Many years ago there was a British radio programme that began each week with presenter and pianist Alberto Semprini announcing his intention to play ‘Old ones, new ones, loved ones, neglected ones’. It would have been hard for him to achieve the right balance and devote a sufficient proportion of his attention to each of these four categories, but evidently he succeeded as his programme ran for nearly 25 years.

Health policy makers might well envy Semprini’s talents; they have to perform a balancing act involving some surprisingly similar categories. It might be argued that no one loves an infectious disease but the complex relationship scientists have with their main interest is not so far removed from love, and policy makers too can come to focus on a particular disease that has aroused their fascination. This makes it hard to be objective in deciding how much attention (and funding) should be devoted to diseases that are old, new, loved or neglected. Policy makers’ decisions can of course lead to a disease shifting from one category to another. HIV/AIDS, for example, was not so long ago a new infection but, following some very effective campaigning, has become a ‘loved’ disease, attracting funding for research and control efforts that are disproportionately large, given its contribution to the global disease burden. Diarrhoeal disease and lower respiratory infections, which kill more children than does AIDS, have meanwhile been reassigned to the neglected category.

The 2009 meeting of WHO’s governing body, the World Health Assembly, has been controversial. Médecins Sans Frontières allege that a new disease, swine flu, pushed a neglected disease (Chagas) off the WHA agenda – see TropIKA.net News. Did the WHA get the balancing act right here? The situation demonstrates one of the dilemmas that policy makers face. Without, at this stage, adequate evidence as to how the swine flu epidemic will progress, it is impossible to say whether its impact will exceed that of Chagas disease, which kills 15,000 people each year. But some specialists say that swine flu could cause up to two million deaths globally – as mentioned in one of our occasional TropIKA.net updates on the disease – and WHO has urged its member states to be prepared to deal with a potentially serious pandemic. (As reported elsewhere in TropIKA.net News, the WHA did pass resolutions concerning several other key issues, including primary health care and the social determinants of health.)

A very distinguished panel assembled by the US Institute of Medicine also needed to perform a balancing act in producing their new report (The US Commitment to Global Health: Recommendations for the Public and Private Sectors) featured in TropIKA.net’s Reports section. The authors want to see the US double its financial commitments to global health by 2012. This would amount to a total of $15 billion, but what proportion of such a sum would be received by each of the many competing priorities? The report identifies three main categories: 64% of funding would go towards AIDS, malaria and tuberculosis; 23% would support programmes on women and children’s health, nutrition and the neglected diseases of poverty; and 13% would be devoted non-communicable diseases and injuries. Few would disagree with the authors that these are all priority areas but it is not clear on what basis they have divided up the funds that they hope the US will choose to make available.

TropIKA.net has reported many other developments during the last couple of weeks that may not have led to controversy but are nevertheless important: the Malaria Eradication Research Agenda (malERA) has launched a website; concerns over the appearance of malaria parasites that show resistance to artemisinin are discussed in the News and in the TropIKA.net Blog; and poor technique in the use of quinine injections continues to be an issue in Uganda where many children have suffered sciatic nerve damage. We have also featured another leading researcher from the South in our Profile series, where our latest interviewee is Professor Ogobara Doumbo of the Malaria Research Training Centre, Mali.

Paul Chinnock
Editor-in-Chief, TropIKA.net