Applying science to the diseases of poverty.

Abstract

TDR, the Special Programme for Research and Training in Tropical Diseases, was set up in the mid-1970s to promote research to improve the health of the poor. This year TDR celebrates 30 years of its key decision-making body, the Joint Coordinating Board--one of the first such bodies to represent a balance of donor and disease-endemic countries. This year a new strategy marks a turning point for TDR, which is co-sponsored by the United Nations Children's Fund, the United Nations Development Programme (UNDP), the World Bank and the World Health Organization (WHO). Dr Robert Ridley explains. Q: Why was TDR originally set up? A: TDR was set up in the mid-1970s when WHO, through its Advisory Committee on Health Research and the World Health Assembly (WHA), recognized that science was not being applied enough to of poverty. The idea was to create an organization that had a broad-based governance mechanism beyond WHO, since it would rely on voluntary contributions and would not take contributions from the core needs of WHO. WHO and the WHA recognized that this research had to be done through partnerships. UNDP and the World Bank backed the project and other organizations came on board. TDR's original goal was to promote research led by people and institutions in countries that are affected by diseases. That model and goal are as valid today as they were. Q: The concept of tropical diseases originates from the practised by 19th century colonial powers to protect themselves in the tropics. Have you considered changing your name? A: There has been some discussion about the name. Our new strategy refers more to infectious of poverty, but if you look at the terms tropical disease and medicine they still cover a field that is generally recognized today. You still have associations and institutes with the name and--at WHO--a department of neglected diseases, The name has other connotations which we should be aware of, but given the recognition of the name and loyalty to TDR, particularly in developing countries, we decided to keep it. Q: Has the Global Fund to Fight AIDS, Tuberculosis and Malaria drawn donor funds from TDR? A: The fund is not pulling resources from TDR. The fund finances drug procurement and national strategies. We promote research on how to scale up provision of those drugs in resource poor settings for the implementation of public health programmes and the effective delivery of products. Control and implementation are too often seen as distinct, but in fact they are two sides of the same coin. The best control programmes take account of research from the start and vice versa. Q: TDR is working with developing countries to protect clinical trials participants. But do the resulting national ethical review committees have the technical competence? A: There is a common misperception that there isn't adequate capacity to carry out any research in developing countries and that they are reliant on researchers in developed countries. We need partnership between north and south but we also need to recognize the ability of developing countries to fully participate and engage, and to initiate things on their own. That way we can avoid the mistakes often made by top-down approaches, whether in research or in development aid. The Strategic Initiative for Developing Capacity in Ethical Review, or SIDCER, was prompted by the need for strong ethical review in countries. Many ethical committees are now starting to submit themselves to systems and standards of accreditation. It is adding to the quality of clinical research. Most success so far has been in WHO's South-East Asia Region and the Commonwealth of Independent States but there is increasing activity in other regions. Q: One of the most elusive quests of scientific research has been for a malaria vaccine. Why have so many promising candidates failed and should more money be invested in this area? …