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  <front>
    <journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><!--===== Grouping journal title elements =====--><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="epub">1935-2735</issn><publisher>
        <publisher-name>Public Library of Science</publisher-name>
        <publisher-loc>San Francisco, USA</publisher-loc>
      </publisher></journal-meta>
    <article-meta><article-id pub-id-type="publisher-id">PNTD-D-10-00008</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0001132</article-id><article-categories>
        <subj-group subj-group-type="heading">
          <subject>Editorial</subject>
        </subj-group>
        <subj-group subj-group-type="Discipline-v2">
          <subject>Medicine</subject>
          <subj-group>
            <subject>Infectious diseases</subject>
            <subj-group>
              <subject>Neglected tropical diseases</subject>
              <subj-group>
                <subject>Ascariasis</subject>
                <subject>Chagas disease</subject>
                <subject>Hookworm</subject>
                <subject>Lymphatic filariasis</subject>
                <subject>Onchocerciasis</subject>
                <subject>Schistosomiasis</subject>
                <subject>Soil-transmitted helminths</subject>
                <subject>Trichuriasis</subject>
              </subj-group>
            </subj-group>
            <subj-group>
              <subject>Parasitic diseases</subject>
              <subj-group>
                <subject>Ascariasis</subject>
                <subject>Chagas disease</subject>
                <subject>Hookworm infection</subject>
                <subject>Hookworm</subject>
                <subject>Lymphatic filariasis</subject>
                <subject>Onchocerciasis</subject>
                <subject>Schistosomiasis</subject>
                <subject>Soil-transmitted helminths</subject>
                <subject>Trichuriasis</subject>
              </subj-group>
            </subj-group>
          </subj-group>
        </subj-group>
        <subj-group subj-group-type="Discipline-v2">
          <subject>Social and behavioral sciences</subject>
          <subj-group>
            <subject>Sociology</subject>
            <subj-group>
              <subject>Religion</subject>
            </subj-group>
          </subj-group>
        </subj-group>
        <subj-group subj-group-type="Discipline">
          <subject>Infectious Diseases</subject>
        </subj-group>
      </article-categories><title-group><article-title>Neglected Tropical Diseases in the Catholic World</article-title><alt-title alt-title-type="running-head">.</alt-title></title-group><contrib-group>
        <contrib contrib-type="author" xlink:type="simple">
          <name name-style="western">
            <surname>Hotez</surname>
            <given-names>Peter J.</given-names>
          </name>
          <xref ref-type="aff" rid="aff1">
                        <sup>1</sup>
                    </xref>
          <xref ref-type="aff" rid="aff2">
                        <sup>2</sup>
                    </xref>
          <xref ref-type="corresp" rid="cor1">
                        <sup>*</sup>
                    </xref>
        </contrib>
      </contrib-group><aff id="aff1">
                <label>1</label>
                <addr-line>Sabin Vaccine Institute, Washington, D.C., United States of
                    America</addr-line>
            </aff><aff id="aff2">
                <label>2</label>
                <addr-line>Department of Microbiology, Immunology, and Tropical Medicine, George
                    Washington University Medical Center, Washington, D.C., United States of
                    America</addr-line>
            </aff><author-notes>
        <corresp id="cor1">* E-mail: <email xlink:type="simple">Photez@gwu.edu</email> or <email xlink:type="simple">peter.hotez@sabin.org</email></corresp>
        <fn fn-type="other">
          <p>Peter J. Hotez, MD, PhD, is Distinguished Research Professor, the Walter G.
