A singular focus on HIV/AIDS and a lag in translating medical discoveries into approvable medicines could be keeping the U.S. from getting its money's worth from R&D aimed at addressing the most pressing global health needs.

While the U.S. government is the leading funder of R&D for 26 of the 30 most neglected diseases and conditions affecting the developing world, nearly 60 percent of the $1.4 billion the U.S. invests annually in global R&D is dedicated to HIV/AIDS research, according to a recent report from PATH's Global Health Technologies Coalition.

The next biggest chunk of U.S. funding, 12 percent, is spent on tuberculosis (TB) R&D, and 10 percent goes for malaria R&D. The rest is divided among other diseases and conditions, such as dengue fever, that afflict many parts of the developing world.

While HIV/AIDS research is important, more R&D is needed to attack other diseases before they become a problem throughout the world. "We cannot ignore infectious diseases," coalition Director Kaitlin Christenson told BioWorld Today, adding that some of the diseases once constrained to developing countries are affecting Americans and making their way into the U.S. and other countries. For instance, she said, more U.S. soldiers are affected by malaria than by gunfire.

George Painter, director of the Emory Institute of Drug Discovery, agreed, noting that TB has become rampant in the UK and mosquitoes carrying the dengue virus have been found as far north in the U.S. as Pennsylvania.

Those are world diseases now, he told BioWorld Today, as "diseases afflicting the developing world are emerging diseases in the developed world."

The reverse is true with some noncommunicable and chronic diseases, said Venkat Narayan, the Ruth and O.C. Hubert professor of global health and epidemiology at Emory University's Rollins School of Public Health.

Once thought the domain of affluent countries, conditions and diseases such as diabetes, hypertension, high cholesterol, lung cancer and cardiovascular illnesses are crossing all income areas – even in remote areas of countries with the lowest incomes, Narayan said.

As they expand across the globe, noncommunicable and chronic diseases are becoming the biggest health problem in the developing world. Metabolic diseases are responsible for 60 percent to 80 percent of mortality worldwide, he noted, but only 3 percent of global funding is directed toward research into those diseases.

The U.S. and other developed countries need to pay greater attention to how chronic diseases are affecting the developing world, Narayan told BioWorld Today. If the current trend is not arrested, chronic disease will have a serious impact on the global economy because of the escalating costs of therapies and losses in the labor force.

Going forward, the government needs to invest in R&D based on fact, not opinions and advocacy, Narayan added.

Meanwhile, the return on the government's investment has been restricted by the lag in translating research into approvable, affordable medicines. Translation is an "endemic problem," even in the U.S. itself, Narayan said.

But translation is made more challenging on the global level where drug development often involves partners from several countries, which raises issues of governance and incentives. The risk analysis also differs from country to country, depending on the prevalence of a disease, Painter noted.

Countries where drug-resistant TB is killing people would likely have a different risk analysis for a TB drug than the U.S., where it is not that big of a problem, he explained.

As a result of all those factors, finding new cures and treatments for global health problems will take a lot of innovative research translated into applied research that fits into the confines of regulators, Painter said.

"Changing that game a little bit is going to take some time," Narayan said.