Rough Draft: “Neglected Diseases”

In September of 2000, the United Nations, backed by all the member states, signed the Millennium Declaration. This declaration set up a list of eight Millennium Development Goals that the 191 UN member states have agreed to try and achieve by the year 2015. The majority of these goals seek to help the poorest of the poor by offering assistance in trying to reduce worldwide hunger as well as child and maternal mortality rates. One of the major ways the Development Goals seek to reduce these mortality rates is “halt and begin to reverse the spread of HIV/AIDS.” This goal was designed to tackle the most prevailing of diseases in the poorest corners of the world, but it has also cast a shadow over seemingly less important diseases caused by parasites and other childhood diseases. These “neglected diseases” are still ravaging the poor and young around the world, yet are not receiving the appropriate attention.

Large numbers of the world’s poorest populations in countries like Africa, India and South America, are afflicted by common viral, bacterial and parasitic infections that lead to high mortality rates. Despite the availability of cost-effective and easily administered cures, these neglected diseases such diarrhea and sleeping sickness kill tens of millions around the world every year. “Tropical diseases account for about 12 per cent of global sickness, yet only 1.3 per cent of all drugs developed between 1975 and 2004 were for treating these infections.”[2] These tropical bacteria and parasites thrive in conditions that exist in the rural regions of Africa and the poorest urban areas of South America and China. Many of these regions are plagued by unclean drinking water, malnutrition and poor housing conditions. These problems, combined with the unavailability of proper medicine and healthcare, have created a global health crisis that is undermining the forces of development in these areas. A simple source of these problems can be traced back to a lack of money. In a worldwide capitalist system based around getting what you pay for, many of these people in these poorest sections of the world, are unable to pay for even the most basic of medicines or care. But the broader problem is rooted deeply in profit driven industries, narrow UN goals and mismatched or poorly spent funds.

The pharmaceutical and biotechnology (biotech) industries operate on high profit margins found in developed countries. Since most of the products are viewed as public goods, the governments in these developed countries highly subsidize both pharmaceutical and biotech companies. Both subsidies and large tax breaks lead to extremely padded profit margins for both the companies and their share holders. “Not surprisingly the focus of its (the companies) investments is towards their own markets (countries).”[3] This localized profit mentality leads both pharmaceutical and biotech companies to invest heavily in their own developed markets where they have become “accustomed to unrealistic profit margins.”[4] It is because of these high profit margins that lead companies to invest heavily in the public health sector, which has greatly increased the standard of living in these developed countries. “In contrast, in many developing countries people are dying for lack of appropriate R&D investments. Their needs are over looked because their markets are simply not profitable compared with those in developed countries.”[5] The reason for this “market failure” between the developed countries and underdeveloped countries is not that the technological prowess or knowledge does not exist, but it is simply the lack of returns that have caused pharmaceuticals to shy away. In the research and development(R&D) based industries of biotech and pharmaceuticals, companies shy away from producing vaccines and drugs for use in poor countries. “These diseases are neglected because the market-driven drug R&D system that predominates in the developed world neglects the needs of the patients in the developing world,” says Ann-Marie Sevcsik of the Geneva-based Drugs for Neglected Diseases initiative.”[6] Instead of looking at the human profits in terms of lives saved or improved, they instead seek out highly marketable drugs to sell developed nations. “For example, from 1975 to 1999, of the 1393 new chemical entities approved, approximately 70% were “me too” drugs.”[7] The “me too drugs” refer to marketing campaigns in wealthy nations that seemingly invent diseases but lead people to believe that they are indeed sick and should be treated. It is for this very reason that billions of dollars are spent annually in developed countries on drugs for non life-threatening ailments. This market failure, the over production of high profit non-necessary drugs and under production of life saving vaccines, has led to a worldwide problem. By focusing purely on profits in developed nations, a huge hole has formed in the poorest corners of the world that leads to tens of millions of deaths every year.

