By Lars Güttier
Will we reach immortality before finding a vaccine for malaria? It may seem a slightly disturbing question, but the fact is that the medical research development over the course of the last two decades has made the question valid. Developments within the field of genetic engineering have had scientists pondering the mind-boggling prospect of ending death by aging. Meanwhile in the field of malaria, despite still leaving some 400.000 dead each year, money invested in malaria research remains around 2 billion dollars a year. In 2013 the world spent more money fighting baldness than it did fighting malaria.
Yet this question aptly mirrors another crucial and much broader question in medicine: What health issues are being researched and what health issues are not?
Welcome to the exciting sphere of drug research economics. As in most fields of economics it all starts with supply and demand.
Medical research costs a lot of money. In order to encourage companies to invest in research, societies protect companies through strong patent laws, allowing drug companies a monopoly on certain products. But more importantly, the sheer cost of medical research drives pharmaceutical companies to primarily research drugs that can be sold in rich countries.
Stated differently: The production costs are high, and demand is skewed towards the health problems of wealthy people. This means that while we are constantly developing new ways to battle obscure forms of cancer, a disease like malaria stays thoroughly under researched in relation in spite of its impact.
With malaria leaving some 400.000 people dead each year it also has a crippling effect on development. Alongside HIV/AIDS, it contributes to the stagnation of sub-Saharan economies, limiting the productivity of large parts of its population.
It is a vicious circle. Bad health hinders economic growth, and low levels of income means no possibilities to set the demands on what is being researched.
If the problem lies in supply and demand, then how can research be shifted towards malaria and similar developing country health issues?
First world governments and the international community clearly have a role to play here through subsidizing prices or the cost of research in these fields. But changes in demand and supply may happen without the intervention of subsidies. For diseases most prevalent in the tropics, the economic and institutional advancement of the countries concerned may kick start a new wave of research. A continued fast growing Indian economy could be an example of this.
Yet in the case of malaria, India will probably not prove to be the savior. The lion’s share of malaria infections and deaths do not occur in Asia at all but in sub-Saharan Africa, where 90% of the cases were documented. Arguably, in order to fuel demand-based research, the economic strength of the central and south parts of Africa must be expanded where, unfortunately, the growth prospects still look quite dented.
In other words, again it is a vicious circle. Sub-Saharan Africa lacks the economic strength to set the agenda of the medical research, leaving them unduly effected by under researched medical issues which in turn limits economic growth.
What other factors need to be considered? The solution may come from an unexpected angle. With rising temperatures prospectively impossible to keep under 2 degrees Celsius, malaria is expected to spread towards the global north. Having been eradicated in Spain and the southern parts of the United States malaria is expected to return to its old hunting grounds as temperatures rise worldwide. As a result, malaria will once again become a field of interest western drug firms. Thus, ironically the northwards reexpansion of malaria could very well prove the end of it.
Finally, we return to the first question: will we be immortal before we find an effective vaccine against malaria? The answer, of course, is probably not. Yet as for what the experience tells, it seems research into developing country diseases will not boom before the suffering countries gain the economic strength to influence the medical agenda – a prospect arguably decades into the future.