In his inauguration speech, President Barack Obama had both a warning for and an offer to countries that are hostile to the U.S.

"We will not apologize for our way of life, nor will we waver in its defense," he said. But even to those countries that are currently enemies, "we will extend a hand if you are willing to unclench your fist."

At a meeting of the Center for Strategic & International Studies in Washington, and in an editorial published in PLoS Neglected Tropical Diseases, Tommy Thompson and Peter Hotez made a joint pitch for how to get hostile countries to unclench their fist: through medical diplomacy, in particular a commitment by the U.S. to contribute to eradicating the neglected tropical diseases that bedevil the developing world.

Neglected tropical diseases are a group of roughly a dozen diseases, caused mainly be parasitic worms, that affect almost exclusively the poorest billion people in the world.

In contrast to the so-called "Big Three" diseases – HIV/AIDS, malaria and tuberculosis – neglected tropical diseases do not kill their victims. But "when you look at them in terms of disability – not so much in terms of death but in terms of ability to ruin lives ... these neglected tropical diseases in the aggregate are as important" as the Big Three, Hotez said.

And treating them is dirt cheap. A four-drug cocktail that treats seven neglected tropical diseases costs 50 cents per person. Per year.

Of course, Thompson acknowledged, even that much money is hard to come by during the current downturn, which has governments and philanthropic foundations alike scrambling to cover more people with more needs for less money. "Nobody knows what's going to happen with this recession and downturn – it's serious. And we all know that," Thompson said.

"But I can make a very valid argument, and will to anybody that will listen, that this is not the place to cut. This is the place to expand. It's cheaper, and it's a long-term investment in the future of our country and the world. And that to me is worth the expenditures seven days a week."

And, Hotez added, the cost is trivial compared to military expenditures on the part of the U.S. that such countries might otherwise necessitate. For several reasons, neglected tropical diseases are an insidious but no less powerful destabilizing force in impoverished nations.

Because they stunt both growth and cognitive abilities, they take away the future of those they infect. Chronic hookworm infection, Hotez said, reduces earnings potential by almost half.

Such dismal prospects, in turn, further destabilize the already-unstable nations that are home to the poorest of the poor. Countries with high rates of neglected tropical disease are "country hotspots that Secretary of State Hillary Clinton will be concerned about in the coming administration," Hotez said. "Angola, Central African Republic, [Democratic Republic of Congo,] Somalia, Iran, Burma, Cambodia, North Korea, Columbia, Haiti – one of the things they share is that they have the highest rates of neglected tropical diseases."

In their paper, Hotez and Thompson point out that "poverty breeds political instability, and some of the most troubled regions on our planet are disproportionately represented by nations with large numbers of people who live on less than $1 per day. It has been observed that most of the people living in the societies of the "bottom billion" ... are either currently engaged in a civil war or have recently been through one, and today civil war breaks out almost exclusively in low-income countries."

And compared to the costs of possibly needing to intervene in a civil war, that drug cocktail seems even cheaper. "For the cost of two F-18s we could take on the neglected tropical diseases in all the conflict countries in Africa," Hotez said. "The add-on cost is trivial" compared to the impact; "for an extra 5% – for an extra 2% – you can double your impact."

Spending money on medical diplomacy also would be more in line with the Obama administration's stated goal of improving relationships with hostile countries, rather than threatening them with force.

"I think President Obama wants to get away from the militaristic type of things, and what better place to do something new?" Thompson said. "It's like the Marshall plan all over again."

Medical diplomacy initiatives, the duo argued in their talk, have been successful before. Hotez cited the case of oral polio vaccine. "Very few people are aware of it," he said, "but the oral polio vaccine ... was developed jointly by the Americans and the Soviets at the height of the cold war."

Because the Soviet Union was having massive polio outbreaks in the 1950s, Soviet scientists came to Cincinnati to work on the vaccine with Albert Sabin. Sabin's live weakened vaccine was tested on tens of millions of Soviet children before being licensed in the U.S. It remained the standard polio vaccine for several decades, although today Jonas Salk's vaccine, which is based on killed virus, is more commonly used in the U.S.

Hotez said that in addition to donation of medicines, such international collaborations are another potential avenue to improve relations between countries. "We are also very interested in looking at the possibilities to see how we can apply that model today to some of the countries that we may not have the very best of diplomatic relationships with."

In a similar vein, Thompson argued that "the strongest part of [former president Bush's] legacy is going to be what he did in medical diplomacy."

The Bush medical diplomacy initiative, Pepfar, or the President's Emergency Plan for AIDS Relief, Thompson said, brought with it a sea change in Africans' attitudes and beliefs abut the developed world. "For the first time, the continent of Africa really felt that the United States and Europe really cared about the plight of people in Africa. It was a whole different concept, a belief that people really cared about what was taking place in Africa," Thompson said.

And that, in turn, has improved their view of the U.S. "Seven of the 10 countries that value America the most are from Africa," Thompson added. "And you know why? It's [the] Pepfar program, it's the [former president Bill Clinton's] global fund, it's medical diplomacy."

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