Moving From Outsider to Insider Status Through Metrics: The Inclusion of “Neglected Tropical Diseases” Into the Sustainable Development Goals

“Neglected Tropical Diseases” (NTDs) are lesser-known diseases, existing in the poorest communities in the shadow of the high-profile and well-funded “Big Three” (HIV/AIDS, tuberculosis and malaria). Blame for neglect is pointed towards protagonists, which include pharmaceutical companies, for not investing in diseases of poverty and donor governments and NGOs, for directing attention to high mortality diseases. Yet, other sites of neglect tend to be ignored, such as global governance priorities. Exclusion of NTDs from the Millennium Development Goals (MDG) in 2000 started the ball rolling for an advocacy campaign to raise these diseases higher up the global health agenda. The MDG omission was used as a frame by advocates to highlight neglect and led to inclusion in the Sustainable Development Goals (SDGs). The SDGs, set out in 2015, now include NTDs alongside HIV/AIDS, tuberculosis, malaria, hepatitis, water-borne diseases and other communicable diseases in a goal to end epidemics by 2030. However, reframing based on a concept of neglect was not sufficient to ensure a place at the top of global health priorities. The NTD problem also needed to be made measurable, with metrics set in evidence-based logic, to provide a rationale for intervention and track progress towards quantifiable success.