global reporT for research on infectious diseases of poverty 2012 wiTh financial supporT of European Union global report for research on infectious diseases of poverty with financial support of European Union WHo library Cataloguing-in-publication Data: Global report for research on infectious diseases of poverty. 1.communicable disease control. 2.research 3.poverty. 4.health behavior. 5.developing countries. i.World health organiza- tion. ii.unicef/undp/World Bank/Who special programme for research and training in tropical diseases. isBn 978 92 4 156 448 9 (nLM classification: aW 110) Copyright © World Health organization on behalf of the Special programme for research and training in tropical Diseases 2012 all rights reserved. the use of content from this health information product for all non-commercial education, training and information purposes is encouraged, including translation, quotation and reproduction, in any medium, but the content must not be changed and full acknowledgement of the source must be clearly stated. a copy of any resulting product with such content should be sent to tdr, World health organization, avenue appia, 1211 Geneva 27, switzerland. tdr is a World health organi- zation (Who) executed unicef/undp/World Bank/World health organization special programme for research and training in tropical diseases. this information product is not for sale. the use of any information or content whatsoever from it for publicity or advertising, or for any commercial or income-generating purpose, is strictly prohibited. no elements of this information product, in part or in whole, may be used to promote any specific individual, entity or product, in any manner whatsoever. the designations employed and the presentation of material in this health information product, including maps and other illustrative materials, do not imply the expression of any opinion whatsoever on the part of Who, including tdr, the authors or any parties cooperating in the production, concerning the legal status of any country, territory, city or area, or of its au- thorities, or concerning the delineation of frontiers and borders. Mention or depiction of any specific product or commercial enterprise does not imply endorsement or recommendation by Who, including tdr, the authors or any parties cooperating in the production, in preference to others of a similar nature not mentioned or depicted. photos: Who/tdr photo library; Ministério da saúde, Brasil; un photo library Graphic design: Lisa schwarb, Lausanne, switzerland printing: Who document production services, Geneva, switzerland Table of Contents Foreword ............................................................................................... 1 How tHe report was developed ................................................... 3 acknowledgements ........................................................................... 5 abbreviations ........................................................................................ 6 summary .................................................................................................. 9 Introduction 1. Why researcH inFectious diseases oF poverty? ............................. 10 Poverty and infectious disease – a problematic relationship ................ 12 Infectious disease – the true burden on communities ............................ 13 The value of research: new ways to end old diseases .............................. 15 Poverty, infectious disease and policy: moving beyond the Millennium Development Goals ............................... 15 The cost of inaction – social and economic consequences ..................... 18 Tackling disease – a need for investment .................................................... 19 Ten reasons to research infectious diseases of poverty .......................... 19 1. Break the vicious cycle of poverty and infectious disease ............................... 22 2. Forge an escape for the poor and vulnerable ................................................ 24 3. Tackle multiple problems ............................................................................ 26 4. Commute the life sentence .......................................................................... 28 5. Be prepared – forewarned is forearmed ........................................................ 30 Global Report for Research on Infectious Diseases of Poverty 6. Reach the hardest to reach .......................................................................... 33 7. Prevent loss in translation ........................................................................... 34 8. Identify small changes that can make a big difference .................................. 35 9. Stay focused on the light at the end of the tunnel ......................................... 36 10. Act quickly on what we know .................................................................... 38 Under the lens… ................................................................................................. 39 References – Chapter one ............................................................................... 40 i 2. environment, Climate change, SoCial FaCtorS anD tHe impliCationS For Controlling inFeCtiouS DiSeaSeS oF poverty ............................................................. 45 understanding the microbial world – the inescapable starting point ............................................................... 47 Drug and insecticide resistance – magic bullets will not suffice ......................... 48 Climate change – not entirely to blame ........................................................... 49 Deforestation – cutting the branch we sit on .................................................... 50 Urbanization – is wealthier always healthier? .................................................. 51 Agriculture – also sowing seeds of sickness ...................................................... 52 Hunger and malnutrition – getting the right food to the right table .................. 54 Conflict – another man-made disaster, amplifying infectious disease ................ 54 Migration and globalization – disease, a worldwide traveller ............................ 55 infectious diseases, the environment and poverty – a time bomb in the making? ........................................................................... 56 approaches for future research – three tracks to explore ...................... 57 Intorduction Better understanding of the microbial world ................................................... 58 Expand and better utilize existing data and resources ...................................... 58 “ One World, One Health”................................................................................ 59 overty p conclusion: a big picture requiring intelligent investment and interaction .................................................................................................. 61 iseases of references – chapter two ............................................................................... 62 d nfectious i 3. HealtH SyStemS .............................................................................................. 68 understanding the relationship between health esearch on r systems and diseases control programmes and the role of health systems research ............................................................. 70 Leadership and governance – getting a grip on things ..................................... 72 eport for r Financing – the right level at the right time and place ...................................... 74 Human resources for health – caring comes from people .................................. 76 Global Medicines and technology – an essential combination ..................................... 78 Health information and health infrastructure – good data clear the path .......... 79 Communities and health systems – people make the difference ........................ 80 Infectious diseases, poverty, health systems and health systems research – bringing it all together ................................................................................... 81 Developing the interface between health system components and infectious disease control programmes – the missing link ..................... 83 Developing systemic approaches .................................................................... 84 Strengthening research capacity for a positive interrelation between disease control programmes and the rest of the health system ..................................... 86 conclusions – from dependence to ownership .......................................... 87 references –chapter three ............................................................................. 89 ii table of contents 4. innovation anD neW technologieS to taCkle inFeCtiouS DiSeaSeS oF poverty ..................................................................................... 94 understanding the health innovation system – navigating unchartered waters ..................................................................... 96 Global initiatives to encourage innovation – turbo-charging ................ 98 funding for innovation – food for brains .................................................... 99 priority setting for health r&D – where to start? .................................... 101 policy environments in developing countries – more than scaffolding required ................................................................... 102 public–private product development