Many neglected diseases lacking research funding

The first comprehensive survey of global spending on neglected disease R&D, published in this week's PLoS Medicine, finds that just over $US 2.5 billion was invested into R&D of new products in 2007, with three diseases-HIV/AIDS, TB, and malaria-receiving nearly 80% of the total.

However, the survey finds that many neglected diseases, responsible for killing millions of people in developing countries, are significantly underfunded.

Researchers from The George Institute report that while HIV/AIDS, TB and malaria collectively received the majority of R&D funding, other diseases and disease categories each received less than 5% of global funding.

Sleeping sickness, leishmaniasis and Chagas disease collectively received only 4.9% of total global funding; the diarrhoeal illnesses surveyed collectively received 4.5% of global funding; the helminth (worm) infections received 2%; and bacterial pneumonia and meningitis received only 1.3%. Five diseases - leprosy, Buruli ulcer, trachoma, rheumatic fever, and typhoid and paratyphoid fever - each received less than $10 million or 0.4% of total global investment. For many of these diseases, funding was not enough to create even one new product.

The need for R&D to develop new drugs and vaccines for preventing and treating neglected tropical infections in developing countries is widely accepted. For example, the creation of a vaccine for HIV/AIDS, more effective tools to diagnose TB, and better drug treatments for leishmaniasis and sleeping sickness would greatly improve health in the developing world. However, there has until now been an "information gap" for funders wishing to invest in this area.

In the new survey by Dr Mary Moran (The George Institute for International Health, Sydney, Australia) and colleagues, commissioned by the Bill and Melinda Gates Foundation, the researchers set out to fill this information gap. While specific R&D investment data were previously available for some neglected diseases, these cannot readily be compared since each survey used different methodologies and covered different diseases, products, donors, and countries. Moran and colleagues' survey was designed to include all neglected diseases and all control tools of significance to developing countries, and to gather funding data as consistently and comprehensively as possible.

The survey found that public and philanthropic donors collectively invested $US 2.3 billion (about 90%) of total funding in 2007. The US government represented nearly three quarters of global public spending. The largest organizational donors were the US National Institutes of Health (42% of total funding) and the Bill & Melinda Gates Foundation (18% of total funding). About a quarter of donor funding was routed to public-private product development partnerships (PDPs), such as the International AIDS Vaccine Initiative and the Medicines for Malaria Venture.

The survey's findings, say Moran and colleagues, suggests that "investment decisions are not only influenced by scientific or epidemiological considerations, but may also be influenced by factors such as the presence of advocacy and fundraising groups; by funder perceptions or preferences; or by the presence of policy frameworks and funding mechanisms that prioritise specific diseases."

The researchers also note that some of the world's wealthiest countries are "missing in action" from the top 10, top 20, or even top 50 funders of R&D for neglected diseases.

"A broadening of funding efforts," they say, "so that all who are able to contribute do so, and all diseases receive the attention they deserve, would lead to a dramatic positive impact on the health of developing country patients afflicted with these diseases."