The World Health Organization has reported that every year, 14 million people die of treatable infectious diseases. Most of these deaths occur in the developing world, and most have one primary causelack of the drugs needed to cure these illnesses, which are common to the poorest nations. The drugs are either too expensive for local people to afford them or have not been developed by Western pharmaceutical companies, which are concerned that the return on their investment would be too small. As a result, their research has focused largely on diseases that affect people living in wealthy countriesincluding nonfatal conditions like impotence and obesity. Research and development in the kinds of tropical diseases that afflict large segments of populations in sub-Saharan Africa, on the other hand, are at a virtual standstill.
Some of the diseases are well known not just in poor countries, but throughout the world. Tuberculosis, for instance, causes two million deaths a year. Although it wreaks its greatest devastation in the poorest nations, wealthier ones are also affected. This creates a small but economically viable Northern market. The same is true for H.I.V.-AIDS, afflicting as it does people in rich countries as well as poor ones.
But there is another class of life-threatening diseases that receives next to no attention from the pharmaceutical industry, because there is practically no financial incentive. International humanitarian health organizations like the Nobel-prize winning Doctors Without Borders refer to them as most neglected diseases. A conference on these, as well as on neglected diseases in general, was held in New York in March. Sleeping sickness, a ravaging ailment that takes its greatest toll in sub-Saharan Africa, offers an example. Under colonial rule, the disease had almost been eliminated by the 1960’s, but because of the disruption to health and sanitation systems caused by civil wars, it has made a resurgence. Spread by tsetse flies, if left untreated it eventually causes a state of coma leading to death. Although it threatens 60 million people, only 7 percent have access to a drug called eflornithineso effective that medical workers in the field refer to it as the resurrection drug.
Eflornithine went out of production in the late 1990’s, however, because it was unprofitable for the manufacturers. Ironically, production resumed in 2001 because a cosmetic use was accidentally discovered: it retards the growth of women’s facial hair. This discovery rendered the drug profitable, and it continues to be made by Aventis. According to Rachel Cohen, a spokesperson for Doctors Without Borders, Aventis has committed itself to donating a supply of eflornithine for five years as a humanitarian gesture. And, as Ms. Cohen told America, the company has agreed to look for a long-term manufacturer to whom it could transfer the technology as a move toward a sustainable solution. So far, though, no such manufacturer has appeared.
While for diseases like TB and malaria, public-private partnership ventures offer some hope for further research and development of new drugs, the same is not true of those in the most-neglected-diseases category. Ms. Cohen said that Doctors Without Borders is supporting a drug development initiative that would be funded primarily from public sources in both wealthy and developing countries. With public funding of up to 70 percent or 80 percent, she said, contractual relationships with the pharmaceutical industry could then be established that would take advantage of their scientific expertise for the development of needed new drugs for the most neglected diseases. Doctors Without Borders already has several pilot projects under way for the development of new drugs.
But public funding itself may not be easy to obtain. Although it is the richest country in the world, the United States is the least generous in foreign aid. It allocates only 0.1 percent of its gross national productmuch of it for military purposes. Of this 0.1 percent, only one-eighth goes for health. In March, the Bush administration announced a plan to add $10 billion to overseas aid over the next few years, and the president himself said in Monterey that the wealthy countries need to do more to help the poorest. But as noted in a report jointly issued around the same time by the Center for Global Development and the Center on Budget and Policy Priorities, the proposed increase would lift the amount of foreign aid to only 0.13 percent, so the United States would continue to contribute a far smaller portion of its economy to aid than nearly every other donor country. If the president is true to his word, Congress should be asked to contribute enough in foreign aid for health purposes to ensure the development and distribution of drugs to combat neglected diseases that ravage some of the world’s poorest people.