Nuclear weapons and neglected diseases: the "ten-thousand-to-one gap".

Together, the world's eight acknowledged nuclear powers—the United States (US), Russia, United Kingdom (UK), France, China, India, Pakistan, and the Democratic People's Republic of Korea (North Korea)—have amassed an arsenal of almost 30,000 nuclear weapons since 1945. In addition, Israel is believed to be a nuclear power while Iran (and possibly Syria as well) is also suspected of developing nuclear weapons. Despite the technological sophistication that has enabled the 11 nuclear weapons states to produce and deliver nuclear bombs, most of these nations simultaneously also suffer from high internal rates of poverty and endemic neglected diseases. They include high prevalence rates of neglected tropical diseases in India, China, Pakistan, Iran, and Syria, and related neglected infections of poverty in the US and Europe. Indeed, the 11 nuclear weapons states together account for up to one-half of the global disease burden from all neglected diseases. However, for a tiny fraction (less than 1/10,000th) of the costs of producing and maintaining a nuclear arsenal the 11 nuclear powers could eliminate most of their neglected diseases and engage in joint neglected disease research and development efforts that help to reduce international tensions and promote world peace. Shown in Table 1 and Figure 1 are the 11 established and suspected global nuclear powers. Following the development and deployment of the atomic bomb by the US in 1945 (at an estimated cost of US$20 billion), Russia became the second nuclear power in 1949, and in every decade since then at least one new country has joined the nuclear club [1], [2]. In addition three countries, South Africa, Argentina, and Brazil, began active nuclear weapons programs, but subsequently abandoned them by mutual treaty [1]. Today, only the first five nations to produce nuclear weapons,,the US, Russia, UK, France, and China, have signed the nuclear nonproliferation treaty [1]. The costs to maintain these nuclear arsenals are staggering. According to the Brookings Institution, which in 1998 published their US Nuclear Weapons Cost Study Project, the US alone spent $35 billion that year on nuclear weapons technology [2]. Further estimates indicate that the US may have spent more than $5.5 trillion in developing their nuclear arsenal, while France has invested approximately $1.5 trillion [3]. Although the data are unavailable, the costs for other nuclear weapon states are believed to be similar [3]. Therefore it is likely that the 11 nuclear weapons states together have invested at least $10 trillion on weapons production and maintenance. Figure 1 Map of countries with nuclear weapons. Table 1 Estimated number of nuclear weapons by Country, 1945–2008. Despite this massive expenditure, each of the 11 nuclear weapons states, with the possible exception of the U.K., also suffers from high rates of neglected tropical diseases (and related neglected infections of poverty), defined as chronic and debilitating parasitic and other infectious diseases that occur in association with extreme poverty [4]. In addition to their health effects, the neglected tropical diseases also cause poverty through their ability to impair child physical and intellectual development, pregnancy outcomes, and worker productivity, while simultaneously promoting conflict and war through their agriculturally and socially destabilizing effects [4], [5]. Although it is common to think of neglected diseases as confined to low-income countries in sub-Saharan Africa, Southeast Asia, and Latin America, as shown in Table 2 these infections also exhibit a high prevalence in middle-income countries such as China, India, Pakistan, North Korea, Iran, and Syria, as well as in selected areas of poverty found in the US, Russia, and Eastern Europe [6]. Indeed, with the possible exceptions of the UK, high neglected disease burdens are present in all of the nuclear weapons states, particularly the helminth infections, leishmaniasis and Chagas disease, toxoplasmosis, and trachoma. Table 2 The major neglected tropical diseases or neglected infection of poverty endemic to countries with nuclear weapons. Helminthic Neglected Infections The four major soil-transmitted helminth infections of humans include ascariasis (roundworm), trichuriasis (whipworm), hookworm infection, and strongyloidiasis (threadworm) [7]. These intestinal worm infections represent the most common neglected tropical diseases of humans living in poverty [7], [8]. Of the estimated 800 million ascariasis infections found predominantly in low- and middle-income countries [7], approximately one-third of the cases occur in nuclear weapons states including India (140 million), China (86 million), North Korea (8 million), Pakistan (7 million), and Iran (5 million) [8], [9]. These nations also account for 20% of the world's cases of hookworm infection, which is associated with anemia and extreme poverty resulting from impairments in child development and cognition, maternal morbidity during pregnancy, and diminished agricultural worker productivity [4], [7], [8], [9]. Trichuriasis and strongyloidiasis are endemic to these countries as well, and the US and France have pockets of endemic strongyloidiasis in, respectively, Appalachia and in Region Midi-Pyrenees in the Southwest [10], [11]. In the US and elsewhere, toxocariasis is a soil-transmitted helminth zoonosis associated with larval migrans syndromes, asthma, and developmental delays in up to 3 million African Americans living in poverty [10]. India accounts for roughly one-quarter of the world's 120 million cases of lymphatic filariasis, a disfiguring and stigmatizing vector-borne infection associated with elephantiasis [12], while China accounts for most of the world's food-borne trematode infections, including 13 million cases of clonorchiasis (liver fluke infection associated with liver fibrosis and bile duct cancer) and paragonimiasis (lung fluke infection associated with hemoptysis and other pulmonary disorders) [9], [13], [14]. Clonorchiasis is also endemic to North Korea [15], while a related liver fluke infection known as opisthorchiasis is highly endemic to Russia where an estimated 12.5 million people are at risk of infection, and in some parts of Siberia up to 95% of the population is infected [13], [16]. Up to 169,000 cases of cysticercosis occur among Hispanic Americans in the US [10].