This article first appeared in the Journal of the American Medical Association JAMA Vol. 286 No. 23, December 19, 2001
We agree with Mr Folkers and Dr Fauci that the success of acquired immunodeficiency syndrome research over the last two decades shows what can be achieved if enough financial and human resources are provided.
But many infectious diseases that continue to be the leading cause of death in poor countries do not affect industrialized countries. Without enlightened self-interest by Western governments and a profitable market for industry, drug development has ground to a virtual stand still
Exacerbating this neglect, drug resistance is reducing the effectiveness of many available drugs. Recently, the Drugs for Neglected Disease Working Group and the Harvard School of Public Health questioned the world's top 20 pharmaceutical companies on their research and development activities for malaria, tuberculosis, sleeping sickness, Chagas disease and leishmaniasis.3 Eleven companies responded (representing $117 billion of the $406 billion world-wide pharmaceutical market.).
Of these, seven reported spending less than 1% of their research and development budget over the last fiscal year on any of the five diseases; eight spent nothing on the three most neglected diseases (ie, sleeping sickness, Chagas disease, and leishmaniasis). The public sector, increasingly focusing research along profitable avenues, is also failing. Experts estimate that annual public funding for drug research and development on these same five diseases is less than $75 million.
Global liability and moral obligation must be the driving force behind research efforts. Governments could frame a compulsory research obligation that would require industry - highly profitable thanks to increasing levels of patent protection
Ultimately, not-for-profit drug development initiatives should be explored, to take drug research and development for neglected diseases out of the marketplace altogether. Nathan Ford, BSc Els Torreele, PhD Drugs for Neglected Disease Group/Médecins Sans Frontières Geneva, Switzerland