Geneva, May 2002—The allocation of only about 10% of the US$73 billion spent globally every year on health research for 90% of the world’s health problems persists, but for the first time there is real hope of narrowing this 10/90 gap.

“We have reason to be optimistic,” says Richard Feachem, chairman of the Global Forum for Health Research, who has just been appointed Executive Director of the Global Fund to Fight AIDS, TB and Malaria.

Dr Feachem made his comment in connection with the release of the third report on this imbalance in health funding, The 10/90 Report on Health Research 2001-2002.

“While this 10/90 gap was known to relatively few people ten or even five years ago, its existence is widely recognized today. The 10/90 concept has spread widely to political, academic and media circles. When a problem has been widely recognized as a very serious one, it mobilizes forces to find a solution.”

He adds that “the human and economic costs of such misallocation of resources are enormous, particularly for the poor. It is now recognized that investment in global health will save millions of lives and also produce enormous economic gains. This report underlines the crucial role of health and health research in breaking the vicious circle of poverty.”

The 10/90 Report points out that “of the 1,233 drugs that have reached the global market between 1975 and 1997, only 13 were for tropical infectious diseases that primarily affect the poor.”

Compared to the billions of dollars invested in research on diseases in the industrialized North, only $383 million was spent in 2000 on four tropical diseases prevalent in the South – malaria, TB, trypanosomiasis (sleeping sickness) and leishmaniasis – and yet together they account for at least 5% of the total global health burden. Five percent of the total burden should mean an investment of US$3.5 billion.

Roughly 50% of all health research funding comes from governments, while the pharmaceutical industry contributes 42%. The remainder is financed by the not-for-profit private sector (foundations, NGOs).

"Setting priorities for health research is just as critical as carrying out the research itself," insists Louis Currat, Executive Secretary of the Global Forum. "Since research funding is limited, a rational and scientific process for determining priorities is essential. But there is no simple way to set priorities. It is the failure to do so that has led to the 10/90 gap."

The report stresses that prioritization of health research spending at the global and national levels is an absolute necessity if our limited health research funds are to have the greatest impact possible on the level of world health.

But it is not enough to set priorities in terms of individual diseases. What must also be considered in the prioritization exercise are such cross-cutting influences as the capacity of a country to deliver health services, the necessity to look at gender differences, behaviour and lifestyles harmful to health, and environmental problems like indoor air pollution.

The report presents new work on priority-setting methodologies. "This is what we call the Combined Approach Matrix, says Louis Currat. "It borrows from the best features and methods of other approaches."

The methodology has been tested during the past two years with institutions working on malaria, onchocerciasis (river blindness) and indoor air pollution (IAP). IAP derives from the use of simple biomass fuels (wood, dung and crop wastes) by poor people. It is in fact a major public health problem since it affects 3 billion human beings, almost half of the world population, and is responsible for about 4% of the total global disease burden. Women and young children are particularly exposed.

"These were successful pilot tests," asserts Louis Currat. "We are actively encouraging our partners to pursue this approach and to share their results."

As Walter Fust, Director of the Swiss Agency for Development and Cooperation, put it at the last annual meeting of the Global Forum in Geneva in October 2001, “We know that without progress in health and development, there will be no global security, and industrialized countries will in turn be confronted with all the consequences of preventable man-made disasters.”

The link between health, health research and global security; the definition of priorities for health research; the development of partnerships and networks; a stronger emphasis on poverty and health from a gender perspective; and the use of the Global Forum's priority-setting approach are five of the many issues covered in the 240-page Report. They are also on the agenda of the Global Forum's next annual meeting, Forum 6, in Arusha, Tanzania, from 12 to 15 November 2002. For details, see www.globalforumhealth.org.

GLOBAL FORUM CONTACTS for additional information or interviews:

Richard G.A. Feachem
Director, Institute for Global Health,
USA
Tel. 1 415 597 8208
E-mail rfeachem@psg.ucsf.edu

Louis J. Currat
Executive Secretary, Global Forum
Health Research, Geneva
Tel. 41 22 791 3418
E-mail curratl@who.int

Susan Jupp,
Senior Communication Officer,
Global Forum for Health Research,
Tel. 41 22 791 3450
E-mail info@globalforumhealth.org