* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
Not enough research is done on diseases which affect the world's poorest
This week we learned that the trial of a vaccine for the Ebola virus run in Guinea was successful. It now looks as if there may soon be a medical tool that could vastly reduce the risk of Ebola infections and therefore deaths.
The vaccine has been developed and tested with unprecedented speed. The Ebola epidemic was declared an emergency almost exactly one year ago, and before that few members of the general public knew Ebola existed.
It comes too late for the 11,000 people who died in West Africa from the infection. That number is testament to just how quickly an infection like Ebola takes hold in a poor country lacking the infrastructure and medical provision to contain it.
There are many other diseases particularly afflicting poor people in the developing world yet to be tackled by the big pharmaceutical companies we rely on to develop vaccines. The Ebola epidemic shone a light on those serious and dangerous gaps in the world’s pharmacy, which is handsomely stocked with medicines to tackle the diseases of rich nations – pills to lower cholesterol, counter depression or treat impotence.
Until this trialled Ebola vaccine gets onto those pharmacy shelves there will remain absolutely no medical response to the infection. The vaccine would not mean there are no more cases, but it would provide an effective barrier method; governments in countries at risk will be able to routinely vaccinate all medical staff, so they could respond to cases without the risk of catching it and passing it on themselves.
ActionAid is one of the organisations which acted during the Ebola epidemic, working to educate affected communities about arresting its spread using methods including soap-and-water hand-washing and regular disinfecting. But no amount of good hygiene is better than a vaccination programme.
The problem of research into diseases of the poor is not unique to Ebola. Only 4 per cent of new therapeutic products in recent years have been for these diseases. The reasons for this are not hard to guess. Pharmaceutical research is big business, while treating poor populations is not as lucrative as treating rich populations. ActionAid’s new discussion paper After Ebola – research into medicines for diseases of poor countries looks at the options on the table.
There are two ways to encourage neglected disease research. It can be funded up front through a ‘push mechanism’, where the money to fund the research and development of medicines is provided before the work begins. Or a ‘pull mechanism’ can be used, where rewards are promised to pharmaceutical companies or partnerships for successful discoveries – for example, by an aid donor commitment to purchase a medicine once it exists.
Most existing initiatives are currently push mechanisms, and the potential for the pull type is underexplored. Push mechanisms pay out whether there is a viable medicine at the end of the process or not.
One pull mechanism in particular merits further investigation. The Health Impact Fund, a proposal co-initiated by Thomas Pogge, a Yale professor of philosophy and international affairs, would guarantee the purchase of new medicines at prices set according to the number of lives that could be saved or improved by the medicine. This would be an attractive incentive for medicines that treat or vaccinate against diseases such as Ebola.
All this needs financing. Knowledge that prevents the spread of disease benefits everybody, and the benefits must not be restricted to those who buy them. Public health, while so heavily monetised by big business, is still a public good. For this reason, much of the funding for enhanced research into diseases of the poor in the developing world will need to be public funding.
The World Health Organisation recommends that aid donors contribute 0.01 per cent of gross national income to research into neglected diseases, as part of their aid commitments. For the UK, which is already a leading donor in this field, this would mean around £160 million this year – less than half of UK spending to date on the Ebola crisis in Sierra Leone.
Backed by public money, if big pharma put more time and money into developing better responses to the other diseases that mostly affect the poor – such as tuberculosis, malaria, HIV/Aids – generations of lives would be saved. Development would have a chance to take root. The Ebola epidemic put Sierra Leone’s nascent development and emergence from civil war back by many years.
There are those who argue that diseases of the poor are not ‘our’ problem because they happen in faraway lands. They should remember that cases of Ebola did make their way onto British soil. British aid workers and medical personnel who cared for Ebola sufferers in West Africa brought the infection home. But they were fortunate to have access to world-class healthcare; they got better.
Ebola is a disease of mass communication – its spread is facilitated by the interconnectedness of our world. The global fallout of other diseases of the poor in the developing world that are still lacking a medical response is in itself an economic case governments must take seriously.
Anna Thomas is head of advocacy at ActionAid UK.