                        Ross Professor and Chair of the Department of Microbiology, Immunology, and
                        Tropical Medicine, The George Washington University, and President of the
                        Sabin Vaccine Institute.</p>
        </fn>
      <fn fn-type="conflict">
        <p>PJH is a co-founder of the Global Network for Neglected Tropical Diseases. He is
                    an inventor on U.S. Patent 7,303,752 B2 (issued December 4, 2007) entitled
                    "Hookworm vaccine".</p>
      </fn></author-notes><pub-date pub-type="collection">
        <month>4</month>
        <year>2011</year>
      </pub-date><pub-date pub-type="epub">
        <day>26</day>
        <month>4</month>
        <year>2011</year>
      </pub-date><volume>5</volume><issue>4</issue><elocation-id>e1132</elocation-id><!--===== Grouping copyright info into permissions =====--><permissions><copyright-year>2011</copyright-year><copyright-holder>Peter J. Hotez</copyright-holder><license><license-p>This is an open-access article distributed under
                the terms of the Creative Commons Attribution License, which permits unrestricted
                use, distribution, and reproduction in any medium, provided the original author and
                source are credited.</license-p></license></permissions><funding-group><funding-statement>The author received no specific funding for this work.</funding-statement></funding-group><counts>
        <page-count count="3"/>
      </counts></article-meta>
  </front>
  <body>
    <sec id="s1">
      <title/>
      <p>
                <italic>Roughly one-quarter of the world's most common neglected tropical
                    diseases and almost all of the cases of Chagas disease occur in the Catholic
                    majority countries of Africa, Asia, and Latin America. This finding highlights
                    new opportunities to lift the poorest Catholics in developing countries out of
                    poverty.</italic>
            </p>
      <p>The neglected tropical diseases (NTDs) are the most common infections of the
                world's poorest people living in developing countries. Through their impact on
                child growth and development, pregnancy outcome, and worker productivity, the NTDs
                cause a massive global disease burden and have also been shown to promote poverty
                and economic underdevelopment <xref ref-type="bibr" rid="pntd.0001132-Hotez1">[1]</xref>. In previous analyses, I have suggested that the NTDs are
                not evenly distributed throughout the developing countries of the tropics <xref ref-type="bibr" rid="pntd.0001132-Hotez2">[2]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Hotez3">[3]</xref>. Instead,
                approximately 30%–50% of the most common NTDs, such as
                intestinal helminth infections, schistosomiasis, and trachoma, occur in the nations
                that comprise the Organisation of the Islamic Conference, especially the poorest
                Islamic countries in Asia and Africa <xref ref-type="bibr" rid="pntd.0001132-Hotez2">[2]</xref>. Another 20%–30% of these high
                prevalence NTDs are found among the poorest people who live in large middle-income
                countries such as India, China, Pakistan, and Iran. Despite their huge disparities
                of income and levels of poverty, ironically, these same countries also have
                tremendous scientific prowess, including the capacity to produce and maintain
                nuclear arsenals <xref ref-type="bibr" rid="pntd.0001132-Hotez3">[3]</xref>.</p>
      <p>The next largest category of countries with a high prevalence of NTDs is countries
                with Catholic majorities. Listed in <xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref> (and shown in <xref ref-type="fig" rid="pntd-0001132-g001">Figure 1</xref>) are the nations where most of the world's 1.1 billion
                Catholics live <xref ref-type="bibr" rid="pntd.0001132-Cheney1">[4]</xref>. Only countries with Catholic majorities are included (in
                addition to Canada and Uganda, each with more than 40% of its population
                Catholic). Not included are large NTD disease-endemic nations such as India,
                Indonesia, Kenya, Nigeria, and Vietnam that contain sizeable Catholic minority
                populations. At least 5 million Catholics live in each of the 31 countries in <xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref>, and together the 818
                million Catholics living in these countries comprise three-quarters of the
                world's Catholic population. Seventeen of the countries are in the Latin
                American and Caribbean region, led by Brazil and Mexico (the most populous Catholic
                countries with 146 million and 123 million Catholics each, respectively), followed
                by the Philippines, as the only Asian country on the list (70 million), and the
                European nations of Italy and France. Four sub-Saharan African countries are listed
                in <xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref>, including the
