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Boko Haram and Africa’s Neglected Tropical Diseases

Peter Hotez General

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.

doi:10.1371/journal.pmed.0050055.g001
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.

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