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tion. The goal of these non-profit PPPs is to stimulate research and determine how to deliver vaccines and medicines to people too poor to afford them. However, critics of the partnership say the goals of drug manufac- turers have seldom been altruistic. With quarterly profit reports to file and fidgety stockholders to satisfy, they say, the pressure on cor- porate executives is to avoid producing products with little return on investment. That leaves research firms like GSID in a complex world. Not only must they negotiate the mix of foundations with large endowments, stock price-minded drug companies, and NGOs and government agencies, they must sort through idiosyncrasies within the field, like use of technology. In mapping and following vaccine policy, research firms may find the cell language of diseases easier to understand. Meanwhile, as meetings and emails and telephone calls and lunches take place, millions of people around the world are dying from disease. Many deaths are preventable. No Longer Ignored started in the mid -1990s, such PPPs as Roll Back Malaria and the Global Alliance for Vaccines and Immunization are leading cam- paigns against the so-called "neglected diseases" that inflict millions of deaths each year, particularly among the poor, and especially in sub-Saharan Africa. According to Doctors Without Borders/Medecins sans Frontieres, between 1973 and 1997, out of 1,450 new drugs, only 13 were for the "ignored diseases." Even worse, the number of vaccine developers declined from 26 in 1967 to five today. That may be changing. A Wellcome Trust study by the London School of Economics suggests that PPPs are successful in generating new drugs. Since 2000, some 63 new drugs aimed at these diseases are in the pipeline, 18 of them in clinical trials. Some even see vaccines as a growth industry. According to a study by the investment bank, Morgan Stanley, reported in the Financial Times June 30, "Vaccines are one of the most overlooked new oppor- tunities in pharma/ biotech." Which some people see as a problem. "We have gone from people seeing vaccines as something that is for the public good and that should reside in the public sector, to something that makes profits," says Dr. Anthony Robbins of Tufts University. Robbins, who has directed several state public health pro- grams, is a former president of the American Public Health Associa- tion (APHA) and a former director of the U.S. National Institute for Occupational Health and Safety. "We haven't changed the behavior of the private sector, we are just financing it," Robbins told Revolution. An analysis of contributions and partnership participants tends to bear Robbins out. According to a study by the South Asian health and environmental magazine Down To Earth, the public sector, including WHO and the U.S. National Institute for Health (NIH), underwrites about 88 percent of PPP budgets. The private sector contributes about 10 percent, and philanthropy picks up the rest. Philanthropic contributions, led by the Bill and Melinda Gates Foundation with its $29 billion endowment, more than doubled from 2002 to 2004. Gates accounts for 75 percent of philanthropic dona- tions and recently announced an infusion of $258.3 million to malaria research. In contrast, private sector contributions appear to have fallen. Drug and biotech companies donated $68 million last year, $31 mil- lion less than in 2004. The annual WHO budget is $1.65 billion. While pharmaceutical companies contribute only a small part of PPP research and development money, they reap the patents. The AIDS drug AZT was developed by Yale University on a grant from NIH, but GlaxoSmithKline ended up holding the patent on it. Drug companies also fiercely defend intellectual property laws. "Our ability to invest such huge sums in R&D (research and develop- ment) depends on strong patent protection," Richard Sykes, former CEO at Glaxo Wellcome, is quoted in an Oxfam International report. A patent lasts 20 years. The companies claim it costs between $500 million and $800 mil- lion and takes 12 to 15 years to develop a drug. But those are industry-generated figures. No outside agency has ever examined drug company books, nor has Congress ever subpoe- naed such records. Critics claim the costs are overblown, and that such non-research and development costs as marketing, administra- tion and lobbying are folded into that $500-$800 million figure. According to health researcher Hannah Plumb in "Putting a Price on Life," advertising costs are more than double R&D. In 2000, Merck spent $6.2 billion on marketing and advertising (M&A), and $2.3 bil- lion on R&D. Pfizer spent $11.4 billion on M&A and $4.4 billion on R&D. And BristolMyersSquibb spent $5.6 billion on M&A and $1.9 billion on R&D. By comparison, of R&D money spent for an AIDS vaccine in 2004, 67 percent was spent on pre-clinical research, 32 percent on clinical trials and development, and 1 percent on advocacy. The companies also write off 46 cents for every $1 spent on R&D, a deduction they conveniently ignore when they add up bottom-line figures for drug development. Profits have never been a problem for drug companies, which posted gains four times greater than the aver- age Fortune 500 company in 2000, outperforming even mega- empires like Microsoft. The Malaria Malady this private -public alliance is not always a comfortable one, and public health advocates like Dr. Victor Sidel are "very suspicious" of the private side's motivations, since their "bottom line is to make 14 C A L I F O R N I A N U R S E W W W . C A L N U R S E S . O R G A P R I L 2 0 0 6 The public sector, including WHO and NIH, underwrites about 88 percent of PPP budgets. The private sector contributes about 10 percent and philanthropy picks up the rest.