The Global Health Crisis and Our Nation's Research Universities

Abstract

On September 14th, 2009, the presidents of five United States universities—Boston University, Brown, Duke, Johns Hopkins, and the University of Washington—and representatives of over 50 North American institutions convened for the first meeting of the Consortium of Universities for Global Health (http://www.cugh.org). The meeting was in response to the demonstrated passion and interest of students in the field of global health and the responses needed from universities to cope with increasing student interest in this field. Of 37 institutions surveyed that feature global heath programs, the number of undergraduate and master's level students studying in the field has doubled since 2006. In this arena, growing student movements have helped lead the way. Organizations such as Clinton Global Initiative Universities have also successfully tapped into university student interest in global public health outreach and research. To be sure, universities are well poised to lead such a movement for global health: They are independent organizations, boast central missions to promote public welfare, and possess copious resources and knowledge to share with partner institutions globally [1]. All the while, what remains overlooked in this rapidly expanding global health movement is real innovation for prevention and treatment of the diseases of poverty; existing drugs, some more than 50 years old, accrue microbial resistance and, on the whole, exist only in unadjusted dosages for pediatric patients [2]. What's more, some drugs (e.g., the arsenicals and pentamadine) exhibit toxicities that we would consider unacceptable if they were widely used in the developed world. The innovation gap for the diseases of poverty is growing at a frightening pace. For instance, some estimates indicate that the total research and development funding for diabetes is more than 15 times that of malaria, and more than 100 times that of other parasitic infections such as hookworm, elephantiasis, and schistosomiasis. Because these diseases almost exclusively afflict the world's poorest people we must look to universities to provide some of the leadership on this issue. Other funding bodies—including the US National Institutes of Health (NIH)—are providing fresh capital for basic science research, but more funds are needed to cope with the global burden of neglected diseases [3]. Certainly, Dr. Francis Collins, the new NIH Director, has affirmed a strong commitment to global health in his strategic vision. but while we feel that he has made almost heroic efforts to ensure prioritization of a global health research agenda, the harsh reality is that the NIH budget has been essentially flat since 2003 [4]. The American Recovery and Reinvestment Act committed to $10 billion of stimulus funds to the NIH, US$8.2 billion of which is to be directed to scientific research priorities [5]. Treating the full range of diseases prominent in the global health arena is important. While we advocate an increase in the overall investment in global health disease research, we specifically call for a new and prominent focus on research for neglected tropical diseases (NTDs), a group of infections that together rival the disease burdens of more widely known global health epidemics, yet receive especially limited research and development [6]. The most recent global estimate of funding on all neglected diseases is at US$3 billion, with nearly three-quarters of the research funds earmarked for HIV/AIDS (40%), tuberculosis (15%), and malaria (18%) [7]. Just 0.4% of this pot (less than $10 million each) is targeted for diseases like leprosy, Buruli ulcer, or trachoma which affects over a billion people, 16% of the global population [7].