Every few days there seems to be an announcement of the launch of a new programme or a new organization that seeks to address in some way the infectious diseases of poverty. When one considers the previous neglect of the disease burden in the world’s poorest countries, new initiatives are to be welcomed. One result, however, is that the so-called “institutional landscape” of global health is growing ever more complicated.

A study in the Lancet, highlighted on TropIKA.net analysed the flow of funding for global health programmes and one of its findings was that the role of the UN system has been diluted in recent years, since the launch of new programmes and agencies. An accompanying editorial asked, “Who runs global health?” The same study confirmed the dominance of HIV/AIDS, malaria and tuberculosis in the funding provided for global health, and another Lancet study bears out the view that big programmes focusing on these diseases can harm the ability of health systems to provide comprehensive health care. There is cause for concern that the proliferation of agencies and programmes, each with their own agenda, may have harms as well as benefits. Are there now too many institutions in the landscape?

Could there also be too many conferences? There are numerous TB conferences and when the annual Pacific Health Summit also chose to focus this year on drug-resistant TB one delegate told the meeting that she was tired of attending expensive gatherings hearing the same people say the same things – see TropIKA.net News. The organizers of this event did have a specific aim in mind – to get industry more involved in efforts to beat drug resistance and – while phrases like “stakeholder engagement” seem to many of us to be the worst sort of jargon – the activity they describe is important and international meetings are a part of the process. That said, many will have sympathy with the view that the global health conference circuit is getting out of hand.

Does it all lead to advances in research, and to progress in the control and treatment of diseases on the front line of health care? There has certainly been no shortage of progress for us to report on TropIKA.net in recent days. There has been media interest in the continuing phase 3 trials of the most advanced vaccine under development for malaria, RTS,S. The development of further malaria vaccines may be assisted by the resources for immunologists made available by the US National Institute of Allergy and Infectious Diseases on the new website of its malaria research programme. Meanwhile, a dengue candidate vaccine is soon to enter a phase 1 trial. The TB Alliance will provide support for the further development of a promising new TB drug.

Vaccination against pneumococcal disease in developing countries has come a step closer with the announcement of a $1.5 billion “Advance Market Commitment” [8].

Reports from Ethiopia describe the successful integration of trachoma and malaria control campaigns. Community level action has been shown in a study to be effective in controlling the mosquito vector of dengue fever in Cuba, and from India there are encouraging reports of community level projects for TB. All this is a long way from complex institutional landscapes and expensive conferences. However, if constant new initiatives and meetings at a global level really are essential to progress on the front line, then we shall have to learn to live with them.

Paul Chinnock
Editor-in-Chief, TropIKA.net