Rich countries study the diseases that afflict their citizens. For the ailments of the poor world, they offer sympathy and perhaps a few bucks. And that explains the plight of malaria, a disease that ranks high for death and disability in poor countries but very low in research expenditures among the rich, where it is rare to nonexistent.
An effort to break out of that bind recently failed when a group of the world's leading pharmaceutical companies turned down a proposal to establish a consortium of public and private organizations for research on malaria and other tropical diseases. According to a report in Science magazine, the companies begged off on a variety of commercial, legalistic and scientific grounds, with some of them explaining that they're already doing some work on malaria drugs and vaccines.
But malaria researchers skeptically note that the disease, which is virulent in many parts of Asia and Africa, offers little potential for long-term profits or even recouping the costs of research. The prevention and treatment of malaria pose daunting scientific problems that many researchers would happily confront. Politically and commercially, however, the wasting disease is a non-starter.
The rejected plan for a consortium called for a seven-year buildup to an annual level of about $30 million, with private firms providing 70 percent of the total and foundations, governments and international health agencies contributing the balance.
In the global bookkeeping of health research, the sums involved are minuscule. The U.S. government alone spends more than $14 billion a year on biomedical research, while pharmaceutical firms report their combined expenditures exceed that amount. Western Europe and Japan are also big spenders, in the multi-billion-dollar range.
Malaria sickens scores of millions and annually kills an estimated 3 million, including a high proportion of children. The disease is not altogether ignored by the scientific powers of the world, which are almost wholly anchored in the developed world. But in terms of scientific purchasing power, it's small stuff, with annual worldwide expenditures of around $100 million.
Of that sum, the U.S. government provides about $25 million, mainly through the National Institutes of Health and the U.S. Army, which is increasingly concerned about health threats in tropical areas of potential deployments. But if money talks, it's saying that malaria is not our problem. When politics is agitated by public concern about disease, the money flows freely. Thus, NIH spends $2.5 billion a year on cancer research, while the Army, at the direction of Congress, spends $135 million a year on breast cancer studies. Propelled by fear, intense lobbying and politics, AIDS research soared from nothing to more than $1.5 billion annually in 15 years.
Humanitarian concern has clearly proven insufficient for mobilizing the industrialized world's scientific resources against a distant disease. But maybe it's not so distant, thanks to the never-ending boom in air travel. Though malaria was banished from the United States by strict application of mosquito-control measures, the disease is brought home by some 3,000 travelers per year who were infected abroad. Recent outbreaks in popular areas of tourism, including Thailand and the Pacific coast of Mexico, are noted with concern by malaria specialists.
And then there's "airport malaria," the term for domestic cases that have been traced to mosquitoes from malarial regions hitching rides aboard U.S.-bound aircraft. Malaria specialists say that 50 to 100 cases per year in the United States are attributable to that source of transmission. And there's deep concern about the development of resistance to widely used drugs -- for which there are no reliable replacements in the pharmaceutical pipeline.
If malaria becomes a serious problem for the rich nations, it's a certainty that their formidable scientific resources will be deployed against the disease, with very good chances of success.
The unfortunate fact is that foresight and compassion are no match for politics and profits in setting priorities for disease research. When malaria comes here, we'll seriously get to work on it. But sadly, not until then.
Daniel S. Greenberg is editor-at-large of Science & Government Report, a Washington newsletter.
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