                Democratic Republic of Congo (DRC) with 30 million Catholics, Angola and Uganda
                (10–11 million each), and Burundi (5 million).</p>
      <fig id="pntd-0001132-g001" position="float">
        <object-id pub-id-type="doi">10.1371/journal.pntd.0001132.g001</object-id>
        <label>Figure 1</label>
        <caption>
          <title>Catholic majority countries.</title>
          <p>From <xref ref-type="bibr" rid="pntd.0001132-Wikimedia1">[30]</xref>.</p>
        </caption>
        <graphic mimetype="image" position="float" xlink:href="info:doi/10.1371/journal.pntd.0001132.g001" xlink:type="simple"/>
      </fig>
      <table-wrap id="pntd-0001132-t001" position="float"><object-id pub-id-type="doi">10.1371/journal.pntd.0001132.t001</object-id><label>Table 1</label><caption>
          <title>NTDs in the Catholic World.</title>
        </caption><!--===== Grouping alternate versions of objects =====--><alternatives><graphic id="pntd-0001132-t001-1" mimetype="image" position="float" xlink:href="info:doi/10.1371/journal.pntd.0001132.t001" xlink:type="simple"/><table>
          <colgroup span="1">
            <col align="left" span="1" width="88*"/>
            <col align="center" span="1" width="57*"/>
            <col align="center" span="1" width="72*"/>
            <col align="center" span="1" width="43*"/>
            <col align="center" span="1" width="99*"/>
            <col align="center" span="1" width="79*"/>
            <col align="center" span="1" width="43*"/>
            <col align="center" span="1" width="77*"/>
            <col align="center" span="1" width="74*"/>
            <col align="center" span="1" width="250*"/>
          </colgroup>
          <thead>
            <tr>
              <td align="left" colspan="1" rowspan="1">#<xref ref-type="table-fn" rid="nt101">a</xref>, <xref ref-type="table-fn" rid="nt102">b</xref></td>
              <td align="left" colspan="1" rowspan="1">Country<xref ref-type="table-fn" rid="nt101">a</xref>,
                                    <xref ref-type="table-fn" rid="nt102">b</xref></td>
              <td align="left" colspan="1" rowspan="1">Catholics<xref ref-type="table-fn" rid="nt101">a</xref>, <xref ref-type="table-fn" rid="nt102">b</xref></td>
              <td align="left" colspan="1" rowspan="1">% Catholic<xref ref-type="table-fn" rid="nt101">a</xref>, <xref ref-type="table-fn" rid="nt102">b</xref></td>
              <td align="left" colspan="1" rowspan="1">Cases of Ascariasis<xref ref-type="table-fn" rid="nt103">c</xref></td>
              <td align="left" colspan="1" rowspan="1">Cases of Trichuriasis<xref ref-type="table-fn" rid="nt103">c</xref></td>
              <td align="left" colspan="1" rowspan="1">Cases of Hookworm<xref ref-type="table-fn" rid="nt103">c</xref></td>
              <td align="left" colspan="1" rowspan="1">Cases of Schistosomiasis<xref ref-type="table-fn" rid="nt104">d</xref></td>
              <td align="left" colspan="1" rowspan="1">LF or Oncho Transmission +/–<xref ref-type="table-fn" rid="nt105">e</xref></td>
              <td align="left" colspan="1" rowspan="1">Chagas Transmission +/−<xref ref-type="table-fn" rid="nt106">f</xref>, <xref ref-type="table-fn" rid="nt107">g</xref></td>
            </tr>
          </thead>
          <tbody>
            <tr>
              <td align="left" colspan="1" rowspan="1">1</td>
              <td align="left" colspan="1" rowspan="1">Brazil</td>
              <td align="left" colspan="1" rowspan="1">145 million</td>
              <td align="left" colspan="1" rowspan="1">79%</td>
              <td align="left" colspan="1" rowspan="1">42 million</td>
              <td align="left" colspan="1" rowspan="1">19 million</td>
              <td align="left" colspan="1" rowspan="1">32 million</td>
              <td align="left" colspan="1" rowspan="1">2–7 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">2</td>
              <td align="left" colspan="1" rowspan="1">Mexico</td>
              <td align="left" colspan="1" rowspan="1">123 million</td>
              <td align="left" colspan="1" rowspan="1">87%</td>
              <td align="left" colspan="1" rowspan="1">9 million</td>
              <td align="left" colspan="1" rowspan="1">18 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">3</td>
              <td align="left" colspan="1" rowspan="1">Philippines</td>
              <td align="left" colspan="1" rowspan="1">70 million</td>
              <td align="left" colspan="1" rowspan="1">81%</td>
              <td align="left" colspan="1" rowspan="1">41 million</td>
              <td align="left" colspan="1" rowspan="1">38 million</td>
              <td align="left" colspan="1" rowspan="1">18 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">4</td>
              <td align="left" colspan="1" rowspan="1">Italy</td>
              <td align="left" colspan="1" rowspan="1">58 million</td>
              <td align="left" colspan="1" rowspan="1">97%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">5</td>
              <td align="left" colspan="1" rowspan="1">France</td>
              <td align="left" colspan="1" rowspan="1">44 million</td>
              <td align="left" colspan="1" rowspan="1">76%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">6</td>
