Funding research into the infectious diseases of poverty: what happens now?

24 Feb 2011

Paul Chinnock

Source: TropIKA.net

Comments

The latest G-FINDER report from Policy Cures.

Until February 2009, when the first G-FINDER report was published, it was not possible to determine how much was actually being spent, and by whom, on research and development efforts focused on the infectious diseases of poverty (IDPs). Nor was it clear how the money was being distributed – on which diseases and on which interventions to control them. Effective policy making requires that we know both where the money is coming from and where it is going. The G-FINDER project, now run by the Policy Cures group, is performing a considerable service in compiling this information and making it freely available.

The third G-FINDER report Neglected Disease Research and Development Is the global financial crisis changing R&D? was published last week. The importance attributed to the report is indicated by the media coverage that it has already received – see for example:

Commentators have been studying the report looking for the emergence of any trends in funding and expenditure but – based on a series of only three annual reports – what appear now to be trends could turn out to be misleading.

Funding for IDP research has risen in total, which one can only hope reflects a continuing trend. In 2009 the overall figure was $3.2 billion – 8.7% higher than in 2008. Another encouraging development is that the funding available was distributed more widely amongst the 31 infectious conditions that G-FINDER classes as “neglected”. HIV, TB and malaria still dominate but, having taken 77% of what was available in 2007, they attracted 72% of IDP research funding in 2009. Diarrhoeal diseases, dengue and the kinetoplastid group of infections (i.e. Chagas disease, leishmaniasis and sleeping sickness) each increased their share to above 5%. Leprosy, rheumatic fever, trachoma and Buruli ulcer still fared badly, receiving less than 0.3% of global R&D investment.

There are other trends – if that indeed is what they are – that worry both commentators and the authors of the report themselves. The first is that financial support from philanthropic organizations, including the Gates Foundation, fell by 8.7%. This contrasts with the increase of 14% in funding from public institutions, such as the US National Institutes of Health. But is this rise the result of a few large “one-off” grants that may not be reflected in future funding?

Public institutions tend to finance different types of research from philanthropic bodies and this is linked to the second of the concerns that has been identified – the increasing proportion of funding (a rise of 21%) going to basic scientific research, and the decline in support for product development. While research at the basic level is important, for many IDPs, product development offers greater potential gains. Much is already known, for example, about the biology of the kinetoplastid parasites but the drugs available against the diseases they cause are of limited effectiveness and have a poor safety profile. As the report points out, “…more than half of sleeping sickness funding went to basic research, although this area would benefit markedly from the development of new, safe, oral drugs that are active against both stages of the disease”.

Product development partnerships (PDPs) – set up as a response to the reluctance of industries and government to fund the development of drugs for the world’s poorest people – have assumed a central role in translational research in recent years. Javier Guzman, a co-author of the report, says: “PDPs have delivered nine new drugs, diagnostics and vaccines for malaria, tuberculosis, meningitis and visceral leishmaniasis, and have developed the largest pipeline of neglected disease products ever assembled with over 140 projects now in development”. But in 2009 PDPs received $50m less in funding than they did in 2008 – a fall of 8.6%. Individual PDPs with a reduced income included the Medicines for Malaria Venture, the Sabin Vaccine Institute and the International AIDS Vaccine Initiative.

Whether or not there is a trend emerging here, the serious decline in the revenue of these organizations in a single year is a significant concern. It would be particularly tragic if products were to reach the crucial but most expensive stage of their development (Phase III clinical trials) and then run out of funding.

Making plans

Now that funding bodies have the information provided by G-FINDER to guide them, how should they proceed? Decisions on where future support should be targeted must be made in the light of what is known about the disease burden, but also on the basis of need. For some diseases a major effort is needed at all stages of the development process but for others – for example the soil-transmitted helminthiases for which there are already effective treatments – more modest funding, appropriately targeted, may be all that is required.

The report points out that:

“…funders need tools to help them assess and compare disease burden, state of the science, and knowledge and product gaps, as the basis for deciding into which disease and product areas they can best invest. For some diseases, this may mean a stronger focus on basic science rather than product development. For other diseases, basic science is at the right stage to be translated into useable health technologies, and funding should preferentially be directed to product development.”

It is also important that funders should work together, instead of in the uncoordinated way that they do now. To quote the report once more:

“A solid investment strategy will not suffice in the absence of coordination. Once funders know where their investments are likely to have the highest health return, they need to be able to funnel their disbursements in the most effective way, including being aware of choices made by other funders. This is particularly the case for the most neglected diseases, which are seeing a highly scattered approach with multiple small funders disbursing grants that, although considerable for them, are not appropriately sized or targeted to the products needed for that disease…”

Finally, however, we need to note (as we have often done on TropIKA.net) that the effectiveness of the delivery of interventions to address the IDPs depends requires the strengthening of health systems. That, in turn, requires investment in health systems research. HSR falls outside the remit of the G-FINDER report but it too is a neglected area.