Epidemiology and Economics of Deworming

Global access to deworming is one of the public health success stories of the twenty-first century and was the key catalyst for creating the neglected tropical disease (NTD) agenda. Human worm infections appear to have been with us since the domestication of household animals, some 10,500 years ago, and putative treatments are known from the earliest pharmacopoeias, but it has only been in the last 100 years that we have sought a public health solution and only in the last 5 years that real success at scale has been achieved. This is a success that depends on donated drugs and targeted treatment campaigns outside of the traditional health system. In this chapter, we explore the scientific foundations for this success and explore what this implies for the future management of soil-transmitted helminths (STHs) by health systems. This chapter describes the evolution of public health approaches to reduce the prevalence and morbidity of STH and the evidence of impact of mass drug administration on their target populations, and provides context for the debate that has surrounded these results. This chapter also details the costs of delivering these interventions as well as how future delivery approaches can align with Universal Health Care objectives.