              <td align="left" colspan="1" rowspan="1">Colombia</td>
              <td align="left" colspan="1" rowspan="1">38 million</td>
              <td align="left" colspan="1" rowspan="1">86%</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">15 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">7</td>
              <td align="left" colspan="1" rowspan="1">Spain</td>
              <td align="left" colspan="1" rowspan="1">37 million</td>
              <td align="left" colspan="1" rowspan="1">88%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">8</td>
              <td align="left" colspan="1" rowspan="1">Poland</td>
              <td align="left" colspan="1" rowspan="1">35 million</td>
              <td align="left" colspan="1" rowspan="1">94%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">9</td>
              <td align="left" colspan="1" rowspan="1">Argentina</td>
              <td align="left" colspan="1" rowspan="1">34 million</td>
              <td align="left" colspan="1" rowspan="1">89%</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">2 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">10</td>
              <td align="left" colspan="1" rowspan="1">DRC</td>
              <td align="left" colspan="1" rowspan="1">30 million</td>
              <td align="left" colspan="1" rowspan="1">50%</td>
              <td align="left" colspan="1" rowspan="1">23 million</td>
              <td align="left" colspan="1" rowspan="1">26 million</td>
              <td align="left" colspan="1" rowspan="1">31 million</td>
              <td align="left" colspan="1" rowspan="1">15 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">11</td>
              <td align="left" colspan="1" rowspan="1">Peru</td>
              <td align="left" colspan="1" rowspan="1">28 million</td>
              <td align="left" colspan="1" rowspan="1">88%</td>
              <td align="left" colspan="1" rowspan="1">7 million</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">1.5 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">12</td>
              <td align="left" colspan="1" rowspan="1">Venezuela</td>
              <td align="left" colspan="1" rowspan="1">25 million</td>
              <td align="left" colspan="1" rowspan="1">88%</td>
              <td align="left" colspan="1" rowspan="1">7 million</td>
              <td align="left" colspan="1" rowspan="1">9 million</td>
              <td align="left" colspan="1" rowspan="1">1.5 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">13</td>
              <td align="left" colspan="1" rowspan="1">Canada</td>
              <td align="left" colspan="1" rowspan="1">13 million</td>
              <td align="left" colspan="1" rowspan="1">44%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">14</td>
              <td align="left" colspan="1" rowspan="1">Ecuador</td>
              <td align="left" colspan="1" rowspan="1">12 million</td>
              <td align="left" colspan="1" rowspan="1">90%</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">2 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">15</td>
              <td align="left" colspan="1" rowspan="1">Uganda</td>
              <td align="left" colspan="1" rowspan="1">11 million</td>
              <td align="left" colspan="1" rowspan="1">42%</td>
              <td align="left" colspan="1" rowspan="1">4 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">9 million</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">16</td>
              <td align="left" colspan="1" rowspan="1">Chile</td>
              <td align="left" colspan="1" rowspan="1">11 million</td>
              <td align="left" colspan="1" rowspan="1">71%</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">17</td>
              <td align="left" colspan="1" rowspan="1">Guatemala</td>
              <td align="left" colspan="1" rowspan="1">10 million</td>
              <td align="left" colspan="1" rowspan="1">77%</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">9 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">18</td>
              <td align="left" colspan="1" rowspan="1">Angola</td>
              <td align="left" colspan="1" rowspan="1">10 million</td>
              <td align="left" colspan="1" rowspan="1">50%</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">11 million</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">−</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">19</td>
              <td align="left" colspan="1" rowspan="1">Portugal</td>
              <td align="left" colspan="1" rowspan="1">9 million</td>
              <td align="left" colspan="1" rowspan="1">90%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">20</td>
              <td align="left" colspan="1" rowspan="1">Bolivia</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">85%</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">21</td>
              <td align="left" colspan="1" rowspan="1">Dom. Rep.</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">86%</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">22</td>
              <td align="left" colspan="1" rowspan="1">Belgium</td>
              <td align="left" colspan="1" rowspan="1">8 million</td>
