When the outbreak of Ebola in West African spiraled out of control in the middle of 2014, health-care advocates pointed to it as a reason why countries like the United States need to engage in health globally. There are many other problems that affect more people than Ebola and that also pose a threat to Americans. It all comes at a time when the United States is making cuts to vital research and development supporting drugs and vaccines for neglected tropical diseases, say advocates.
The world spent $3.2 billion on research and development for neglected diseases in 2013. That is $193 million less than what was spent in 2012, and it is pretty much all at the fault of the United States. The budgetary stand-off in Washington, D.C., that ended in the sequester led to a $188 million cut for the U.S. National Institutes of Health. Blame is not solely on the United States, says the new G-FINDER report, published by the research group Policy Cures. The pharmaceutical industry spent $74 million less than it did in 2010. In sum, the industry contributes to only 12 percent of neglected disease spending globally.
“If we want effective medicines for diseases like Ebola, TB and malaria, then governments and industry do need to do better. Too many of the world’s big economies, and too many of the world’s top drug companies, are still missing from the funding table,” said Dr. Mary Moran, executive director of Policy Cures.
Pharmaceutical companies are working quickly to develop and test new treatments for Ebola in response to its unprecedented spread across Liberia, Guinea and Sierra Leone. This week saw the launch of a new vaccine trial in Oxford, England. Johnson and Johnson is testing a small group of volunteers to test the safety of the vaccines. If all goes well, they will progress on to the next stage of clinical trials with the hopes of making the vaccine available in West Africa by the middle of this year. It is one of at least four vaccine trials currently under way. They all show how the global health community to take action and produce results.
“We all want the momentum and sense of urgency to continue,” said WHO director-general Dr. Margaret Chan, to the media this week. “Previous experts agreed that vaccines will have an impact on the Ebola epidemic in any future scenario, whether worst-case or best-case. I see no indication that this view has changed.”
The problem for other neglected diseases is that urgency is not the same.
“The total amount being spent is woefully insufficient. Over the long term, there are not really new resources available for global health when they are needed,” said Dr. Mel Spigelman, president and chief executive officer of TB Alliance in an interview with Humanosphere.
Spigelman is particularly worried about the lack of progress on new treatments for Tuberculosis. The G-FINDER report supports these concerns. Just 18 percent of global research and development funding goes to TB. The NIH is still the leading funder for TB. It made a major jump in spending from $127 million in 2008 to $183 million in 2009. Since then, spending has wavered around $175 million and fell to $165 million in 2013. It is a trend followed by funders from the U.K. to Germany, a spike in spending in 2009 has plateaued and, in some cases, declined.
It is troubling because of the continued spread of TB and the rise of multi-drug resistant forms. New drugs to treat TB are needed. The vaccine that is currently available is 80 years old and works only for children. New drugs are progressing through clinical trials, but Spigelman is concerned that they will stall if resources continue to dry up.
“The situation is that there has been a lot of progress made and based on that success, more is needed because projects have gone from early state, where they are inexpensive, to late stage where they are more expensive,” he explained. “There is a responsibility for us to produce successes that are tangible products. We are on the brink of doing that, but we could really use an infusion in the next few years.”
And it is not just TB where there are concerns. Malaria is showing resistance to one of the best drugs against it and the bed-nets that protect people from mosquitoes. Dengue makes a deadly surge each year in places like India and diarrheal disease is one of the leading killers of children around the world. All are serious threats that require a strong health response, from trained medical professionals to well-maintained health centers to cutting edge drugs and vaccines.
Doing so requires political will. Spigelman says he learned from the Ebola outbreak just how much fear can drive action. He says there are some politicians in Washington, D.C., who support global health investments, but they need more. That burden rests with the advocates to make a compelling case for increasing funds.
“We have to make the economic argument for R&D as an investment,” said Spigelman.
“I think we need to get a hard-core number of people in positions of power who realize and take it as a cause and form it as a base to push for the advocacy for this. I think it always starts with champions and we have to generate those champions.”