In rural Alabama, and across much of the US South, a growing number of poor Americans are being faced with a difficult decision: pay for groceries or pay for medicine.
Hookworm — long thought to be eliminated across the US — and other “neglected tropical diseases” affect as many as 12 million Americans each year, but a new report from NPR’s Goats and Soda development blog found that the cures to these diseases are often sold at prices well above what poor, rural Americans can afford.
Factors for the recent rise in these diseases include increased global migration, which has allowed them to migrate northward from Latin America — where they’re still prevalent; a changing climate; and a decreasing number of doctors specialized in treating them. Often known as “diseases of poverty,” they disproportionately affect low-income residents of states like Alabama, where in some counties nearly three in four people report exposure to raw sewage and improper sanitation systems.
But even as the number of people affected by these diseases has increased, few pharmaceutical companies have patents on treatments to cure them — leading to exorbitant prices, NPR reports.
A treatment plan for hookworm runs at an average price of $400.43 in a state where more than 500,000 people don’t have medical insurance and the average yearly income in some counties is under $20,000 per year.
“People have told me they sometimes have to choose between buying medication and eating," Catherine Flowers, founder of Alabama Center for Rural Enterprise, told NPR.
It’s not just hookworm that’s placing a disproportionate financial burden on those living in poverty.
Pills to treat a tropical disease called Neurocysticercosis, which can induce epilepsy, cost $525 each. Treatments for toxoplasmosis, a parasitic disease that affects more than 1 million Americans, run between $3,000 and $3,400, according to NPR.
Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, told NPR that as many as 12 million Americans “now live in extreme poverty with a neglected tropical disease.”
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Hookworm is spread through exposure to untreated sewage, and affects more than 400 million people around the globe.
A study published in September of this year found that one out of every three residents in one Alabama county tested positive for a certain type of hookworm called Necator americanus.
Only one pharmaceutical company in the United States produces pills to treat hookworm, according to NPR.
Impax Laboratories owns the rights to the two top generic pills for treating hookworm — albendazole and mebendazole — and, having a monopoly on the market, has significantly raised prices in the past half decade.
Mebendazole cost $4.50 in 2011, according to NPR. In 2016? It retailed at $369.
"There really is no good reason for this price," Dr. Jonathan Alpern, who works for a health care company called HealthPartners Institute, said. “When there's limited competition in the market, the company that holds the monopoly is able to price [the drug] however they want. In these cases, we often see companies taking advantage of their market position."
Skyrocketing drug prices made the news in 2015, after “pharma bro” Martin Shkreli bought the rights to an AIDS drug called Daraprim and raised prices by 5,000% in one night, and in 2016, after it was revealed that the the price of EpiPens had risen by 600% in half a decade.
Although neglected tropical diseases are not as common in the US as AIDS or asthma, the New York Times has called neglected tropical diseases the “new plague of poverty” on account of its disproportionate effect on people already living in poverty, who often lack access to health care and basic infrastructure.
In a 2012 opinion piece, the Times called for more research into the prevalence of neglected tropical diseases; “better diagnostic tests”; and “safer and more effective drugs and new licensed vaccines.”
“Without new interventions, [tropical diseases] are here to stay and destined to trap people in poverty for decades to come,” the New York Times wrote.