Global Health Research

Science  27 Jun 2003:
Vol. 300, Issue 5628, pp. 2003
DOI: 10.1126/science.300.5628.2003

Research is a critical part of any effort to improve the world's health. Yet there are significant political, social, and organizational barriers to increasing funding for research on the infectious diseases of the poor. Malaria, tuberculosis (TB), and AIDS have gained particular attention in the past several years because they have become overwhelming burdens on the world's poorest people. Worldwide, 40 million are infected with AIDS, more than 300 million seek treatment for malaria each year, and a staggering 2 billion people are infected with tuberculosis. During the past several years, there have been substantial increases in support from public and private funds. Most recently, an international nongovernmental organization called the Global Fund to Fight AIDS, Tuberculosis & Malaria (http://www.globalfundatm.org/) was proposed at the 2000 G8 meeting of industrialized countries in Okinawa, with input from several national governments as well as the Bill and Melinda Gates Foundation. The Global Fund was established and is held in trust by the World Bank; it funds the treatment, care, and prevention of malaria, TB, and AIDS, but not research and development. Other important infections, including child-killing diarrheal and respiratory diseases, acute and chronic Chagas' disease, and leishmaniasis and parasitism by worms, have not benefited from the same kind of attention. Although many governments have increased their support for health-related international development and applied research, they have not rallied around a recent World Health Organization (WHO) call (http://www3.who.int/whosis/menu.cfm?path=whosis,cmh&language=english) for the creation of a global health research fund to coordinate increased spending on basic and applied research against these diseases.

Independent foundations and charities are a valued part of the funding mosaic worldwide, despite only contributing about 4% of the $60 billion spent globally each year on health research. They lack the spending power of government health agencies, but their biggest asset is not their money but their flexibility. Founders and boards of foundations have the power to shape and reshape their organizations' missions and strategies toward dealing with new health challenges as they arise. Foundations can take on leadership roles and set priorities independently of governments, as the Rockefeller Foundation has done in incubating public-private partnerships such as the Medicines for Malaria Venture (MMV). Similarly, the Bill and Melinda Gates Foundation has provided MMV and other partnerships with unparalleled levels of support.

Foundations and charities operating for the public good can work across boundaries posed by academia and industry, and among disciplines and nations. The entry of new private funders, such as the Bill and Melinda Gates Foundation, can have a stunning impact, bringing new dollars and new attention to addressing global health inequities and accelerating the development and deployment of health interventions. Other funders such as the Wellcome Trust, the Howard Hughes Medical Institute, the Ellison Medical Foundation, and the Burroughs Wellcome Fund have focused their support on research, not development. Their dollars have provided the risk capital for the scientific community working on the intractable diseases of the developing world.

Despite the impact that foundations can have on global health, too few of them are being attracted to the field. Many other needs, both local and global, compete for their money and attention. Yet few problems could be as effectively improved by philanthropic investment as the neglected health needs of the world's poor. Flexible support from foundations can open up new areas of research, especially the substantially underfunded work that translates results from the laboratory (often in a developed country) to the field and clinic in a developing country. Existing foundations need to collaborate to recruit new partners and to work with each other, government sources, and the scientific community to identify opportunities for new investment. “Selling” this critical need requires better communication about how international scientific research helps to build a healthier, safer world in both developed and developing nations.

Treatment programs or vaccine development projects by themselves cannot meet the challenges to global health. Major commitments to basic research are needed, and the charitable funding sector cannot do it alone. The WHO proposal will require an investment that is an order of magnitude greater. So recruiting new foundation players, welcome though they will be, just won't be enough. Government agencies, such as the National Institutes of Health and the Centers for Disease Control, have to be major supporters. Governments need to give their health institutions a mandate that identifies such support as clearly being in national interests. The U.S. scientific community has been remarkably effective in making the Congress and the policy sector aware of the health needs of its own constituents. Scientists everywhere should turn these persuasive skills toward the pressing concerns of the world's poorer citizens.

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