It has been about a year since the US, traditionally the largest donor to global health initiatives, ended funding for thousands of programmes aimed at fighting infectious diseases and providing vaccines and essential care across low-income countries, including those in Africa.

The impact of the pullback on more visible scourges – the likes of HIV/Aids and TB – has been well documented, but something of a blind spot is observable in the popular media around the so-called biblical diseases – long-standing infections that once killed at scale before modern medicine and global immunisation efforts.

Examples are what healthcare workers call neglected tropical diseases (NTDs), such as river blindness, elephantiasis, schistosomiasis (commonly known as bilharzia or snail fever), and soil-transmitted worms – which cause chronic disability, stigma and economic hardship. The World Health Organisation (WHO) has identified 21 NTDs, 20 of which are found in Africa. The continent carries about 40% of the worldwide burden – with about 500-million people afflicted.

The term ‘biblical diseases’ is not used literally but to convey the gravity of the possible situation – the return of what feel like remnants of a pre-modern era if health systems continue to lose support.

According to the WHO, as of May last year, 56 countries – 24 in Africa – had successfully eliminated at least one NTD, demonstrating significant progress towards its target of 100 countries reaching elimination by 2030.

A notable African milestone in 2025 was Niger achieving WHO certification for eliminating river blindness – the second-leading cause of blindness after glaucoma – making it the fifth country globally and the first in Africa to do so. This marks the country’s second major success in tackling NTDs, having been certified Guinea worm-free in 2013.

Chad, Guinea and Mauritius also eliminated at least one NTD in the last few years, joining Togo, which has eliminated four, and Benin and Ghana, which have eliminated three each.

African countries’ progress shows strong political support from the African Union Common African Position and Continental Framework on the Control and Elimination of NTDs and the WHO NTD Roadmap.

But the dismantling of US official assistance for global health under Trump 2.0 threatens to jeopardise the success of 19 years of investment in the global effort to eliminate NTDs, according to the WHO.

Early reports indicate that the immediate impact of the withdrawal has delayed 47 campaigns involving mass treatment to free 143-million people from the burden of NTDs.

The US is not the only major overseas funder that has become tight-fisted in recent years. According to WHO data, official development assistance for NTDs fell by about 41% between 2018 and 2023.

This decline comes despite the economic case for investing in NTD elimination efforts – every dollar invested in preventive chemotherapy yields an estimated return of about $25. Without renewed action, NTDs will continue to drain more lives and livelihoods, costing affected families and communities an estimated $33-billion each year in lost wages and out-of-pocket expenses.

The human cost, however, extends beyond such economic calculations. Children unable to attend school because of debilitating infections fall behind academically, while adults are often forced to abandon work, trapping families in cycles of poverty.

Health experts argue that the solution lies not just in restoring funding, but in strengthening local health systems, training community health workers and integrating NTD prevention with other public health initiatives. For example, combining mass drug administration campaigns with vaccination drives, clean water initiatives, and education programmes can create sustainable improvements.

As the world confronts new infectious disease threats, the fight against NTDs serves as a reminder that progress can be fragile. The achievements in Africa demonstrate that elimination is possible, but only with sustained investment, political will, and community engagement. Losing momentum now risks not just reversing health gains, but undermining decades of knowledge and infrastructure built in some of the most vulnerable regions of the globe.

NTDs may not make headlines like pandemics or high-profile outbreaks, but their consequences are no less devastating. Without renewed attention and resources, the biblical diseases that modern medicine had once nearly banished could quietly re-emerge, leaving millions once again to bear the weight of preventable suffering.