From bright ideas to tools: the case of malaria.

Abstract

Securing the right of the world's poor to live and thrive by developing effective weapons to prevent, reduce, cure, or eliminate infectious diseases was the goal underpinning the creation of the United Nations Children's Fund (UNICEF)/United Nations Development Program (UNDP)/World Bank/World Health Organization (WHO) Special Programme on Research and Training in Tropical Diseases (TDR) [1]. At the time of its creation, 1975, the WHO Smallpox Eradication Unit had successfully led, and was on the verge of concluding, smallpox eradication efforts [2]. Hope was high that a targeted tropical disease program could bring state-of-the-art knowledge to the development of new tools to reduce the large burden of six diseases—malaria, schistosomiasis, trypanosomiasis, leishmaniasis, filariasis, and leprosy [3]. Tool development required knowledge, and knowledge required research. The best science was clearly the place to start. Scientific Steering committees were created to fund the best scientific ideas in each disease, to upgrade research capacity to self-sufficiency in disease-endemic countries (through a Research Capacity Strengthening Committee [RCS]) and to improve the delivery of new tools and understand economic aspects of disease control (through a Social and Economic Research Committee [SER]). These committees reviewed and funded research annually or biannually, assessing the best ideas, whatever their origin, much like the “Grand Challenges” approach of today. Scientific peer reviews regularly fine-tuned the structure and direction of research undertaken and approved budgetary allocations. The exception was RCS, which received 25% of the Programme budget until around 2004 (Fig. 1), thus safeguarding one of TDR's goals—to develop local capacity to contribute research for disease control [4]. Figure 1 TDR Research and Research Capacity Strengthening (RCS) funding, 1975–2008. The budget allocated to research (excluding program costs) was above US$20 million annually, with the largest contributions from Scandinavian countries; the United States; and the UNDP, World Bank, and WHO as co-sponsors (1974–1992) [5] and thereafter from increasingly diverse designated funders [6]–[7]. Throughout, TDR kept internal electronic records of the research it funded, until 2008, when the records management system changed for the whole of the World Health Organization. In this paper, we use TDR internal data from 1975 to 2008 to review changes in strategy and funding which separated the first 20 years from subsequent years, focusing on malaria. We provide a personal perspective and some reflections on the rationale underpinning the changes.