Aid cuts by rich nations are bad for global health
Medical innovators in developing countries rely heavily on funds for their research
In 2012, the London Declaration on Neglected Tropical Diseases signalled a bold new vision for international cooperation, in which networking and globalisation could underpin efforts in the global South to eradicate deadly diseases that disproportionately affect the poorest communities. The London Declaration — the largest global public-health collaboration to date — helped to foster trust in the rules-based global order that emerged after World War II.
But this hard-earned trust is now in grave danger as populist forces across the Western world take aim at their countries’ foreign-aid commitments. In particular, US President Donald Trump has announced sweeping cuts to its international aid budget. What this approach fails to recognise is that the longterm rewards of supporting medical research in the global South far outweigh the short-term costs.
As a Bangladeshi researcher at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), I have been intimately involved in local efforts to eradicate visceral leishmaniasis (VL, also known as kala-azar), one of the diseases covered by the London Declaration. Thanks to support from international donors, I have been able to conduct path-breaking research.
Back in 2006, through research funded by the World Health Organization’s Special Programme for Research and Training in Tropical Diseases (TDR), I found virtually no sand fly-control initiatives in place in districts where VL — spread by a single species of sand fly — was endemic. That realisation was a wake-up call to policymakers and led to the initiation of sand fly-control efforts throughout the country. Years later, as part of UBS Optimus Foundationfunded research into household-level insect-control methods, my team found that a novel technology — durable wall linings soaked with the insecticide deltamethrin — was effective at killing sand flies for up to a year after application. We are currently testing other durable insect-control solutions, including wall paints blended with three different insecticides.
This work has implications beyond VL — and beyond Bangladesh. Indoor spraying remains the most widely used method of household insect control worldwide. But in isolated rural communities, the solutions that we are researching may be more robust, convenient, and effective against not just sand flies, but also other kinds of disease-carrying insects, such as Zika-infected mosquitoes.
I have also been engaged in research on novel types of VL transmission. After recovering from VL, many patients in Bangladesh go on to develop a condition known as macular post-kala-azar dermal leishmaniasis. In order to find out whether PKDL patients can act as a reservoir for VL — and therefore boost our capacity to eradicate the disease — my team and I have set up an insectarium to breed sterile sand flies.
Our insectarium is one of just seven in the world (with the majority located in developed countries). It amounts to a permanent and valuable resource for research into vector control and disease transmission in Bangladesh.
Already, the insectarium has facilitated important progress. Recent pilot experiments showed that macular PKDL could act as a source of infection, with the results published in the journal Clinical Infectious Diseases. We are also using the insectarium to test insecticide resistance and susceptibility in captive sand flies — research that will support the optimisation of sand fly-control strategies throughout the Indian subcontinent.
Of course, a key element of any strategy to eradicate disease is early and effective diagnosis. So my team went to work to develop a system for enabling DNA-based diagnosis in low-resource settings. We are now trying to repurpose that suitcase, so that it can also enable the diagnosis of typhoid fever and tuberculosis, further revolutionising disease surveillance in poor and rural communities. In other words, the development of cold-chain-independent disease detection, like the rest of our research and innovations, has far-reaching implications for global health.
Yet all of the success we have achieved over the last two decades is now at risk. Donor agencies, facing reduced aid from major players like the US, could
Donor agencies, facing reduced aid from major players like the US, could be forced to withdraw funding for the kind of research described here. With Bangladesh unable to pick up the slack, life-saving projects like ours will collapse be forced to withdraw funding for the kind of research described here. With Bangladesh unable to pick up the slack, life-saving projects like ours will collapse; the long-term resources we have developed, from the insectarium to new diagnostic devices, will have to be abandoned; and the developing world’s poorest communities will suffer.
More is at stake than generosity. Aid donors accrue important benefits from financing scientific research in the global South, beginning with reinforcement of the trust that underpins the fragile international order on which we all depend. More directly, supporting the development of low-cost health innovations could play a vital role in reducing the now-colossal health-care expenditure of advanced countries like the US. Those savings could easily offset the cost of supporting the life-saving work. — Project Syndicate Dinesh Mondal is a senior scientist in the Nutrition and Infection Interaction
Research Unit at icddr,b