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Neglected Diseases

What is the 10/90 Gap?  – Neglected Diseases

Activists claim that only 10 per cent of global health research is devoted to conditions that account for 90 per cent of the global disease burden – the so-called ‘10/90 Gap’. They argue that virtually all diseases prevalent in low income countries are ‘neglected’ and that the pharmaceutical industry has invested almost nothing in research and development (R&D) for these diseases.

Citing this alleged imbalance as justification, activists have been calling for a complete redesign of the current R&D paradigm in order to ensure that more attention is paid to these ‘neglected diseases’.

This could include measures such as an ‘essential research obligation’ that would require companies to reinvest a percentage of pharmaceutical sales into R&D for neglected diseases, either directly or through public R&D programs.

But does such an imbalance really exist and what would be the effect of redesigning the R&D system? This article investigates the realities of the 10/90 gap and its relation to the diseases of poverty.

Neglected diseases

Many scholars and activists have suggested that the pharmaceutical industry is failing to devote sufficient R&D effort towards finding effective cures and treatments for tropical infectious diseases such as leishmaniasis, lymphatic filariasis, Chagas’ disease, leprosy, Guinea worm, onchocerciasis and schistosomiasis.

These so-called ‘neglected’ diseases predominantly effect poor populations in low income countries, and pose particular social and economic problems for those affected.

Patrick Trouiller, for example, has pointed out that of the 1,393 total new drugs approved between 1975 and 1999, only 1 per cent (13 drugs) were specifically indicated for a tropical disease.

Research conducted by the DND Working Group and the Harvard School of Public Health in 2001 revealed that of the 20 global pharmaceutical companies surveyed, only two had research projects underway for the ‘neglected’ diseases of Chagas and leishmaniasis.

However, these bare statistics serve to mislead people into thinking that the poor are suffering at the expense of the rich. The reality is that ‘neglected’ diseases often do not represent the most pressing public health priorities in low income countries.

They constitute a small fraction of their total disease burden. According to the 2002 World Health Organisation’s (WHO) World Health Report, tropical diseases accounted for only 0.5 per cent of deaths in high-mortality poor countries, and only 0.3 per cent of deaths in low mortality poor countries.

Moreover, treatments already exist for many of these diseases. Schistostomiasis (bilharzia), which predominantly affects children in Africa, can be treated with praziquantel at a cost of 30 cents per child per year. Onchocerciasis (river blindness) is controllable with ivermectin.

A range of treatments exist for lymphatic filariasis (elephantiasis). The only significant tropical disease for which there is no existing medicine is dengue fever, but even for this disease there are five compounds currently at the state of discovery and preclinical development, a further two in Phase 1 trials and one more in Phase 2 trials.

In fact, the WHO acknowledges that there are only three diseases that are genuinely ‘neglected’: African trypanosomiasis, leishmaniasis and Chagas disease.