What Counts Isn’t Always Counted

There can be no doubt that “sick people in poor countries are deeply disadvantaged,” and the author clearly demonstrates compassion on their behalf. Yet, the data presented overstates the case for neglected diseases in the developing world. The WHO classifies ten diseases as ‘neglected.’ They include the six tropical diseases, plus HIV/AIDS, TB, Malaria, and Diarrhoeal Diseases. Taken together, WHO records a mortality of 5.4 million in 2004, or slightly less than 5% of the global total.   

The author ignores the substantial progress made on the reduction of tropical diseases over the past decade or so. WHO records that 200,000 died of schistosomiasis in 1993; that number was reduced to 0% by 2004. In that same year, WHO documents that of the six tropical diseases, total mortality fell from 171,000 in 2000 to 129,000 in 2004, and that for four of them, the mortality rate was 0%.  

Moreover, the work on the part of the WHO and other organizations on tropical diseases has been significant. WHO’s Tropical Disease Research Programme has invested some $900 million since 1977 and has successfully developed several new therapies. The Gates Foundation has a $400 million program in malaria research, and USAID is currently conducting a $1.2 billion malaria program in Africa. The Global Fund for HIV/AIDS, TB and Malaria, and the PEPFAR effort has invested billions in these diseases over the past four years.  

Placing blame on the pharmaceutical companies for their failure to invest in research and development of medicine for neglected diseases contravenes this fact: in the 21 years since the AIDS virus was identified, these same companies developed 86 new drugs for treatment, at an estimated investment of $69 billion. In the annals of science, seldom—if ever, has a single industry been able to respond to a global crisis in this same expeditious manner. In WHO’s Progress Report on the ‘3 by 5’ plan, it states that between 250,000 – 350,000 deaths were averted as a result of this R&D investment.   

The author is correct in stating that taxes, duties and mark-ups for drugs result in high prices to patients. However, the exact quote from this WHO study is even more telling: “One major finding of the surveys was that taxes and duties levied on medicines, as well as the mark-ups applied, frequently contribute more to the final price than the actual manufacturers’ price.”  

More importantly, however, the greatest health problems in the developing world—and the costliest to societies, no longer stem from tropical or neglected diseases. In October 2005, WHO published a report detailing how 388 million people will die by 2015 from chronic diseases. Of this total, 80% of the mortality will fall on the developing world. In China alone, WHO estimates that it will forego $558 billion in national income over the next ten years as a result of premature deaths caused by heart disease, stroke and diabetes.  

As a matter of public health policy, we ought to encourage the pharmaceutical companies to keep their engines of innovation running at fever pitch. In this manner, their R&D outputs can continue to provide a steady infusion of contemporary therapeutic products to those most in need of medical treatments. This month, the U. S. Food and Drug Administration approved the world’s first vaccine for a cancer. After cardiovascular disease as the leading killer on a global basis, cancer is rated by WHO as the 2nd leading cause of death. Now, with a vaccine for cervical cancer, one of the primary causes of mortality for women in the developing world, they may need never to face the specter of this dread disease.