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Funding R&D for neglected diseases: the urgency is to grow the pie rather than redistributing the parts.

Posted by plosmedicine on 31 Mar 2009 at 00:35 GMT

Author: Christian Lienhardt
Position: Senior Scientific Advisor
Institution: Stop TB Department , WHO, Geneve
Additional Authors: Marcos Espinal and Mario Raviglione
Submitted Date: March 05, 2009
Published Date: March 6, 2009
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Sir,

The paper by Moran et al is an important evaluation of the global funding of research and development (R&D) in the area of neglected diseases (1). While we appreciate this effort, we however do not concur with some of the conclusions made. According to the authors, over USD 2.5 billions were invested into R&D of new neglected disease products in 2007 and the largest concentrations of these were in three main diseases “receiving nearly 80% of the total” – i.e. HIV/AIDS, malaria and tuberculosis (TB) - with respective figures of USD 1.08 billions (42.30%), USD 468.5 millions (18.30%) and USD 410.4 millions (16.03%). Although the authors cautiously warn that “they are not seeking to analyse whether investment is best spent”, they state that the disproportional distribution of R&D funding for HIV, TB and malaria has little correlation with the burden of disease - and they cite the example of pneumonia and diarrheal diseases that do not receive the part of funding they would deserve if DALY alone were taken as an indication of burden of disease. We fear that this report may erroneously give the impression that increased funding to the so-called “big three diseases” are no longer justified – an interpretation that already appeared in a commentary in Science, stating that “the big three no longer deserve the term neglected” and that “policymakers must shift resources […] to other underfunded diseases" (2).

We must first note that the grouping of these 3 diseases wrongly conveys the message of a “block-funding”, which in fact hides severe imbalance in terms of respective contributions: according to the paper, funding for R&D in TB in 2007 was slightly more than a third of funding for HIV/AIDS (16% vs. 42%), while the burden of disease in terms of DALY, according to latest estimates in 2004 (3), was more than half: 34,217 (2.2%) for TB vs. 58,513 (3.8%) for HIV/AIDS.

While focusing on the total amount spent in R&D, the G-FINDER report fails to consider the actual funding needs, based on assessing the gaps between the existing tools and those needed for optimal control. The Global Plan to Stop TB 2006-2015 estimated that USD 9 billion was needed over that time period for R&D in new diagnostics, drugs and vaccines for TB in order to reach the Millennium Development Goals (4). For the single year 2007, estimates were USD 800 millions for R&D, twice more than what has been invested in real terms that year according to the G-Finder report.

Further, while public and private institutions have increased funding for TB R&D from a few million dollars in the early 80s to 400 millions USD in 2007, it is clear from a series of reports that this needs to increase further (5, 6). In 2007, there were more than 9 million new cases of TB worldwide and the death toll was 1.7 million people. The number of MDR cases is estimated at 500 000 new cases per year and cases of XDR-TB have now been reported in 27 countries. Yet, diagnosis of TB is still done by staining bacilli in sputum of patients, a technique developed 125 years ago that is still insufficient for diagnosis in almost half of the TB cases, including most HIV co-infected individuals. The Bacillus Calmette & Guerin (BCG) vaccine that was developed in the beginning of the 20th century has a very variable efficacy. The drugs in current use, developed during the period 1944-1970, still demand to be given for 6 months, and treatment of MDR-TB with second-line drugs is very lengthy, painstaking and costly. Hence, the full armamentarium for efficient disease control in TB needs to be fully revitalized.

Promising advances have been made recently in the field of diagnostics, drugs, and vaccines for TB. Several feasibility and clinical trials are under way. However, not every but a few of the products entering the pipeline will ultimately make it to the public. Therefore, funding must be sustained and increased in order to bring some of these products into practice, so that all these encouraging efforts are not made in vain. At a time that the world is facing a major financial crisis, and that both governments and non-governmental institutions might be tempted to reduce funding for R&D, it would be disastrous to infer that HIV/AIDS, malaria and TB deserve less attention than other diseases, and that TB be singled out as receiving more than its due part compared to other diseases when gaps are so big. In our view, the main message should not be one of competing for resources and reducing funding for some diseases at the expense of others, but to intensify advocacy for R&D for all these diseases that are disproportionally affecting the poor.


1. Moran M, Guzman J; Ropars AL, McDonald A, Jameson N, et al. Neglected disease research and development: how much are we really spending ? PLoS Medicine 2009;6 (2); e1000030
2. News of the week. Global Health: some neglected diseases are more neglected than others. Science 2009; 323: 700
3. accessed 20/02/2009
4. World Health Organization/Stop TB Partnership. The Global Plan to Stop TB:2006-2015. Geneva, World Health Organization, 2006.
5. Kauffman SHE, Parida SK. Changing funding patterns in tuberculosis. Nature Medicine 2007; 11 (3):299 - 303
6. Feuer C. Tuberculosis Research and Development: A critical analysis of funding trends, 2005-2006: An Update. Harrington M, Huff B & Syed J eds. New York, Treatment Action Group, July 2008.

No competing interests declared.