Abstract
In the time it takes you to read this preface, 100 people will die of diseases that can already be prevented with vaccines, and 150 more will die of malaria, HIV or tuberculosis.
If American or European children were dying at a rate of an average-sized high school every hour, it would lead the news every day. We would be devoting serious resources to finding a cure urgently.
But the people who die are too poor to command that sort of attention. Just 10% of the world’s research and development on health is targeted on diseases affecting 90% of the world’s people. Of more than a thousand new medicines developed over the last 25 years, just 1% were specifically for diseases of tropical countries.
There is not enough research and development because technological progress is a global public good. In the case of tropical diseases, no single individual enterprise has an incentive to pay for the full costs of developing new medicines. As a result, we invest far too little as a global community.
Nation-states have developed institutions, however imperfect, to invest in public goods, and these mutual commitments form part of the fabric of society. Nations provide security and financial stability, enforce contracts, protect the environment, limit inequality and poverty and invest in knowledge that enriches all their citizens. No doubt most countries could do these things better, but even so the provision of these common goods underpins the domestic social contract.
