The age of hypocrisy has been succeeded by that of indifference, which is worse, for indifference corrupts and appeases: it kills the spirit before it kills the body. It has been stated before, it bears repeating: the opposite of love is not hate, but indifference.—Elie Wiesel



The last five years have witnessed increased efforts by G8 nations and United Nations agencies to improve the health of the world's 3 billion people living on less than US$2 a day. Most of this attention has focused on efforts to intensify resources for fighting the three most devastating diseases: HIV/AIDS, tuberculosis, and malaria. Together, these “big three” account for a staggering 5.6 million deaths and the loss of 166 million disability-adjusted life years (DALYs) annually (see annex tables 2 and 3 in [1]). Prominent partnerships and initiatives are now devoted to the big three (Box 1), and increased global attention to these diseases (and to the risks posed by avian influenza and other emerging viral infections) culminated in the November 2005 TIME Global Health Summit, branded by Bono as the “Woodstock of Global Health” (http://www.time.com/time/2005/globalhealth).



These new initiatives and “Woodstock” Global Health have done much to raise funds and elevate public awareness in order to launch a serious war on the big three. Conspicuously absent from these activities, however, has been commensurate advocacy for a group of diseases that exclusively affect the poor and the powerless in rural and impoverished urban areas of developing countries. An increasing body of evidence indicates that this group of “neglected tropical diseases” may not only threaten the health of the poor as much as HIV/AIDS, tuberculosis, or malaria, but even more importantly, may have effective treatment and prevention strategies that can be delivered for less than US$1 per capita per year. Furthermore, new evidence points to substantial geographic overlap between the neglected tropical diseases and the big three, with emerging data suggesting that control of the neglected tropical diseases could actually become a powerful tool for combating HIV/AIDS, tuberculosis, and malaria. Therefore, achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases and waging a larger battle against a new 21st century “gang of four.”