Why south-east Asia must lead the fight against neglected tropical diseases

Neglected tropical diseases (NTDs) are a persistent public health threat^[1], and tackling them is not just a moral obligation, but a smart investment.

NTDs are a group of infectious diseases that mainly affect poor people^[2] in tropical and subtropical regions. These diseases are called “neglected” because they have received less^[3] attention and fewer resources than other major health issues, despite affecting over a billion people^[4] worldwide.

NTDs disproportionately affect^[5] the poorest communities in low- and middle-income countries (LMICs) where they lock people in cycles of poverty^[6] by hindering physical and cognitive development, reducing school attendance and limiting economic productivity.

Wealthier nations experience far lower rates^[7] of these diseases. Yet it’s in LMICs that cost-effective interventions^[8] like improved water, sanitation, hygiene and vector control – methods used to limit or eliminate insects that spread diseases to humans – can deliver the greatest return. According to the World Health Organization^[9] (WHO), every dollar invested in controlling and eliminating NTDs can yield up to US$25 (£19) in economic and health benefits, through lower healthcare costs, increased productivity and improved education outcomes.

While vaccines are one of the most powerful tools for disease prevention, there are still no vaccines for most NTD^[10]. Progress has been slow, largely due to fragmented funding and limited investment in research. This gap continues to leave millions vulnerable.

To address this, we helped establish the UK–South East Asia Vaccine Manufacturing Research Hub (UK-SEA Vax Hub) in 2023 to reduce the burden of infectious diseases in LMICs, with a special focus on south-east Asia. Its mission is to strengthen regional capacity in vaccine research, development and manufacturing. Dengue and rabies – both persistent NTDs – are among its priorities.

The urgency of this work is underscored by the growing threat of dengue. Between 2015 and 2019, dengue cases rose by 46%^[11] in south-east Asia. Countries like Indonesia, Myanmar and Thailand are among the most affected globally^[12]. This region accounts for more than half^[13] of the world’s dengue cases.

Dengue is hard to diagnose. Its symptoms – fever, rash and joint pain – overlap with other illnesses^[14] like chikungunya^[15], Zika, malaria and typhoid. Misdiagnoses are common and no specific antiviral treatment exists^[16].

While vaccines are available, their use is limited by strict eligibility criteria^[17] based on age, infection history and local disease patterns. This leaves many people without protection^[18].

What’s urgently needed are more effective, affordable and widely accessible vaccines. But vaccines alone won’t solve the problem. Combatting dengue and other NTDs requires an integrated strategy^[19], particularly in poor countries with limited health infrastructure.

To stop the spread of diseases like dengue^[20], it’s not enough to just treat people or use vaccines. You also need to control the insects^[21] that carry and spread the disease – in this case, mosquitoes.

That includes actions like removing standing water where mosquitoes breed, using insecticides, or installing window screens and bed nets. These steps are essential to reducing infection rates and protecting communities. These interventions, driven by local action, are just as essential as biomedical advances. Together, they build a more sustainable and resilient defence against mosquito-borne diseases.

For decades, public health initiatives in low-income countries were largely funded by wealthy countries – through development aid, international donors and philanthropic foundations^[22]. But with shifting global priorities and tightening budgets, it’s increasingly clear that this model is no longer sustainable^[23].

Long-term health security must be led from within. That means a shift in mindset^[24]. Low-income countries must see themselves not just as aid recipients, but as innovators^[25], implementers and investors in their own health futures.

This transition is already underway. The UK-SEA Vax Hub has evolved beyond its original research remit. By embedding its work within the broader regional health agenda, the hub is promoting government ownership and regional collaboration: critical steps in building stronger, more self-reliant health systems.

While progress is promising, major challenges remain. One of the most pressing is the need to develop a new generation of public health leaders across south-east Asia – people who can lead research and development, champion vaccine production and help shape policy based on local needs. These leaders will be essential for ensuring that south-east Asia becomes not just a regional health player, but a global one.

Another key challenge is regulatory. In a diverse region like south-east Asia, varying national policies can slow innovation and emergency responses^[26]. Streamlining and harmonising these systems is essential for responding quickly and effectively during future outbreaks or pandemics.

South-east Asia has the potential to become a global hub for vaccine manufacturing. The region benefits from growing scientific and industrial capacity, relative political stability and a shared interest in tackling shared health threats^[27]. It also has a strong case to lead the fight against NTDs, which continue to disproportionately affect its populations.

South-east Asia stands at a critical juncture. With strategic investment, regional leadership and cross-border collaboration, the region can protect its people, drive innovation and shape the future of global health.

The fight against NTDs is more than a public health challenge – it’s a chance for south-east Asia to lead by example and redefine its role on the world stage.

References

1. ^{^} persistent public health threat (www.who.int)
2. ^{^} mainly affect poor people (www.sciencedirect.com)
3. ^{^} received less (www.mdpi.com)
4. ^{^} over a billion people (unitingtocombatntds.org)
5. ^{^} disproportionately affect (pmc.ncbi.nlm.nih.gov)
6. ^{^} cycles of poverty (pmc.ncbi.nlm.nih.gov)
7. ^{^} experience far lower rates (www.ncbi.nlm.nih.gov)
8. ^{^} cost-effective interventions (pmc.ncbi.nlm.nih.gov)
9. ^{^} World Health Organization (iris.who.int)
10. ^{^} no vaccines for most NTD (pmc.ncbi.nlm.nih.gov)
11. ^{^} rose by 46% (www.who.int)
12. ^{^} most affected globally (www.sciencedirect.com)
13. ^{^} more than half (travelhealthpro.org.uk)
14. ^{^} overlap with other illnesses (pmc.ncbi.nlm.nih.gov)
15. ^{^} chikungunya (travelhealthpro.org.uk)
16. ^{^} no specific antiviral treatment exists (www.mdpi.com)
17. ^{^} limited by strict eligibility criteria (www.statnews.com)
18. ^{^} people without protection (pmc.ncbi.nlm.nih.gov)
19. ^{^} an integrated strategy (iris.who.int)
20. ^{^} spread of diseases like dengue (www.cdc.gov)
21. ^{^} need to control the insects (www.ncbi.nlm.nih.gov)
22. ^{^} and philanthropic foundations (www.thinkglobalhealth.org)
23. ^{^} no longer sustainable (d2nhv1us8wflpq.cloudfront.net)
24. ^{^} a shift in mindset (pmc.ncbi.nlm.nih.gov)
25. ^{^} as innovators (gh.bmj.com)
26. ^{^} and emergency responses (www.sciencedirect.com)
27. ^{^} shared interest in tackling shared health threats (iris.who.int)