In the Sars pandemic of 2003, the microbial agent involved (Sars coronavirus) was swiftly identified and sequenced in a remarkable collaboration between otherwise highly competitive laboratories in Asia, Europe, and North America.

These early exchanges, however, very soon gave way to a mutual wariness at the point when intellectual property claims were filed for the pathogen's sequences and other patentable findings with commercial potential.

Further progress in Sars research may now have to contend with the restrictions and secrecy dictated by proprietary and commercial imperatives.

Without belabouring the point, it seems clear that the issue at hand is not so much the globalisation (internationalisation) of biomedical research, as the commodification of 'intellectual property'.

The consequences of market-driven R&D and the commodification of biomedical outputs have been well documented by Mdecins Sans Frontires (MSF).

Of the 1,393 new drugs approved between 1975 and 1999, only 16 (or just over 1 percent) were specifically developed for tropical diseases (such as malaria, sleeping sickness, Chagas' disease, kala azar) and tuberculosis - diseases that account for 11.4 percent of the global disease burden.

For 13 out of those 16 drugs, two were modifications of existing medicines, two were produced for the US military, and five came from veterinary research. Only four were developed by commercial pharmaceutical companies specifically for tropical diseases in humans.

These diseases mainly affect poorer communities in countries of the South, which do not constitute a valuable enough market to stimulate adequate R&D by the multinational pharmaceutical companies.

An indication of their priorities was provided by Malaysian Organisation of Pharmaceutical Industries (MOPI) president Lee Yee Chong, who revealed at a 2002 national health conference that the two top-selling patented drugs in Malaysia at that time were Viagra and Xenical (a slimming supplement) - two lifestyle drugs.

Responding to market failure

Prompted by this persistent market failure and the harm and misery caused by the neglect, MSF recently launched the Drugs for Neglected Diseases Initiative (DNDi).

This consortium currently includes MSF, WHO/TDR, Oswaldo Cruz Foundation/Far Manguinhos (Brazil), Indian Council of Medical Research, Institut Pasteur (France), Kenya Medical Research Institute, and the Ministry of Health (Malaysia) as founding partners.

A principal aim of the consortium is to take the development of drugs for neglected diseases out of the market place and to encourage the public sector to assume greater responsibility for a needs-based R&D agenda.

Parallel efforts are underway in the US where Congressman Dennis Kucinich has proposed to take it beyond R&D into the realm of production and marketing (distribution).

He intends to introduce legislation "that would create a new network of government labs for the research, development and manufacture of pharmaceutical products and biologics".

Kucinich said: "When discoveries are made, the patents would be held by the government and non-exclusive licenses would be attached to them. This would allow companies to compete to manufacture pharmaceutical products, just like generic drug companies do now. This would radically bring down the cost of drugs (and would also) increase the affordability of cures worldwide

"We have watched the pharmaceutical industry fail on three counts: submitting fewer and fewer drugs to FDA for approval, creating 'copycat' drugs instead of truly new cures, and raising drug prices higher every year. Our current patent system is what encourages artificial improvements and keeps prices high. It seems clear that one of the keys to public health is establishing public patents."

The European Commission (Research Directorate) is also a significant funder of international collaborative research in the health sector, through its INCO programme.

Public domain

Researchers and research managers from the South have proposed that the fruits of such international collaborations could perhaps be similarly vested in international agencies such as the World Health Organisation (WHO), to keep the prerogatives within the international public domain.

At the moment, the EC's policy objectives are geared more towards the R&D needs of small and medium enterprises (SMEs), which lack the in-house R&D capacity of larger firms.

SMEs, many of them innovative and dynamic, are viewed as the preferred vehicles for commercialising the outputs of EC-funded research in science, technology, and development.

This is not necessarily incompatible with the publicly-held patents and non-exclusive licensing as envisaged in the Kucinich initiative, or with other scenarios which the 'open source' movement is actively deliberating, experimenting with, and promoting for knowledge-intensive industries.

(The stereotypical model was pioneered by software writers for open-source applications such as the Linux computer operating system, but the generic ideas are now making inroads as well into the scientific publications and communications arena.)

Social ecology

Finally, the Sars epidemic has also reminded us to retain a sense of proportion when considering disease etiology and society's coping responses. Notwithstanding the rapid success in isolating and sequencing the Sars coronavirus, the epidemic quickly subsided in the absence of reliable diagnostics, vaccines, or efficacious therapies.

WHO gave much credit to institutional responses such as isolation, contact tracing, ring fencing, and quarantines (i.e. centuries-old techniques), with lesser mention of personal risk avoidance and the possible contributions of seasonality effects or cross-reacting immunity from related endemic micro-organisms.

Most pertinently, the economic and financial stakes involved ensured that Sars would not be a 'neglected disease' .

A social-ecological perspective of health and disease teaches us to be wary of the extravagant claims of genohype (expressive phrase popularizsd by NA Holtzman) - of genomics as all-round panacea for the major health (and social) problems of humanity.

CHAN CHEE KHOON is Co-ordinator of Citizens' Health Initiative, a coalition of non-governmental organisations and special interest groups working on public health issues. For this article, he referred to:

1. P Trouiller, P Olliaro, E Torreele, J Orbinski, R Laing, N Ford. Lancet 359:2188-2194 (June 22, 2002); R Cohen. 2002. 'Neglected Diseases and the Health Burden in Poor Countries'. Multinational Monitor (June 2002)

2. Michael Kremer & Rachel Glannerster, 'Creating a Market for Vaccines', New York Times, June 1, 2001

3. Health Ministry management conference 'Facing the Challenges of Globalisation and the New Trade Agenda', Oct 10-12, 2002, Penang, Malaysia

4. WHO Press Release, June 25, 2003

5. Dennis J. Kucinich. 2003. 'The Case for Public Patents'. (The Nation, June 19, 2003).

6. Third World Resurgence (July/August 2003, special issue on SARS and New Diseases, p 29)

7. CK Chan. 2003. 'Risk Perception and Coping Responses in a SARS Infectious Outbreak'. Third World Resurgence (July/August 2003, p 28-30)

8. R Levins. 2003. 'The Re-emergence of Infectious Diseases on the Public Health Agenda'. Third World Resurgence (July/August 2003, p 5-10). See also Levins' award lecture for the Edinburgh Medal of Science, 1996. 'When Science Fails Us', available on http://www-trees.slu.se/newsl/32/32levin.htm