions living with NTDs

Innovation in treatments is crucial to overcoming neglected tropical diseases. Most important are effective, affordable and accessible innovations that reflect the needs of the communities hardest hit by NTDs – approaches like single-dose regimens, novel drug delivery systems, and vaccines. These can enhance treatment coverage, reduce disease transmission, and help break the cycle of poverty and ill health caused by NTDs.

At Bayer, we have already contributed significantly to innovative treatments for NTDs including Chagas disease, African Sleeping Sickness and onchocerciasis. Most recently, we were incredibly proud to propel forward our work on whipworm infections with our trusted partner Swiss TPH, a world-renowned institution whose pioneering research focuses on improving health in low- and middle-income countries. Whipworm infection (an NTD which primarily affects underserved communities lacking proper water, hygiene, and sanitation resources) develops when people consume soil or water contaminated with whipworm eggs. The parasites then grow and cause appetite-suppressing abdominal pain, compromise the microbiota of the gut, and reduce its ability to absorb nutrients effectively. Whipworm infections are particularly harmful for children: multiple studies have linked whipworm infections to anaemia, stunted growth and impaired cognitive development in preschool and school-age populations. According to the last global estimate in 2010, whipworm infections affect around 464 million people globally, leading to a significant burden of 0.64 million disability-adjusted life years (DALYs) lost annually. The same estimate suggests that in underprivileged communities, the prevalence of whipworm infection could exceed 90%, and affect 144 million preschool children and 233 million school-age children. This means whipworm is jeopardizing the health, education and future prospects of hundreds of millions of the world’s poorest children.

While safe drugs are available to treat whipworm and other soil-transmitted helminth infections, their efficacy varies. Current WHO-recommended treatments, albendazole and mebendazole, have limited effectiveness against whipworm, with a single dose curing only a small proportion of those infected. Furthermore, high reinfection rates, coupled with the rise of resistance to existing anthelmintic drugs (i.e. drugs that combat soil-transmitted helminth infections), make the development of new alternative treatments even more urgent.

We were therefore delighted this year when, together with the Swiss TPH, we developed emodepside, a treatment whose dual-action mechanism distinguishes it from other anthelmintics and helps combat drug-resistant parasites. It has been successfully used as an anthelmintic in veterinary medicine for almost two decades – and recently, researchers from Swiss TPH pioneered its use in humans infected with soil-transmitted helminths through Phase II trials, with results showing the efficacy of high doses of emodepside far outstripped the efficacy of other anthelmintic drugs. Based on these exciting findings, Bayer is now collaborating with Swiss TPH to further develop emodepside, with Phase III trials planned this year. Swiss TPH is also conducting laboratory studies to assess potential drug combinations with emodepside.

These promising results are testimony to the persistence, dedication, and hard work by #TeamBayer and our partners at Swiss TPH – and we have high hopes that emodepside could prove a safe and highly effective treatment for human whipworm infections, improving the health and societal outcomes for the millions of people who currently suffer from the disease.

Public-private partnerships like these are vital in stimulating innovation in the treatment of all neglected tropical diseases – governments and companies must identify and harness opportunities to fill in the gaps, benefitting underserved communities while also opening up new revenue channels.

Incentivizing R&D is crucial to spur innovation – particularly in underserved areas

Of course, often a helping hand is needed to kick-start such collaborations. Like many other overlooked health issues, NTDs are subject to a vicious cycle: the majority of patients are individuals in low- and middle-income countries, where patients and healthcare systems often cannot afford high drug prices. As a result, many drug manufacturers view NTD treatments as a high-risk field that offers minimal potential for recouping (often substantial) investments in R&D and distribution. To overcome this hesitancy, governments must be willing to implement regulatory and financial incentives – like tax credits, priority review vouchers, and funding for public-private partnerships.

One example: the Orphan Drug Designation (ODD), which is granted by the U.S. Food and Drug Administration (FDA) to drugs intended to treat rare diseases or disorders, defined as those affecting fewer than 200,000 patients. The ODD program provides several incentives to encourage the development of treatments for these often-overlooked conditions, including reduced fees for regulatory activities such as protocol assistance, marketing-authorization applications, inspections, applications for changes to marketing authorizations, as well as reduced annual fees. Bayer has a deep appreciation of the value of this designation: thanks to #TeamBayer’s dedication, this month we succeeded in obtaining an ODD for emodepside. This milestone will help facilitate the development process and speed up our ability to bring this game-changing treatment to market – both in and outside of the U.S.

By reducing regulatory hurdles and the costs of R&D, incentives like this create compelling ethical and financial cases to pursue treatments whose development may otherwise be unviable. Such initiatives ensure that life-saving innovations reach the vulnerable populations who need them most.

Prevention is better than the cure: robust infrastructure can reduce the spread of diseases

In parallel, efforts must be made to address the root causes of NTDs – most notably through investments in water and sanitation infrastructure, both of which play a significant role in reducing the transmission of these diseases. Toilets and taps are vital to human health, wealth and happiness: without proper sewage systems, human waste can quickly contaminate ground- or surface water sources, while inadequate handwashing facilities accelerate the transmission of infectious diseases, including NTDs. Poor or inadequate sanitation also fuels inequity, both in terms of wealth (unsafe sanitation causes 1,000 times more deaths in low-income countries than in high-income countries) and in terms of gender (lack of access to toilets and running water increases women’s and girls’ vulnerability to abuse and assault, and restricts their participation in education and economic activities). Despite these shocking figures, however, only just over half of the world’s population uses safely managed sanitation.

But the good news? There are multiple solutions for creating resilient water and sanitation systems. On a local level, many economical innovations are available – from simple handwashing stations, to water purification technologies, to solar-powered or gravity-fed water supply systems, to composting toilets – and the market for such technologies could reach more than US$6 billion globally by 2030, posing significant opportunities for companies and investors.

Of course, wider-reaching projects (like large-scale sewage systems) are also needed to make changes at scale. Here, it will be crucial for governments to attract private sector investment – for instance, through tax breaks, subsidies, or public-private partnership (PPP) frameworks that reduce financial risks for companies (see this example implemented by the World Bank in Cambodia). Additionally, leveraging blended finance models – where public and donor funding is used to de-risk private investments – can attract capital for high-impact projects. Clear regulatory frameworks, transparent governance, and guaranteed demand through government procurement or community buy-in further enhance the attractiveness of sanitation projects for private investors.

And, wherever international companies operate, we should lead by example. At Bayer, we have committed to providing safe drinking water, sanitation and hygiene (WASH) to all employees at all our sites across the world, and we aim to expand this approach further afield in the communities where we operate. We encourage other companies to follow suit: beyond the unquantifiable impact of proper sanitation on individual health and happiness, every dollar spent on sanitation is estimated to provide at least $5 in economic return (by reducing sickness and increasing productivity), creating more resilient communities and markets.

Breaking down barriers to combat NTDs

Bayer remains committed to working with our partners to bring innovative solutions to those suffering from neglected tropical diseases. But drug development alone is not enough. Sustainable progress requires tackling the root causes of NTDs, such as inadequate sanitation and water access, through targeted infrastructure investments. It also requires governments to commit to fostering public-private partnerships, leveraging incentives, and driving innovation in both treatment and prevention. It is a group effort that requires targeted actions in the world’s most vulnerable communities. In contributing to such progress and engaging with others on the topic, however, we have the opportunity to transform the lives of millions suffering from the physical and mental impacts of NTDs, helping break the cycle of poverty and disease and move towards true “health for all”.