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Developing-world health

The fightback starts here

Will 2003 be seen as a turning point in the battle against the infectious diseases — such as malaria, tuberculosis (TB) and AIDS — that blight the lives of millions of people across the developing world? Certainly, big sums of money have now started to flow, and research and control efforts have begun to come together.

This was the year in which US President George Bush pledged to spend $15 billion over five years to tackle AIDS in Africa and the Caribbean. The Global Fund to Fight AIDS, Tuberculosis and Malaria, backed by donations from the world's wealthy nations, approved projects worth $623 million in 50 countries, bringing its total spend to almost $3 billion. And the philanthropic Bill & Melinda Gates Foundation gave out $700 million for global health — including $200 million for basic research.

Although most of the new funds are for efforts to control disease, they will have knock-on effects for research, argues Richard Feachem, executive director of the Global Fund. “They represent a major increase in demand, and guaranteed demand at high volumes is what fuels R&D,” he says. “The world will know that there is now a buyer for medicines for diseases of poverty.” Control funds also pay directly for epidemiological and clinical research, providing substantial new data, particularly on drug resistance, Feachem adds.

AIDS has cruelly exposed the problem of restricted access to expensive drugs in poor countries. But at least new drugs exist for AIDS. For malaria, TB and a host of other diseases, there has been no significant new therapy for decades, because the market-driven drug industry has had little incentive to develop them.

But there are now signs of a new model for drug development for such diseases, in which the public sector works in tandem with the pharmaceutical industry. The Swiss-based multinational Novartis, for instance, has teamed up with the government of Singapore to launch the Novartis Institute of Tropical Diseases, which will focus initially on dengue fever and multidrug-resistant TB. Novartis will provide most of the institute's annual budget of some $15 million, and will make any drugs it finds available to developing countries without royalties. The centre hopes to punch above its weight by getting governments and philanthropists to pay for the most expensive aspects of drug development, such as clinical trials.

A similar public–private partnership underpins the Drugs for Neglected Diseases Initiative, launched in July, which will seek cures for sleeping sickness, Chagas' disease and leishmaniasis. These efforts join existing partnerships such as the Medicines for Malaria Venture (MMV), the Malaria Vaccine Initiative and the Global Alliance for TB Drug Development. It is too soon to say whether these initiatives will deliver, as their research leads have yet to survive the long trek to the clinic. But all have strong product pipelines, where little or nothing existed previously.

The Gates foundation has spurred the growth of such partnerships, priming them with millions of dollars. In September, it gave the MMV an extra $40 million to bring to the clinic the four most-advanced drugs in its 21-candidate pipeline.

Even the wildest optimists, however, point out that the money now being spent is a fraction of the sum needed to defeat AIDS, malaria, TB and other devastating diseases. Indeed, it is likely to be decades before we can assess the impact of today's investments in research and control. “They will need to be sustained for more than a generation to make any significant impact,” warns Paul Herrling, head of corporate research with Novartis.

Global Fund to Fight AIDS, Tuberculosis and Malaria →

Bill & Melinda Gates Foundation →

Drugs for Neglected Diseases Initiative →

Medicines for Malaria Venture →

Malaria Vaccine Initiative →

Global Alliance for TB Drug Development →


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Butler, D. The fightback starts here. Nature 426, 754 (2003).

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