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money." Sidel is a former president of the APHA and co-author of "Social Justice and Public Health." For instance, because the private sector is only willing to under- write vaccines that can be patented, the use of older vaccines is declining at a time when a combination of growing poverty and an explosion of urbanization is increasing the disease burden in the Third World. A UNICEF study found that, in 1990, 80 percent of the world's children were immunized against the main childhood diseases: diph- theria, tetanus, whooping cough, measles, polio and tuberculosis. By 2000, that had fallen to 75 percent. In 19 African countries, only 50 percent were vaccinated for the "big six." The price those children pay for going unvaccinated is a heavy one: about 1.5 million under the age of five die each year, according to an article in the Oct. 24 issue of the New Yorker magazine. While vaccines past their 20-year patent date go a-begging, Sanofi-Pasteur is pouring tens of millions into developing a dengue fever vaccine. According to a 2002 report by Global Alliance for Vac- cines and Immunization, 63 percent of its resources are slotted for new vaccines: vaccines, that is, which can be patented. On the other hand, public health experts generally agree that a major focus of vaccine research and development right now should be malaria. It is an ancient disease that plagued the Greeks and was a major problem in southern Europe and the American South until well into the 1940s. It consumes nearly 40 percent of the public health spending in Africa and cuts a grim swath through children under the age of five. There are at least 500 million cases of malaria a year. "It is a moral outrage," Richard Feachem, professor of public health at the University of California, Berkeley and director of the Global Fund, told the New Yorker magazine. "This is an utterly pre- ventable holocaust, and numbers are far higher than the WHO says. They have put the dead at one million (a year) for years, and now it is really three million in terms of deaths to which malaria might have contributed." And the situation is getting worse, as condi- tions that favor malaria – from increasing urbanization to global warming – widen the disease's reach. Currently, 50 percent of the world's population is exposed to malaria, an increase of 10 percent over the past decade. "More people have suffered from malaria in the past 50 years than in the history of mankind," says Feachem. "It is a remarkable march backward." At the same time, fewer and fewer drugs are effective against it. The plasmodium that caus- es the disease is complex and, in terms of developing a resistance to drugs and insecti- cides and fooling the body's immune system, devilishly clever. Part of the problem is that the developed world eliminated malaria by the mid-1950s, easing the pressure to develop a vaccine. With the exception of the military's interest in a vac- cine, research funds dried up. Abandoned by wealthy nations, and unable to pay for the R&D themselves, Third World countries have increasingly relied on phi- lanthropy to help them control the disease. But how that money is spent is fraught with controversy. For example, the Gates Foundation, the largest of these philanthropies, is strongly biased toward the development of new technology. Almost half of the foundation's recent grant will go toward a malaria vaccine being developed by two drug companies, Rixensart of Belgium and the British giant, GlaxcoSmithKline. A malaria vaccine is certainly a worthy goal, particularly since the disease has long resisted one, and with new biotechnology tech- niques, it may be possible to finally develop one. A GlaxoSmithKline vaccine, largely bankrolled by Gates, is presently being tested in Mozambique and reportedly reduces severe malaria in children by 58 percent. What about Old Tech? b u t a n u m b e r o f p u b l i c h e a lt h advocates argue that what is needed is not so much new technology, as the ability to deliver things like mosquito nets and medicine. "I think we need not put our hopes in magic bullets when we have an arsenal to make such an impact now," argues David Schellenberg from the London School of Hygiene & Tropical Medicine. "What we need are magic guns, not magic bul- lets. We need to be able to deliver what we already have." The influential British medical magazine, The Lancet, recently editorialized that "The eradication of disease and the alleviation of suffering depends more on developing the skills of talented people than on technology," and suggested that PPPs consider underwriting medical training. Canadian health economist Anne-Emanuelle Birn is also critical of the "technology" solution. "In calling on the world's researchers to develop innovative solution targets to 'the most critical scientific challenges in the global health,' the Gates Foundation has turned a A P R I L 2 0 0 6 W W W . C A L N U R S E S . O R G C A L I F O R N I A N U R S E 15 $6.2 $2.3 $4.4 $5.6 $1.9 $11.4 SOURCE: "Putting a price on life: an investigation into the patenting of HIV/AIDs drugs and its devastating effects on the South," Hannah Plumb, 2004–2005 Intellectual Property Dissertation, University of Kent Law School Marketing & Advertising vs. Research & Development