The disequilibrium within health research

Julia Spierings

 

In the past decades, more money was allocated to research on medication against baldness than to serious and life threatening diseases in developing countries. 1 393 new drugs were approved between 1975 and 1999; only one percent was specifically indicated for tropical diseases. In 1986, the global expenses for health related research were 30 billion USD. Less than 10% of this money served the health problems of developing countries, where over 90% of the world’s population lives. The Global Forum on Health Research described this statistical finding the 10/90 gap. The pharmaceutical companies were blamed for their lack of research on tropical diseases.

Is the gap getting smaller?

In the last ten years, the situation has changed, which makes it difficult to define the current dimensions of the gap. In 2003, the global expenditure on health research was 125 billion USD, four times higher than in 1986. The investments on research on tropical diseases have increased as well. However, the exact share for developing countries is not easy to estimate because more people and associations are involved in the funding for research than before.

Also, there is a shift in epidemiology of diseases as developing countries experience an increase in non-communicable diseases, such as cardiovascular diseases and cancer, to 60% of the total disease burden. This unbalances the 10/90 division, because research in developed countries on prevention and treatment of diseases of affluence could apply to developing countries as well. However, these studies do not take into account the differences in genetic components and the specific risk factors related to environmental and social conditions. Very little research focussed on non-communicable diseases in developing countries.

One could question the importance of more research on several underdevelopment related illnesses. In fact 80 to 100% of the childhood diseases (e.g. diarrhoea, malaria, measles and tetanus) can be prevented and cured with existing methods and medications. Prevention programmes and a more effective distribution of medication and vaccinations in areas in need are more helpful than more research, as they can save 3 million children each year. Diseases for which there is no treatment available, such as dengue fever, contribute to a far smaller proportion of low-income country mortality rates than the abovementioned diseases.

Redefining the gap

As it remains difficult to allocate health research investments according to regional disease burden, poorer countries still find themselves on the less endowed side.

Pharmaceutical companies keep being blamed for neglecting diseases that are only endemic in third world countries. In reaction to public and political campaigns, these pharmaceuticals have indeed invested more in the development of medication against these diseases. Still, they are blamed for limiting the access to essential medicines as well as access to information and resources through patents and intellectual property rights.

Other interfering factors are formed by policy makers and governments. Although cures are available, expenses on health, distribution and especially prevention programmes do not obtain sufficient priority. Thus the factors that cause the gap have shifted from a lack of research to disallocation of resources.

How to close the GAP

To narrow the 10/90 gap, we should target the factors that are keeping it open. Concerning the role pharmaceutical companies have, we might impose higher taxes on profits from these companies and limit intellectual property rights. However, implementing these proposals might discourage pharmaceutical companies to invest in research on tropical diseases or on non-communicable diseases on a population specific level. Furthermore, governments should invest in their health care systems, support organisations to start prevention programmes and stop taxation on medication.

However, it is as important to ensure long-term research capacities and adequate coordination and planning in developing countries. The few currently existing research institutions lack resources, education, national investments and health research policies. There are no functional ethical and scientific review committees and there is a huge need for researchers and doctors. Therefore, policy making directed towards these goals, adequate project management and the acquirement of biochemical, socio-economic and political resources are needed.

 

In conclusion, closing the 10/90 gap is not enough to resolve the burden of disease in third world countries. The gap has changed, estimated numbers are old, epidemiology has shifted and mortality could be reduced by efficient use of existing prevention and treatment strategies. Still, the gap describes the lack of research specifically focussed on this population.  

 

About the author

Julia Spierings is a fifth year medical student with a special interest in research on tropical and neglected diseases.

Further reading

• International Policy Network, Philip Stevens. Diseases of poverty and the 10/90 Gap. November 2004
• www.globalforumhealth.org
• WHO (2001). Macroeconomics and Health: Investing in Health For Economic Development. Geneva

References

1. International Policy Network, Philip Stevens. Diseases of poverty and the 10/90 Gap. November 2004
2. Sarah Ramsay. No closure in sight for the 10/90 health-research gap, 2001 Elsevier Ltd. 
3. United Nations (2000). UN Millennium Development Goals. New York.
4. Global Forum for Health Research. Young voices in research for health 2007
5. WHO (2001). Macroeconomics and Health: Investing in Health For Economic Development. Geneva.
6. Global Forum for Health Research. The 10/90 report on health research 2001-2002. Geneva.
7. Global Forum for Health Research Report 2008
8. Bell S. From practice research to public policy--the Ministerial Summit on Health Research. Ann Pharmacother. 2005 Jul-Aug; 39(7-8):1331-5. Epub 2005 Jun 7.
9. WHO. Gender and the 10/90 gap in health research, Bulletin of the World Health Organization. v.82 n.3 Genebra mar. 2004
10. Pakistan Medical Research Council. Hyder AA, Akhter T, Qayyum A. Capacity development for health research in Pakistan: the effects of doctoral training. Health Policy Plan. 2003 Sep; 18(3):338-43. Islamabad, Pakistan. 
11. WHO Report on Infectious Diseases 1999: Removing Obstacles to Healthy Development.
12. World Health Report 2002
13. PhRMA. Medicines in Development Surveys 2003/2004

 

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