APPROXIMATELY ONE half of a million people contract visceral leishmaniasis every year. Another 200 million people are at high risk for contracting the disease, which if left untreated is nearly always fatal. Until recently, available treatments for visceral leishmaniasis — transmitted by a bite from an infected sand fly — were prohibitively expensive and in many cases either ineffective or even toxic.

The problem with developing an effective cure wasn’t technological, it was demographic. The disease affects the poorest people in some of the world’s most underdeveloped areas. Pharmaceutical companies couldn’t make a profit from the cure, so they didn’t try.

It is simply one example of a much greater problem. In few places is the gap between the developed and developing world more pronounced than in drug research and development.

More than $70 billion is spent on health research every year. Only 10 percent of this money is spent on what amounts to 90 percent of the world’s health problems, a phenomenon known as the 10/90 gap. In a study published by Doctors Without Borders, 1,393 new drugs were approved in the 15 years between 1975 and 1990. Less than one percent — 13, to be exact — were for diseases predominantly found in the developing world.

In 1998, Dr. Victoria Hale left her job as a pharmaceutical chemist at the US Food and Drug Administration to try to create a different kind of pharmaceutical company, one whose decisions wouldn’t be based on profit margins. By July of 2000, using her own money and working out of her apartment, she founded the Institute of OneWorld Health. At the time, few were convinced that the project could succeed.

“My colleagues and mentors in the pharmaceutical industry told me it was a wild idea, that it would never work,” she says about the early reactions to her company. Even worse, they told her that she was jeopardizing her reputation and her future.

For their first project, OneWorld Health decided to take on visceral leishmaniasis. They discovered that a promising drug called Paromomycin had been developed decades ago, but was shelved before going through phase III testing, which is required by the regulatory agencies of nearly every country in the world. The drug would only sell for about $10 per treatment and given the impoverished state of those in need of it, there was simply no money to be made from Paromomycin.

After lobbying for and finally receiving permission from the World Health Organization (which controlled rights to the drug) to perform phase III testing, OneWorld Health began the largest clinical trial ever aimed at visceral leishmaniasis in June 2003. After more than a year of comprehensive testing, the results were better than anyone had hoped for: 94.6 percent of all patients were cured outright and the rate of serious adverse side effects was less than one percent. In contrast, previous forms of treatment reported drug resistance in as many as 60 percent of cases, with nearly all early treatments reporting high incidences of serious side effects and costing up to $500.

Having proven themselves, OneWorld Health is ready to take on new challenges. At the Global Forum for Health Research held in Cairo this November, they announced a $46 million grant from the Bill and Melinda Gates foundation to expand research in treatments for diarrheal diseases.

“This is the first time anyone has funded research into diarrheal disease on this scale,” Dr. David Brown, senior advisor and head of drug discovery at OneWorld Health, says. “What people don’t realize — and even I didn’t, before we began this project — is that AIDS, malaria and TB, the three big diseases which are easily the most talked about, aren’t the biggest killers out there.”

Approximately one quarter of all childhood deaths are attributable to diarrheal disease. Two million children die as a direct result every year and it contributes to the deaths of an additional four million. Even those who survive will have lasting health problems brought on by recurring infections and the effects of malnutrition. As is the case with visceral leishmaniasis, the hardest hit by the disease are the poorest of the poor who probably wouldn’t be able to afford even the cheapest of treatments.

The people who make up OneWorld Health come from the very companies who refused to address these diseases. Brown left behind as distinguished a career as a biochemist can have. His CV outlines a career of more than 30 years with four of the world’s top 10 pharmaceutical companies and he can claim partial responsibility for making Pfizer number one, as his name appears as co-inventor on the patent for Viagra.

“Well, I supposedly retired two years ago,” Brown says when pressed about what seems like a rather dramatic change. “But then I volunteered to help out a little with OneWorld Health and I fell in love with the project, and here I still am.”

It’s less of a change than it would appear, he claims. “We are still a group of industry experts and scientists doing the same things as we did in our respective companies but now we’re doing it on a nonprofit basis.” The only difference is he says, “Now we can actually work on the diseases that most companies don’t work on because the treatment wouldn’t be very profitable.”

None of this is meant as a criticism of the pharmaceutical industry that he was a part of for so long. “A nonprofit pharmaceutical company would be an oxymoron, and our work simply wouldn’t be possible if we didn’t have funding from big donors like the Gates Foundation.”

While in Egypt, Brown met with Health Ministry officials and visited the Abu Homos Research Center. “What brought me to Egypt originally was the conference,” he explains. “I was surprised at the capabilities they have,” he says of the Abu Homos Center. “It’s simply excellent and they’re doing really good work.”

Egypt’s infant mortality rate is steadily declining, in large part to the efforts of groups like Abu Homos. Still, nearly 40 out of every 1,000 Egyptian children born will never see their fifth birthday. Given the worldwide average of one out of four of these deaths being related to diarrheal disease, that translates into 15,000–20,000 Egyptian children claimed by this neglected killer every year.

Talks of a partnership are underway and the Abu Homos Center could soon receive a fresh infusion of funds and researchers. The collaboration between OneWorld and Abou Homos will have a lasting benefit not only for children in the poorest countries in the world, but here at home as well.  et