A bevy of diseases common in the third world aren't receiving adequate attention from funders, despite $2.5 billion spent by philanthropic organizations, governments, and pharmaceutical companies in 2007, according to the most comprehensive survey of global health spending conducted to date.

That's because approximately 80% of that money went to developing products targeted towards just three diseases -- AIDS, tuberculosis and malaria.

"When you look at all the diseases in developing world, there's a lot more than just AIDS, TB and malaria," Mary Moran, policy analyst at the George Institute for International Health in Sydney, Australia and first author on the paper announcing the survey results, told The Scientist. "It was clear that there are a bunch of diseases that weren't getting enough support."

The G-FINDER (Global Funding of Innovation for Neglected Diseases) survey aims to track global R&D investment in "neglected" diseases, defined by their disproportionate prevalence in developing nations, their need for treatment products, and their lack of a significant commercial product market. The Bill and Melinda Gates Foundation commissioned the George Institute to conduct the G-FINDER survey each year until 2012. The results of the first iteration of the G-FINDER survey, which was launched online in July of 2008, appear in the latest issue of PLoS Medicine.

More than 130 funders completed the survey, which spanned 30 different diseases, from AIDS and malaria to sleeping sickness and strains of pneumonia specific to developing nations, and 127 different product categories, such as diagnostics, new drugs and vaccines.

Ruth Levine, senior fellow at the Center for Global Development, told The Scientist that the G-FINDER survey is the most comprehensive and detailed look at the global neglected disease R&D funding landscape ever compiled. "It really is great that [the George Institute] has a commitment to do this for a number of years," said Levine, who was not involved with the study. "It really is an important contribution."

Moran said that she and her coauthors were surprised by the fact that the total amount of money going towards research into neglected disease was so high, but added that there are some widespread diseases -- such as pneumonia, diarrheal diseases, and cholera -- that deserve more funding. "There's a lot of money and good will, but there's a lot of concentration in terms of where the funding went," she said. "There are a lot of diseases that need attention."

The sources from which the lion's share of the funding came were similarly concentrated. Moran and her colleagues found that two organizations -- the US National Institutes of Health and the Bill and Melinda Gates Foundation -- contributed approximately 60% of the $2.5 billion spent in 2007. They also found that about 90% of the money came from either public or philanthropic funders, while about 9.1% came from pharma and biotech contributors.

The report also parsed out the contribution of different countries. The US's level of investment dwarfed other countries, at more than 70%. The European Commission came in second with almost 7% of the total, and the UK invested about 5.7% of the total.

"You'd expect to see all of the G8 countries to be big funders," Moran said. "But I have to say, you don't see that."

Moran added that the development of new diagnostics for neglected diseases needs more attention. Diagnostics, she explained, can be developed for proportionally less money than medications, so a small increase in investment can yield far-reaching results. "A little bit of funding can make a big difference," she said.

Jeremy Shiffman, a political scientist at Syracuse University who studies global health policies, told The Scientist that the report is sorely needed in a world where some of the most neglected diseases lack the "advocacy power to generate resources."

"Drawing attention to these most neglected diseases and conditions is very welcome," said Shiffman, who was not involved with the study. "People need to pay attention."

In particular, Shiffman said that he hopes certain advocates for the "big three" neglected diseases are made aware of the breadth of the problem with other neglected diseases afflicting the global poor.

"I think that many AIDS advocates are very open and concerned about other conditions, but there's a small minority who are very myopic, and they only care about people who die from that disease," he said.

Shiffman said that the G-FINDER and other surveys of global public health spending may open up investment opportunities for severely neglected conditions, such as those that claim the lives of 4 million infants every year. But whether funders will step up and devote resources to the most neglected diseases remains to be seen, he added. "What I really hope happens is that we manage increase the pool of money for diseases that affect the poor, including AIDS," he said. "In an ideal world, that is what would happen. But we don't live in an ideal world. The world is not rational."

While he lauded the systematic and detailed nature of the G-FINDER report, Shiffman said that data collection alone does not solve the health problems experienced by millions of the world's poor.

"No matter how much data and information we collect, it's always a political game," he said. "It will take stronger advocacy on behalf of the most neglected diseases and conditions."


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