Malaria research and development is enjoying sustained growth in spending, after languishing for decades until the 1990’s when the disease began making its way back on to the international political agenda. Experts warn against complacency, however, as the gains made could quickly unravel if funding growth slows down. The key tools of insecticides for vector-control and diagnostics are also still being neglected by donors who tend to prefer to fund R&D on more glamorous drugs and vaccines.
Investment in research and development for tools to fight malaria increased fivefold from US$121 million in 1993 to US$612 million in 2009, with a large uptick in funding since 2004, according to a new report – Staying the Course? Malaria Research and Development in a Time of Economic Uncertainty – commissioned from the Policy Cures consultancy by the Roll Back Malaria Partnership and the global health non-profit PATH.
The report’s big conclusion, says Awa Coll-Seck, head of Roll Back Malaria, is that in terms of research, malaria is no longer the neglected disease it was just a decade ago, and the increased funding is generating an unprecedented pipeline of new drugs, vaccine candidates, and other control tools. But the report also shows that the funding must be maintained. Any slowdown in funding risks delaying getting products to market, and increasing costs, warns Janet Hemingway, director of the Liverpool School of Tropical Medicine, and CEO of the non-profit Innovative Vector Control Consortium. “There’s not a lot of slack in the system.” The report estimates that a relatively small increase in funding to US$690 million by 2015, followed by a larger jump in 2016 to US$785 million, is needed.
The overall upbeat picture doesn’t hold for all areas though, and diagnostics and vector-control in particular remain underfunded, attracting just 1% (US$23 million) and 4% (US$72 million) of research spending, respectively over the period 2004 to 2009 – compared with 23% for basic research ($455 million), 28% (($544 million) for vaccines and 38% ($752m) for drugs. Although R&D costs for diagnostics and vector-control are lower than for drugs and vaccines, which explains much of the gap, they nonetheless are badly in need of extra funding — the report estimates annual funding for diagnostics needs to more than quadruple immediately to around $50 million, and vector control threefold to $90 million per year by 2016, if new products and concepts are to be developed.
“There’s gross underfunding of diagnostics,” says David Bell, head of the malaria diagnostics programme at the Foundation for Innovative New Diagnostics, a body created in 2003 to develop and deploy affordable, innovative diagnostics in poorer countries. Diagnostics are crucial to underpinning malaria control efforts generally, he points out, but their importance isn’t as visible as it is for drugs and vaccines: “diagnostics are harder to sell,” he says.
But diagnostics are essential, for example, to prevent unnecessary use of anti-malarial drugs, which is both costly and increases the risk of parasites becoming resistant to drugs – fever in Africa and other malarious regions is often treated as malaria, but up to 85% of fever cases in Sub Saharan Africa have causes other than malaria. In 2009, the World Health Organization endorsed universal diagnosis before treatment with malaria drugs, but while malaria diagnosis is well established in Asia and South America, it is much less so in Africa, he says. Moreover, better and cheaper diagnostics and surveillance infrastructure are critical if countries are to keep tabs on the epidemiology of malaria, and help target areas where treatment and prevention is most needed.
Vector-control research suffers a similar image problem, says Hemingway, with chemicals, not enjoying the same perception as having life-saving benefits as do drugs or vaccines. “It’s not seen as a great vote winner,” she says, noting that this is shortsighted as insecticide-treated bednets and house spraying, mainstays of malaria control, depends on one long-lasting insecticide, pyrethroid, which mosquitoes are fast becoming resistant to. Research to develop new products is urgently needed, she says.
So far, the economic crisis is not affecting malaria research, says Mary Moran, director of Policy Cures. as although several countries have cut back funding this has been more than offset by increases by other countries, in particular the US and UK. Much of new funding is coming from economic stimulus packages to reinforce research is, however, being targeted at basic research to the detriment of other areas, she says, warning that there are signs of a drop in funding for product development, in particular for the drug and vaccine public private partnerships that play a central role here.
The funding base is also narrow. Philanthropies and public bodies accounted for more than four fifths of funding between 2007 and 2009, and funding is worryingly highly-dependent on a few donors. Just two organizations – the Bill & Melinda Gates Foundation and the US National Institutes of Health (NIH) — account for half (and 85% of the increase over the period), while the United States alone accounts for half of all public investment, five times more than any other government.
Auditing the many various funding flows for malaria research is a difficult business, and this is the first such global audit since 2005. The new report will help governments and other donors get a clearer view of the big picture and where funding gaps exist.
There needs to be better analysis of product portfolios by donors, says Moran, to better tailor donations to needs, for example, by cutting back on funding of projects reaching maturity, and increased investment in areas in need of a boost. That doesn’t happen sufficiently, she says, with donors often funding pet areas. There’s a need for greater coordination among donors, agrees Coll-Seck.