All diseases included in and , and many not listed, are critical targets of research and health care. All require more funding and more effort than they now receive. However, if some diseases (such as lung infections) are less widely recognized as critical threats to our health, then resources and efforts will be allocated suboptimally, resulting in poorly tailored responses to public health needs.
Determining whether funds are contributing to research against a given disease is horribly inexact. Furthermore, the conceptual advances with most promise against a particular disease may more likely result from basic research than from disease-focused research. However, substantial resources are allocated to understanding and fighting particular diseases, and biomedical progress against those diseases is influenced by these targeted efforts. While the greatest burdens of disease and the greatest threats to the public health might be presumed to receive the greatest shares of research funding, they do not.
The US National Institutes of Health (NIH) spent approximately US$28 billion on health-related research in 2004 [13
], of which US$287 million was allocated to lung infections. This is substantive and laudable, but it must be considered in perspective. It pales in comparison with the US$1.63 billion spent on biodefense. More NIH money is spent on smallpox research (US$324 million) alone than on lung infection research. While it is essential to be proactive in recognizing, preventing, and preparing for looming or emerging threats to public health, it may be questioned whether funding for speculated risks should so overwhelm funding for diseases already causing such tremendous burdens.
Lung infection research is also poorly funded when compared with other currently significant public health concerns. For example, US$2.85 billion were spent on HIV/ AIDS research, which is substantively improving prospects against this very important disease. It is remarkable, though, that lung infections cause a comparable or greater disease burden ( and ), yet they receive only one-tenth of HIV/AIDS research funding. In a similar vein, the NIH allocated comparable resources to lung infections as to sexually transmitted diseases (US$237 million), even though in wealthy countries such as the US lung infections cause seven times more disease than do sexually transmitted diseases (), with even larger differentials in poorer countries. These figures from the NIH are but a few examples demonstrating that lung infections are relatively under-represented.
Reacting to the pandemic threat of the recently emerging avian influenza virus (H5N1), the president of the US recently requested a lump sum totaling US$7.1 billion [14
]. The majority of requested funds in the president's plan, more than US$5.3 billion, would be slated for the manufacture, purchase, and stockpile of vaccines and antivirals targeting influenza. An additional US$0.8 billion would be allocated for research on new vaccines and antivirals against influenza, US$0.6 billion for influenza preparedness planning, and US$0.3 billion to help countries detect and contain influenza outbreaks. It is this author's opinion that the immediate need for such immense resources results from the potential of a severe influenza pandemic combined with many years of inadequate attention to lung infections. As of the time of writing this essay, the US Congress has yet to approve funding, and it remains unclear how much will be approved and how it will be deployed if approved, but a discrete set of funds may soon become available for fighting influenza specifically.
It is more difficult to assess resources distributed by private organizations, but it is again evident that lung infections are underemphasized. U.S. News and World Report
identifies 20 charities as the largest to deal specifically with diseases and disease-related research [15
]. Of these 20 leading charities, nine focus on cancer, two on organs (heart or kidney), two on classes of disease (mental illness or birth defects), and the rest on six specific diseases (muscular dystrophy, diabetes, multiple sclerosis, cystic fibrosis, Alzheimer disease, and arthritis). Perhaps the most prominent philanthropy focused specifically on infectious disease is The Global Fund to Fight AIDS, Tuberculosis, and Malaria [16
]. This fund reports that it has attracted commitments of US$4.7 billion from national governments, private companies, and other contributors for fighting these three specific diseases. Such philanthropies perform wonderful services in improving health. Lung infections would similarly benefit from such a major philanthropic focus.