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Malaria and other neglected diseases are the itch that must be scratched

At the playground on a beautiful spring day in April, my four-year-old pauses, mid-stride. Between the swings and jungle gym, he’s bitten by a mosquito and absently scratches his arm before running off to play.

Though his arm may be itchy for the next few days, he will survive. In another part of the world, that same mosquito bite could have been a death sentence. My four-year-old has no concept of how lucky he is—that through the accident of birth, he ended up in a place where most mosquito-borne diseases are not a major issue.

{mosads}The Zika virus is the latest tropical disease to generate worldwide concern, and if we lived in Brazil or some other parts of the Americas, we might be worried sick about this bite. In the Caribbean, dengue fever or chikungunya could be a threat to his health. And in sub-Saharan Africa, the specter of malaria—one of the major killers of children under the age of five—would loom over us. While we in the United States shouldn’t dismiss these threats too readily, we have a much stronger public health system and resources, so these are threats rather than urgent health crises.

In the global health field, we celebrate all of the progress that has been made since 2000. Cutting the number of deaths from malaria in half, from one million to approximately one half million, is one of the primary drivers of this progress. Over the past 15 years, we have seen more and more children sleeping under bednets to avoid being bitten by malaria-carrying mosquitoes, and those that are bitten are diagnosed and treated faster. As a father, it’s heartening to know.

But, as a scientist who has dedicated his career to combatting malaria, I am also saddened that so many children, the majority of them under the age of five, still die. I am driven by the need to find solutions—new drugs and vaccines, new technologies that remove the threat of mosquitoes and the malaria parasite to vulnerable populations.

Those of us working to combat diseases like malaria, tuberculosis (TB), HIV/AIDS, and a host of neglected tropical diseases find ourselves in the same proverbial boat. We celebrate partial success even as we keep trying to find more permanent solutions. In the interim, we do what we can to contain and cure these diseases with the tools we have—tools that often wear out over time as drug or insecticide resistance emerges and threatens to unravel the progress we’ve made.

When Ebola became a major issue two years ago, during an epidemic that killed 11,000 people in West Africa, there were no approved drugs to treat the disease or vaccines to prevent transmission of the virus—even though the first known outbreak took place in the early 1970s. The urgency of the situation, along with robust media coverage of the outbreak, resulted in a surge in research funding, which accelerated development and testing of a number of candidate drugs and vaccines in early stage development.

And yet for malaria, the last several years have seen no such surge in funding. We are hopeful for the coming year, thanks to the commitment in President Obama’s State of the Union Address in January and his latest budget proposal. However, the outlook for other neglected diseases and the institutions critical to ensuring their eventual demise is not as rosy.

A new report from the Global Health Technologies Coalition (GHTC) highlights some of these funding problems. The US government’s investment in research and development (R&D) for neglected diseases like malaria, TB, and HIV/AIDS has stagnated since 2009. And if you set aside the Ebola funding surge, funding for these diseases has dropped nearly 13 percent from its peak in 2009.

Echoing these findings is peer-reviewed research just released in The Lancet, which said that a shift in funding away from malaria in particular could endanger elimination efforts in countries such as China, Mexico, Turkey and South Africa—countries right on the verge of finally beating the disease.

What funding the United States has provided is helping to generate a significant number of promising drugs, vaccine approaches, and other technologies. GHTC’s report notes that the global health R&D pipeline—the clinical trial path from exploratory development to regulatory approval—has grown from around 215 products under development in 2004 to nearly 500 products today.

Here in the United States, we are supremely lucky that most of us don’t have to deal with the consequences of these diseases on a daily basis, but that makes it easy for us to become complacent—particularly when disease incidence is on a downward trajectory. Out of sight, however, should not mean out of mind.

While my four-year-old cannot comprehend many of these details, my eight-year-old has a basic understanding. Dinner table conversations on what I do for a living always touch on the importance of curing malaria and all these other diseases. When I tell them about how smallpox has been defeated, and how close we are to beating polio as well, the eight-year-old wants to know why malaria is still a problem elsewhere in the world but not where we live.

The next global epidemic will always be lying in wait unless we’re stocked with the right weapons to fight them. Instead of reactive funding surges, we need a more comprehensive approach so that we can accelerate the eradication of all of these neglected diseases.

Children are more than just numbers. Each one should have the same opportunity to grow up happy and healthy, irrespective of where in the world she or he happens to be born.

Ashley Birkett is the director of the PATH Malaria Vaccine Initiative (MVI). He first joined PATH in 2008 as MVI’s director of research and development.


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