In an attempt to fill this hole, both Nongovernmental Organizations (NGOs) and government subsidized programs have sought out funding to combat the effects of HIV/AIDs and other diseases around the world. Since these poor populations find themselves unable to afford or find even the most basic of health care, it has fallen on these groups to try and supply aid. Groups such as The Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS as well as countless other NGOs are now on the forefront of battling diseases. The three main diseases that are today being fought through the efforts of NGOs are AIDs, tuberculosis and Malaria. Back in 2000 when the United Nations established the Millennium Development Goals, AIDs and Malaria were the only two diseases specifically listed to be combated. For this reason, NGOs such as UNAIDS, International Aids Vaccine Initiative and Roll Back Malaria are three of the highest funded groups fighting diseases today. In part due to the Millennium Development Goals, a spotlight has been shined on both AIDs and malaria but this attention has come at a price; a double standard in combating diseases. Since AIDs and malaria have become such hot button diseases, very little funding has gone to other deadly but less “popular” diseases such as sleeping sickness and Chagas’ disease. In the past, the Global Fund has a goal to raise over US $10 billion every year, but this year they are seeking even more; over US $17 billion. All of the funding collected by the Global Fund goes into fighting AIDs, malaria and tuberculosis while all of the “other diseases” plaguing underdeveloped countries receive little to no attention or funding. Before 2002, tuberculosis was considered an “other disease” according to the Millennium Goals and was largely ignored. But after more accurate numbers were available that suggested that tuberculosis kills more people annually than AIDs, the UN goals were changed to include tuberculosis and put it in the spot light. Also in 2002, when the Global Fund was established, tuberculosis was given a place in the spotlight right beside AIDs and malaria. “The emphasis on the big three killers and the derogatory assignment to the category of “other diseases” of those that can so easily be controlled or even eliminated neglects the proven success of a range of interventions. An investment of a fraction of the annual requirements of the Global Fund would bring long lasting benefit to the millions that still remain disabled, reduce morbidity, and prevent disablement in future generations.”[8] In the two tiered global system of developed and underdeveloped countries, the spotlight on the major three illnesses only acts to further stratify neglected diseases.

While tens of billions of dollars are poured into the war against diseases every year, much of this money is wasted. The two ways that waste occurs in the system are disproportionate funds being allotted to perceived threats in developed countries and to the big three diseases abroad. In an article by David Molyneux, he addresses the discrepancy between the funding supplied in developed nations and the expected return:

The public-health agenda has also been affected during recent years by the interest in emerging infectious diseases. The significance of these diseases in global public-health terms is small when viewed from the basis of the quantifiable value Disability Adjusted Life Years. However, in view of the threat – or perceived threat- from diseases such as Ebola, West Nile, Nipah and SARS to western developed societies, disproportionate resources are deployed.

As in the case of SARS, billions of dollars were spent on research and control of a disease that proportionately affected very few people. According to the World Health Organization’s concluding report issued on April 21^st 2004, only 774 deaths occurred due to SARS between November 1^st 2002 and July 31^st 2003. In that same nine month time span, over roughly two million people were killed by tuberculosis. This huge discrepancy can be directly traced back to the direct –or perceived- threat that SARS posed to the developed countries. With cases of SARS popping up in Canada, France and the United States, pharmaceutical companies tapped into the public’s fear and received large amounts of funding to cure a relatively unthreatening disease.

Not only is money spent more freely on diseases threatening developed countries, but it is also more freely spent when concerning the major three: AIDs, malaria and tuberculosis. While funds for disease prevention might be more efficiently used combating parasite based diseases like Schistosomiasis and Chagas’ disease, the majority of funding goes to the big three based purely on the publicity and popularity. It is estimated that currently 207 million people worldwide suffer from Schistosomiasis –which is a water bred parasite burrowing under the skin- but a cure costs only US $0.20 per child per year. “By comparison, the treatment for HIV/AIDS exceeds US$200 per year per person for the life of the individual, while TB treatment costs at least around US$200 per treatment in Africa.”[9] Widespread diseases with cheap cures are undermining greater efforts to develop impoverished countries. According to the World Health Organization the economic return on curing or preventing a list of “the 13 neglected diseases” is 14-30% over what was invested. “Onchoceriasis (a worm based disease) control in west Africa has been described by the World Bank as one of the most effective investments in any development sector. Likewise, each $1 invested in control of Chagas’ disease in Brazil and lymphatic filariasis in China is calculated to have produced returns of $7.16 and $15 respectively.”[10] The reason that treating these neglected diseases are so cost effective is because they are all caused by parasites, worms or stem from problems with simple necessities like clean drinking water. Parasites and bacteria are extremely slow to adapt to vaccines and medication whereas the big three are all viral diseases and can readily mutate and change to adapt. This leads to a constant need for research to go into finding the new strains and combating them. Since 1974 an estimated meager $3-4 billion has been invested in the treatment and prevention of neglected diseases. That number is in stark comparison to the goal of $17 billion sought out by the Global Fund this year alone. Despite the small amount invested in these diseases, great returns have been seen. Diseases like cholera, leprosy and yellow fever have all seen great reductions around the world, yet due to lack of funding have not been exterminated.

There are many hurdles that face the world today, hunger, poverty and widespread illness. Some of these are hurdles that we can over come, some we cannot. According to the Millennium Development Goals we have a lot to accomplish by 2015, but with better managed resources, a broader spectrum of response and a large portion of human caring, the suffering of millions of people can hopefully be alleviated.

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