              <td align="left" colspan="1" rowspan="1">76%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">23</td>
              <td align="left" colspan="1" rowspan="1">Haiti</td>
              <td align="left" colspan="1" rowspan="1">7 million</td>
              <td align="left" colspan="1" rowspan="1">65%</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">4 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">24</td>
              <td align="left" colspan="1" rowspan="1">Cuba</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">50%</td>
              <td align="left" colspan="1" rowspan="1">&lt;1million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">25</td>
              <td align="left" colspan="1" rowspan="1">Hungary</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">58%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">26</td>
              <td align="left" colspan="1" rowspan="1">Honduras</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">79%</td>
              <td align="left" colspan="1" rowspan="1">2 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">27</td>
              <td align="left" colspan="1" rowspan="1">Austria</td>
              <td align="left" colspan="1" rowspan="1">6 million</td>
              <td align="left" colspan="1" rowspan="1">72%</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">28</td>
              <td align="left" colspan="1" rowspan="1">El Salvador</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">76%</td>
              <td align="left" colspan="1" rowspan="1">2 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">29</td>
              <td align="left" colspan="1" rowspan="1">Paraguay</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">92%</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">3 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">30</td>
              <td align="left" colspan="1" rowspan="1">Nicaragua</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">82%</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">&lt;1 million</td>
              <td align="left" colspan="1" rowspan="1">—</td>
              <td align="left" colspan="1" rowspan="1">−</td>
              <td align="left" colspan="1" rowspan="1">+</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1">31</td>
              <td align="left" colspan="1" rowspan="1">Burundi</td>
              <td align="left" colspan="1" rowspan="1">5 million</td>
              <td align="left" colspan="1" rowspan="1">65%</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">2 million</td>
              <td align="left" colspan="1" rowspan="1">1 million</td>
              <td align="left" colspan="1" rowspan="1">+</td>
              <td align="left" colspan="1" rowspan="1">—</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">Totals for Catholic countries</td>
              <td align="left" colspan="1" rowspan="1">818 million</td>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">176 million</td>
              <td align="left" colspan="1" rowspan="1">168 million</td>
              <td align="left" colspan="1" rowspan="1">123 million</td>
              <td align="left" colspan="1" rowspan="1">29–34 million</td>
              <td align="left" colspan="1" rowspan="1">13/31</td>
              <td align="left" colspan="1" rowspan="1">14/31</td>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">Worldwide</td>
              <td align="left" colspan="1" rowspan="1">6.87 billion<xref ref-type="table-fn" rid="nt107">g</xref></td>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">807 million</td>
              <td align="left" colspan="1" rowspan="1">604 million</td>
              <td align="left" colspan="1" rowspan="1">576 million</td>
              <td align="left" colspan="1" rowspan="1">207 million</td>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1"/>
            </tr>
            <tr>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">Catholics</td>
              <td align="left" colspan="1" rowspan="1">12%</td>
              <td align="left" colspan="1" rowspan="1"/>
              <td align="left" colspan="1" rowspan="1">22%</td>
              <td align="left" colspan="1" rowspan="1">28%</td>
              <td align="left" colspan="1" rowspan="1">21%</td>
              <td align="left" colspan="1" rowspan="1">14%–16%</td>
              <td align="left" colspan="1" rowspan="1">ND</td>
              <td align="left" colspan="1" rowspan="1">100%</td>
            </tr>
          </tbody>
        </table></alternatives><table-wrap-foot>
          <fn id="nt101">
            <label>a</label>
            <p>Catholic populations by country from <ext-link ext-link-type="uri" xlink:href="http://www.catholic-hierarchy.org/country/sc1.html" xlink:type="simple">http://www.catholic-hierarchy.org/country/sc1.html</ext-link>
                            <xref ref-type="bibr" rid="pntd.0001132-Cheney1">[4]</xref>.</p>
          </fn>
          <fn id="nt102">
            <label>b</label>
            <p>Only the top 31 Catholic countries with more than 5 million Catholics and
                            countries in which at least 50% of the population is Catholic are
