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Boko Haram and Africa’s Neglected Tropical Diseases

Peter Hotez (@PeterHotez), Co-Editor in Chief of PLOS NTDs, was named U.S. Science Envoy by the White House and State Department with a focus on vaccine science diplomacy and joint vaccine development with countries in the Middle East and North Africa.

This week The New York Times and other news sources reported on new ties between the Nigerian-based Boko Haram and the Islamic State in Iraq and Syria (ISIS).   A new Jihadi alliance in Africa is concerning on a number of fronts, but through my lens of neglected tropical diseases (NTDs) it has special consequences.

Today, Boko Haram controls an important area of northeastern Nigeria, but it is also threatening neighboring areas of Cameroon, Chad, and Niger. Last year I identified this region as one of ten global “hotspots” for NTDs, and indeed some new numbers on NTDs released by the World Health Organization (WHO) confirm this observation. Currently the four nations under threat by Boko Haram account for approximately one third each of the 169 million people at risk for onchocerciasis (river blindness, and the estimated 472 million people who require mass treatment for lymphatic filariasis (LF), elephantiasis, in Africa. Moreover, transmission of Gambian human African trypanosomiasis (HAT) still occurs in Cameroon, Chad, and possibly Niger.

Figure 1. New Cases of Sleeping Sickness Reported for All Africa between 1927 and 1997 doi:10.1371/journal.pmed.0050055.g001

I am concerned that the expansion of Boko Haram into West and Central Africa could have important consequences for the spread of the vector-borne NTDs highlighted above. For instance, we saw during the last half of the twentieth century how war and conflict produced breakdowns in public health infrastructure that led to dramatic increases in Gambian HAT and hundreds of thousands of deaths (Fig. 1).

My worry is that Boko Haram has the capacity to interrupt onchocerciasis and LF control and elimination activities, while simultaneously thwarting and reversing recent gains in HAT elimination, as they have for polio in recent times. As I have pointed out previously, there are similar concerns for ISIS-occupied regions of the Middle East and North Africa.

The NTD community of scientists and public health experts has much to fear about Boko Haram’s aggressive expansion, and its potential for threatening previous gains in control and elimination efforts in Africa. The global health community must plan accordingly.

  1. I work for a Nigerian grantmaking organisation funding a grand project for the control of NTDs in Taraba, one of the Northeastern states of Nigeria. Our grantee has made significant progress in controlling the disease, having administered no less than 12 million treatments for Onchocerciasis in the last seven years. I agree that the Boko Haram has the capacity to interrupt the treatment, and indeed negate what gains have so far been recorded. I thought to share this information, in case you do not have it as well.

    I also suspect that the Gambian human African trypanosomiasis (HAT) exists in some parts of North central Nigeria; wondering if you know anything about this. The community I come from is likely to be one of a number. In the days of old, HAT is alleged to have nearly wiped out the tribe I belong to (the Aten of Ganawuri), a mountain tribe on the Jos Plateau. I grew up in the early ‘ 60s to mid ‘ 70s seeing old people who had what we generally believed to be symptoms of HAT; one one woman (she is late now) particularly used to be ‘sleeping’ even while walking to the stream or from the farm, or while working in the farm or in the kitchen. My father (late) told me that he lost both his parents to HAT when he was just a few months old. History has it that it took the Christian missionaries to persuade our forebears to migrate from the mountains in order to save the population from extinction – the mountains were infested with the tse-tse fly, and the people were living in caves when inter-tribal warfare was at its peak. I believe some record of these will be in the British colonial archives.

    I am glad to have read your article.

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