Center for Global Health R&D Policy Assessment

The term “10-90 gap” has been used to describe a tragic reality that fewer than 10% of the world’s resources for research and development (R&D) are available for the conditions and diseases affecting 90% of the world’s population – that which is disproportionately represented by people living in low-income countries. Through their G-FINDER series Mary Moran and her team at the George Institute in Australia have been tracking this situation and have determined that almost 80% of R&D funding for neglected diseases actually goes for research on “the big three diseases,” HIV/AIDS, malaria, and tuberculosis, leaving very little for neglected tropical diseases (NTDs) such as hookworm infection, schistosomiasis, river blindness, dengue, and others. I believe that for many of the NTDs we are now facing a “1-99 gap” or even a “1-199” gap for R&D expenditures.

To address this urgent situation, the Sabin Vaccine Institute in 2000 launched one of the first product development partnerships (PDPs) for developing new vaccines against the NTDs. Another is the Infectious Diseases Research Institute (IDRI) in Seattle, Washington. PDPs are non-profit organizations that use industry practices for making new pharmaceuticals. Our Sabin Vaccine Institute Human Hookworm Vaccine Initiative located in Washington DC has been developing and testing new recombinant vaccines for hookworm infection caused by Necator americanus, a disease and important cause of global anemia in about 600 million people living in Africa, Asia, and the Americas; we have since added projects for vaccines to combat schistosomiasis and hopefully soon one for opisthorchiasis/clonorchiasis, both parasitic worm infections linked to cancer in the developing world. I sometimes refer to them as “antipoverty vaccines” because the NTDs actually cause poverty through their impact on impairing child growth and development, pregnancy outcome and agricultural worker productivity. Our partnership works closely with two key Brazilian institutions – the Oswaldo Cruz Foundation and Instituto Butantan, as well as with research institutions and universities in China, UK, and Australia. While the major pharmaceutical companies have been wonderful for donating drugs, they have so far lagged behind in terms of R&D for neglected disease vaccines. However, recently, both Novartis and Merck & Co. (in a partnership with the Wellcome Trust) have also launched entities that resemble product development partnerships for neglected disease vaccines.

I hope the coming decade will be an exciting one for developing new antipoverty vaccines but for this to happen we will need global support for R&D for the NTDs. While the U.S. and UK Governments and a few private entities have been terrific for supporting mass administration of existing medicines, today support for R&D for antipoverty vaccines still relies largely on the Bill & Melinda Gates Foundation and some support from the U.S. National Institutes of Health and the Wellcome Trust. The Dutch Government has recently stepped up to announce support for new neglected disease products and I hope one day all of the G-20 countries will cooperate in creating a new global fund for this purpose. Sadly, today we face a disparity in which our technical capabilities have outpaced our social and political institutions for financing potential new breakthroughs. I hope the Results for Development Institute’s new website for global R&D will become an important vehicle for advancing policy on this and other important global health issues.

Peter Hotez MD PhD is President of the Sabin Vaccine Institute and Distinguished Research Professor at George Washington University