                            included (as well as Canada and Uganda, each with more than 40%
                            Catholic population), which excludes India, Indonesia, Kenya, Nigeria,
                            and Vietnam.</p>
          </fn>
          <fn id="nt103">
            <label>c</label>
            <p>From <xref ref-type="bibr" rid="pntd.0001132-Bethony1">[6]</xref>, <xref ref-type="bibr" rid="pntd.0001132-deSilva1">[7]</xref>.</p>
          </fn>
          <fn id="nt104">
            <label>d</label>
            <p>From <xref ref-type="bibr" rid="pntd.0001132-Steinmann1">[8]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Chitsulo1">[9]</xref>.</p>
          </fn>
          <fn id="nt105">
            <label>e</label>
            <p>From <xref ref-type="bibr" rid="pntd.0001132-Global1">[10]</xref>, <xref ref-type="bibr" rid="pntd.0001132-African1">[11]</xref>.</p>
          </fn>
          <fn id="nt106">
            <label>f</label>
            <p>Chagas disease is found in every South American and Central American
                            country listed <xref ref-type="bibr" rid="pntd.0001132-Hotez4">[5]</xref>.</p>
          </fn>
          <fn id="nt107">
            <label>g</label>
            <p>From <xref ref-type="bibr" rid="pntd.0001132-US1">[31]</xref>.</p>
          </fn>
        </table-wrap-foot></table-wrap>
      <p>While none of the eight European countries (or Canada) in <xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref> suffer from widespread NTDs, all of the
                Latin American nations listed, as well as the African Catholic countries and the
                Philippines, are highly endemic for such conditions. Together, these 22 nations
                comprise a significant percentage of the world's NTDs (<xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref>), including almost 100% of the
                Chagas cases, which are found overwhelmingly in Latin America <xref ref-type="bibr" rid="pntd.0001132-Hotez4">[5]</xref>, and 21%–27%
                of the world's intestinal helminth infections, led by Brazil in Latin America,
                the Philippines in Asia, and DRC in sub-Saharan Africa <xref ref-type="bibr" rid="pntd.0001132-Bethony1">[6]</xref>, <xref ref-type="bibr" rid="pntd.0001132-deSilva1">[7]</xref>. The 22 most populous
                NTD-endemic Catholic countries also account for 14%–16% of the
                world's 207 million cases of schistosomiasis <xref ref-type="bibr" rid="pntd.0001132-Steinmann1">[8]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Chitsulo1">[9]</xref>, and lymphatic filariasis
                (LF), onchocerciasis, or both of these infections are transmitted in 13 of the 22
                nations <xref ref-type="bibr" rid="pntd.0001132-Global1">[10]</xref>,
                    <xref ref-type="bibr" rid="pntd.0001132-African1">[11]</xref>.</p>
      <p>A critical policy implication of these findings is that the major Catholic charities
                and perhaps even the Catholic Church has a unique opportunity to promote NTD control
                in several of the 22 most endemic Catholic majority countries. Today, several
                Catholic charities are making significant contributions to global public health,
                including efforts to promote “deworming”, i.e., mass drug administration
                for human intestinal helminth infections. Catholic Relief Services has assisted poor
                and vulnerable populations for over 60 years <xref ref-type="bibr" rid="pntd.0001132-Hackett1">[12]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Hennigan1">[13]</xref>, with specific efforts to
                provide deworming treatments for school-aged children in Benin <xref ref-type="bibr" rid="pntd.0001132-Catholic1">[14]</xref>, Ghana <xref ref-type="bibr" rid="pntd.0001132-Catholic2">[15]</xref>, and presumably elsewhere in
                over 30 African countries where they work <xref ref-type="bibr" rid="pntd.0001132-Catholic3">[16]</xref>, while also operating
                community health programs in 26 countries that serve 3.5 million people <xref ref-type="bibr" rid="pntd.0001132-Catholic4">[17]</xref>. Similarly,
                the Catholic Medical Mission Board, which was founded in 1928 by Dr. Paluel Flagg
                after a visit to Haiti to help leprosy patients, has provided support to health care
                programs in developing countries since 1966 and today distributes hundreds of
                millions of dollars worth of medicines annually <xref ref-type="bibr" rid="pntd.0001132-Catholic5">[18]</xref>. Many local archdioceses,
                including the Roman Catholic Archdiocese of Manila through its Caritas Manila
                program, for example, also provide deworming treatments <xref ref-type="bibr" rid="pntd.0001132-Archdiocese1">[19]</xref>. Of interest is the
                finding that many Catholic organizations operate in countries both with and without
                Catholic majority populations, recognizing health as a fundamental right for people
                of all denominations <xref ref-type="bibr" rid="pntd.0001132-Catholic3">[16]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Catholic4">[17]</xref>.</p>
