Fighting the 10/90 Gap
Medecins Sans Frontieres initiative targets the most neglected diseases; how scientists can help
from
the-scientist.com
excerpts:
While wealthy nations pursue drugs to treat baldness and obesity, depression in dogs, and erectile dysfunction, elsewhere millions are sick or dying from preventable or treatable infectious and parasitic diseases.1 It's called the 10/90 gap. "Less than 10% of the worldwide expenditure on health research and development is devoted to the major health problems of 90% of the population," explains Els Torreele, co-chair of a working group that provided background recently for an initiative announced by Medecins Sans Frontieres (MSF, or Doctors Without Borders) to fight the gap.
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. Harold Varmus, president of Memorial Sloan-Kettering Cancer Center, cited the huge discrepancy of life expectancy between the five richest and five poorest countries as "one of the greatest disappointments in biological sciences in the 20th century." Morten Rostrup, president of the International Council of MSF in Brussels, described his vigil with a young malaria patient: "For two days and two nights, I fought for the life of this 22-year-old with malaria. On the third night, I finally had to fall asleep, and the patient died. Something is failing terribly." Yet malaria and tuberculosis are among the least neglected of the neglecteds.2 Visweswaran Navaratnam, professor of clinical pharmacology at the University of Science in Malaysia, provided a glimpse of the effect of parasitic disease on society: "An aboriginal farmer in Borneo had eight children, and filariasis, which causes elephantiasis. He became unable to support the family. He thought that the best answer, for him, was suicide. Why couldn't I have given him an alternative? Large populations given these problems can become nonfunctional.
To assess Big Pharma's commitment to neglected diseases, in spring 2001 the DNDi working group and the Harvard School of Public Health surveyed 20 large pharmaceutical firms in the United States, Europe, and Japan. Of 11 responders, eight had done no research over the past year in tuberculosis, malaria, African sleeping sickness, leishmaniasis, or Chagas disease; seven spent less than 1% of their research and development budget on any of these disorders. In contrast, the Pharmaceutical Research and Manufacturers of America's New Medicines in Development survey3 found that, of 137 drugs in the pipeline to treat infectious or parasitic disease, one targeted sleeping sickness and one malaria. Yet eight drugs are in clinical trials for erectile dysfunction, seven for obesity, and four for sleep disorders. The most neglected diseases affect predominantly people in the southern hemisphere who do not contribute to the pharmaceutical market.
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How Scientists Can Help
"Scientists can use their credibility to advocate government spending on health care in poor countries," said Varmus, recommending the WHO's final report of the Commission on Macroeconomics and Health6 as a "blueprint for advocacy." And advocacy can become action. Varmus envisioned an "international corps for global science" in which scientists would serve a year or two on the frontlines.
He concluded, "Advances in biology and medicine can and must be used to combat disease in the developing world." With the framework that the DNDi will provide, that hope is one giant step closer to reality. |
