Could violent conflict derail the London Declaration on NTDs?

The concept of the neglected tropical diseases (NTDs) is built around low socioeconomic status (SES) and poverty as the most important social determinants [1].Poor health is not confined to poor people, but the burden of poor health is disproportionately greater within poor communities.A combination of insufficient social programs, unfair economic arrangements, and corrupt politics creates conditions that allow poverty to obstruct health [2].Within this paradigm is the impact of violent conflict.Conflict not only facilitates the relationship between poverty and poor health, but it also is a social determinant of health in its own right.In other words, violent conflict enables poor health outcomes independent of poverty [3].Here, we quantify the overlap among countries with conflict and countries with high prevalence of NTDs, and we discuss how violent conflict may undermine NTD control efforts, most notably for the 10 diseases slated for control, elimination, or eradication by the 2012 London Declaration on NTDs.The 2012 London Declaration was created after the World Health Organization (WHO) 2020 Roadmap for eradication of NTDs established a priority for NTDs in public health and development efforts.In the London Declaration, 22 partners made a commitment to control, eliminate, or eradicate at least 10 NTDs by the year 2020.Partners included the United States Agency for International Development (USAID), United Kingdom Department for International Development (DFID), Bill & Melinda Gates Foundation, World Bank, and several pharmaceutical or medical technology organizations, including but not limited to Bayer, Merck KGaA, GlaxoSmithKline, Pfizer, and Eisai [4,5].This international agreement declared a commitment to "chart a new course toward health and sustainability among the world's poorest communities to a stronger, healthier future" [4].The London Declaration united leaders in global health and represented a redirection of global health and biotechnology capabilities toward addressing NTDs [5,6]. MethodsSince 2007, the Institute for Economics and Peace (IEP) has ranked states and territories based on their "levels of peacefulness" in the Global Peace Index (GPI).In this annual index, peacefulness is measured using 23 indicators organized into three domains: ongoing domestic and international conflict, societal safety and security, and militarization (Fig 1) [7].From composite scores, each country is designated a level of peace: very high, high, medium, low, or very