      <p>The important work of the major Catholic charities and the Church could ultimately be
                expanded to support national programs of NTD control and elimination. Currently, the
                United States Agency for International Development (USAID) is supporting integrated
                control of the seven most common NTDs through low-cost packages of essential
                medicines in 14 countries including four of the 22 listed in <xref ref-type="table" rid="pntd-0001132-t001">Table 1</xref>, i.e., DRC, Haiti, the Philippines, and
                Uganda <xref ref-type="bibr" rid="pntd.0001132-USAID1">[20]</xref>, while
                the British Department for International Development (DFID) is also supporting
                additional African countries <xref ref-type="bibr" rid="pntd.0001132-Crompton1">[21]</xref>; both agencies are planning to expand their NTD control
                activities in the coming years. Additional countries, including Burundi, are being
                supported through Legatum, Geneva Global, and the Global Network for NTDs <xref ref-type="bibr" rid="pntd.0001132-The1">[22]</xref>.</p>
      <p>In an earlier Editorial, I pointed out that it is unreasonable to expect the United
                States and the United Kingdom to shoulder the entire burden of global NTD control
                and that we must look to other European countries, the Gulf Cooperation Council, and
                even some emerging economies for development assistance on this front <xref ref-type="bibr" rid="pntd.0001132-Hotez5">[23]</xref>. But, in
                addition, the major Catholic charities and the Catholic Church could re-organize
                some of their advocacy and resource mobilization programs to combat NTDs among the
                world's poorest Catholics, including national control programs in the 17
                countries not currently supported by USAID, DFID, or the Global Network for NTDs.
                Efforts could include partnerships with the major Catholic majority endemic
                countries in Latin America, Africa, and the Philippines. Through mass administration
                with a package of preventive chemotherapy drugs costing as little as US$0.50
                annually <xref ref-type="bibr" rid="pntd.0001132-Hotez6">[24]</xref>,
                    <xref ref-type="bibr" rid="pntd.0001132-Hotez7">[25]</xref>, such
                global action could directly benefit the 100–200 million Catholics suffering
                today from intestinal helminth infections, the roughly 30 million with
                schistosomiasis, and tens of millions with LF and/or onchocerciasis. Today, the
                so-called rapid impact packages of NTD control medicines are considered among the
                lowest cost interventions in all of global health, and one of the most
                cost-effective <xref ref-type="bibr" rid="pntd.0001132-Hotez1">[1]</xref>,
                    <xref ref-type="bibr" rid="pntd.0001132-Hotez7">[25]</xref>.
                Partnerships with the Catholic Church or charities could also help to reduce the
                global disease burden of Chagas disease, which, because it is found almost
                exclusively found in the countries of Latin America, is largely a disease of
                Catholics, as well as selected indigenous groups <xref ref-type="bibr" rid="pntd.0001132-Hotez4">[5]</xref>.</p>
      <p>The Catholic Church has also supported scientific research and development in
                tropical medicine, beginning with the origin of the antimalarial drug, quinine, from
                “Jesuit's bark” or “Jesuit's powder” <xref ref-type="bibr" rid="pntd.0001132-Knight1">[26]</xref>, <xref ref-type="bibr" rid="pntd.0001132-Harris1">[27]</xref>. Today, Rev.
                Thomas Streit, CSC, from the University of Notre Dame, is leading efforts to
                eliminate LF through mass drug administration in Haiti <xref ref-type="bibr" rid="pntd.0001132-Streit1">[28]</xref>. Science-based institutions
                such as the Pontifical Academy of Sciences founded by Pope Pius XI in the 1930s
                    <xref ref-type="bibr" rid="pntd.0001132-Vatican1">[29]</xref> could
                also provide important guidance for NTD research and new product development.</p>
      <p>Expanded global public health efforts through programs of national control,
                stepped-up advocacy, and resource mobilization efforts by the major Catholic
                charities, nongovernmental development organizations affiliated with the Church, and
                of course the Holy See, could ultimately lead to reductions of one-quarter of the
                world's intestinal helminth infections, 15% of the world's
                schistosomiasis, and much of the world's Chagas disease. At a modest cost of
                between US$50 and US$100 million annually, such global action would
                establish an amazing legacy for health and economic development by and for the
                global Catholic community.</p>
    </sec>
  </body>
  <back>
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