Neglected tropical diseases

The core insight for anyone building here: NTDs are not underfunded because the interventions are unproven or expensive per person. They are underfunded because the commercial model for pharma is inverted, success shrinks the market, and because philanthropic and government funding for global health has historically prioritized diseases with higher case-fatality rates and stronger advocacy constituencies over diseases that mostly disable rather than kill. Both of those are solvable with market-design and financing tools that already exist elsewhere in global health, they simply have not been fully applied here. What would actually have to be built: (1) pooled, multi-country procurement platforms that aggregate demand across the dozens of endemic countries so drug and diagnostic manufacturers can plan production against a stable, guaranteed volume rather than year-to-year donor whims, the same logic that made Gavi's vaccine pooling work for immunization; (2) milestone-based prizes or advance market commitments that pay for elimination outcomes in a specific geography rather than for drug units shipped, aligning incentive with the actual goal (which is disease absence, not treatment volume); and (3) stabilized field logistics, cold-chain-free formulations where possible, and community health worker networks that can be shared across multiple NTD programs simultaneously rather than each disease running its own parallel delivery system, since much of NTD control shares the same last-mile distribution problem. Why this is buildable now, and was not fully buildable a decade ago: mobile-money and digital-identity infrastructure across Sub-Saharan Africa, the same rails discussed in the extreme-poverty whitepaper, now make it possible to track mass-drug-administration coverage, verify delivery, and pay community health workers digitally at a cost and reliability that did not exist in the 2000s and 2010s, when most NTD programs were designed around paper-based reporting. That is a genuine, dateable infrastructure unlock, not a hopeful assumption. The dollar figure, worked directly: full mass-drug-administration coverage for the 1.7 billion people who need NTD interventions (WHO, Global Report on NTDs 2025), at the well-established benchmark cost of roughly $0.50 per person per year for MDA delivery (CDC; PLOS NTD benchmarking meta-regression, 2016, with country-level costs ranging $0.10-$0.64 depending on context), works out to approximately $850 million a year in direct programmatic cost to sustain treatment at full population coverage. That is a genuinely small number, smaller than a single mid-size biotech Series C, for a program covering 1.7 billion people. That $850 million/year figure is the delivery layer alone. The broader addressable market, including diagnostics and next-generation therapeutics needed for the harder-to-treat NTDs that mass drug administration does not fully address, is estimated at approximately $4 billion at full coverage by a 2026 review of pharma's role in NTD control, a figure already carried in this index's underlying problem data and treated there as low-confidence, since it aggregates diagnostics and therapeutics markets that do not yet fully exist commercially. Confidence note: the $0.50/person/year MDA benchmark is well-established across multiple peer-reviewed cost studies (PLOS NTD meta-regression covering multiple countries and diseases), so the resulting ~$850M/year delivery-layer estimate is medium-to-high confidence on the arithmetic, though it assumes uniform per-person cost across very different country contexts, which the underlying literature explicitly flags as a simplification. The $4B broader TAM figure is lower confidence, a single review's estimate rather than a cross-validated market study. What should not be in question: closing an $850 million-a-year gap, against $105 trillion of global GDP, is not a resource-scarcity problem. It is a coordination and financing-design problem, which is precisely the kind of problem pooled procurement and milestone prizes are built to solve.