New information reveals that the 10 nations currently producing nuclear weapons also suffer with approximately one-half of the world's disease burden from several neglected diseases, including intestinal helminth infections, dengue, and measles.

In the aftermath of World War II and the bombings of Hiroshima and Nagasaki, the Science and Security Board of the Bulletin of the Atomic Scientists established the Doomsday Clock, meant to symbolize the time we have left until global nuclear annihilation strikes at midnight \[[@pntd.0006676.ref001]\]. As of 2018, we have reached two minutes until midnight, the closest we have ever gotten since 1953 when the United States detonated its first hydrogen bomb \[[@pntd.0006676.ref001]\].

Today, the Arms Control Association identifies nine nations---United States, United Kingdom, France, Israel, Pakistan, India, Russia, China, and North Korea---hosting nuclear warhead inventories \[[@pntd.0006676.ref002]\] ([Fig 1](#pntd.0006676.g001){ref-type="fig"}). Together, these countries account for almost 15,000 nuclear warheads. In addition, while Iran cannot be considered yet to be a nuclear weapons nation, according to the Nuclear Threat Initiative (NTI), it has an advanced nuclear program, including substantial uranium enrichment capabilities \[[@pntd.0006676.ref003]\].

![2018 Estimated global nuclear warhead inventories (updated June 20, 2018).\
<https://www.armscontrol.org/factsheets/Nuclearweaponswhohaswhat>. *Reprinted with permission from The Arms Control Association*.](pntd.0006676.g001){#pntd.0006676.g001}

The 10 current nuclear nations also stand out because they are simultaneously affected by neglected diseases. Shown in [Table 1](#pntd.0006676.t001){ref-type="table"} is an assessment of five neglected diseases, including four neglected tropical diseases (NTDs), among the 10 countries, as determined by the Global Burden of Disease Study (GBD) 2016 \[[@pntd.0006676.ref004]\]. It finds that the nuclear weapons states account for more than one-half of the world's incident measles and dengue cases as well as more than 40% of the global prevalence of intestinal helminth infections (i.e., ascariasis, trichuriasis, and hookworm infection) \[[@pntd.0006676.ref004]\]. GBD 2016 further finds that the 10 nations together also account for a significant percentage of the global incidence of cutaneous leishmaniasis and cystic echinococcosis and likely other NTDs \[[@pntd.0006676.ref004]\].

10.1371/journal.pntd.0006676.t001

###### Neglected diseases among the 10 nuclear weapons nations.

![](pntd.0006676.t001){#pntd.0006676.t001g}

  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  Country                              Nuclear Warhead Inventories[^a^](#t001fn001){ref-type="table-fn"}   Incidence of Dengue[^b^](#t001fn002){ref-type="table-fn"}   Incidence of Measles[^b^](#t001fn002){ref-type="table-fn"}   Incidence of Cutaneous Leishmaniasis[^b^](#t001fn002){ref-type="table-fn"}   Incidence of Cystic Echinococcosis[^b^](#t001fn002){ref-type="table-fn"}   Prevalence of Intestinal Nematode[^b^](#t001fn002){ref-type="table-fn"} Infections
  ------------------------------------ ------------------------------------------------------------------- ----------------------------------------------------------- ------------------------------------------------------------ ---------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------------
  Russia                               6,850                                                               0                                                           853                                                          Endemic[^c^](#t001fn003){ref-type="table-fn"}                                3,337                                                                      Endemic[^c^](#t001fn003){ref-type="table-fn"}

  United\                              6,550                                                               23,448                                                      668                                                          5                                                                            281                                                                        Endemic[^c^](#t001fn003){ref-type="table-fn"}
  States                                                                                                                                                                                                                                                                                                                                                                                    

  France                               300                                                                 0                                                           157                                                          4                                                                            55                                                                         0

  China                                280                                                                 2.6 million                                                 133,465                                                      15                                                                           4,974                                                                      232.5 million

  United Kingdom                       215                                                                 0                                                           90                                                           0                                                                            33                                                                         0

  Pakistan                             145                                                                 2.6 million                                                 63,987                                                       13,026                                                                       2,880                                                                      30.6 million

  India                                135                                                                 53.2 million                                                4,441,899                                                    396                                                                          24,929                                                                     364.3 million

  Israel\                              80                                                                  0\                                                          81\                                                          318\                                                                         53\                                                                        0\
  Palestine                                                                                                0                                                           12,752                                                       1166                                                                         287                                                                        0.6 million

  North Korea                          15                                                                  0                                                           2,838                                                        0                                                                            81                                                                         4.1 million

  Iran                                 Not determined                                                      0                                                           7,534                                                        68,947                                                                       1,058                                                                      2.1 million

  Total                                14,570                                                              58.4 million                                                4.66 million                                                 83,877                                                                       37,968                                                                     634.2 million

  Globally                             14,570                                                              101.1 million                                               8.95 million                                                 678,538                                                                      204,202                                                                    1.511 billion

  Percent globally in nuclear states   100%                                                                58%                                                         52%                                                          12%                                                                          19%                                                                        42%
  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

^a^from \[[@pntd.0006676.ref002]\]

^b^from \[[@pntd.0006676.ref004]\]

^c^Listed as 0 in the GBD 2016 but hand search of the literature reveals the disease is endemic

So why should we care? In a previous assessment conducted in 2010, I estimated that the research and development (R&D) dollars spent on neglected diseases among the nuclear weapons countries amounted to less than 1/10,000th of the R&D funding spent to develop and maintain nuclear weapons technologies \[[@pntd.0006676.ref005]\]. Since then, there has been only modest public health gains in terms of the reduction in the prevalence or incidence of these diseases, although measles incidence has been declining globally since the Millennium Development Goals.

As we move closer to midnight on the Doomsday Clock, the leaders of the 10 nuclear nations, which include at least six group of 20 (G20) nations where NTDs are surprisingly widespread \[[@pntd.0006676.ref006]\], must recognize that funding and scientific activities currently focused on nuclear weapons could be redirected towards health expenditures. In so doing, the 10 nations would help to advance Sustainable Development Goals. As in 2010, I once again argue that neglected diseases are wise investments, both in the areas of implementation science and R&D.

There is little doubt that if the scientific leadership of the 10 nuclear nations were allowed to redirect their energies toward vaccine diplomacy \[[@pntd.0006676.ref007]\], either by expanding coverage of existing vaccines and other interventions or by binational or multinational development of new vaccines and other technologies, we might see the elimination of the five diseases highlighted here. Recently, I emphasized the importance of binational cooperation between the two largest nuclear weapons nations, the US and Russia \[[@pntd.0006676.ref008]\]. This approach led to the global elimination of smallpox, and soon polio, but it could be extended to neglected diseases \[[@pntd.0006676.ref008]\]. Moreover, the US and Russia (as well as other nuclear nations) have troops deployed to NTD-endemic areas of the Middle East and elsewhere.

We've come a long way towards reducing the global prevalence and incidence of several NTDs \[[@pntd.0006676.ref009]\]. Through vaccine diplomacy, we now have the opportunity of accelerating neglected disease elimination. In parallel, we might successfully set back the Doomsday Clock for at least a few minutes!

[^1]: I have read the journal\'s policy and the author of this manuscript has the following competing interests: the author is patent holder and principal investigator on several vaccines in development as well as vaccines against schistosomiasis and hookworm, which are in clinical trials.
