In this issue of PLoS Neglected Tropical Diseases, Abdallah Daar and colleagues describe
the fourth independent external analysis and evaluation of the Special Programme for
Research and Training in Tropical Diseases (TDR) and summarize the findings resulting
from the review [1]. The panel responsible for the review and report, which was chaired
by Daar, recommends several critical areas of refocus and reorganization and calls
for additional funding of TDR. In making its recommendations, the panel considers
the changes that have taken place over the last decade. The most notable change was
the unprecedented increase in funding, external to TDR, for research and control of
tropical diseases and the accompanying establishment of product development partnerships
(PDPs).
The panel contends that TDR should increase its focus on research capacity strengthening,
concentrate on neglected populations over neglected diseases, and strengthen its role
in transdisciplinary research, particularly by augmenting its capacity in social sciences.
In spite of TDR's clear successes and accomplishments since its inception, the panel
concludes that TDR has not kept pace with a dynamic and changing world of global health
research. The panel also concludes that TDR has not established itself as a credible
partner with other leading funders, and is in danger of being marginalized to the
point of ineffectiveness in addressing potentially critical gaps in tropical disease
research. The review suggests that in its current form, TDR is overly bureaucratic
and poorly aligned with the World Health Organization (WHO), that it has insufficient
funds and flexibility to carry out its mandate, and that it is not readily able to
adapt to the rapidly evolving and dynamic global health landscape.
In order to ensure that TDR takes its proper role in supporting research and development
(R&D) and training and to capitalize on the tremendous support the organization has
among a broad constituency, especially among scientists in disease-endemic countries,
the report recommends that TDR focus its efforts in four specific areas: (1) stewardship,
(2) expanded interventional research, (3) research capacity strengthening, and (4)
R&D for physical products that are not otherwise supported. In doing so, and with
the recognized need for substantial increases in funding, TDR must dramatically rethink
its objectives and organization. It should also focus efforts on improved relationships
with its sponsoring organizations and forge new interactions with organizations, especially
public–private partnerships, with complementary interests in R&D and capacity building.
In their response to Daar and colleagues' external review, Robert Ridley (the Director
of TDR) and colleagues acknowledge many of the shortcomings identified in the review,
and say that TDR has committed to a series of steps to improve and reorganize based
on the evaluation's recommendations [2]. These steps include a revised strategic focus
on knowledge management, an increased capacity building effort, and an enhanced focus
on neglected areas such as some aspects of translational research. The external review
contributed to TDR's new Ten Year Strategy and Business Plan approved by TDR's Joint
Coordinating Board and endorsed by WHO.
To implement the new strategy, Ridley et al. describe the development of “business
lines” such as “BL3: Lead Discovery for Drugs” or “BL7: Accessible Quality Assured
Diagnostics.” These business lines are supported by expert scientific advisory committees,
and by necessity the business lines can be started or stopped depending on circumstances
and the needs of the stakeholder community. It is envisioned that this business line
model will provide a better means for TDR to make decisions and to respond to changing
priorities. These business lines cover the full product development pathway from basic
research through product development to research for access to interventions. They
are viewed as a critical mechanism to decentralize TDR into discrete functional units
(rather than to decentralize administratively) that is more responsive to changing
environments and to the priorities of TDR's stakeholders. Ridley et al. correctly
point out that TDR has played a key role in the establishment of PDPs, such as the
Medicines for Malaria Venture. However, TDR's influence in this area has been overshadowed
by others, and consequently TDR proposes to shift its focus from supporting PDPs to
other areas where it can have greater influence and impact.
TDR has made major contributions to the lives of those in the developing world and
has supported scores of students and scientists from disease-endemic countries. With
funding from UNICEF, the United Nations Development Programme, the World Bank, and
WHO, TDR is considered the developing world's research arm. It is uniquely positioned
to identify key areas in tropical disease research and training that are not being
met by other funding agencies, and to seek to fill those gaps either through direct
funding or by creating partnerships that leverage other investments. In recent years,
there has been an increased recognition that the scientists, public health workers,
and policy makers in disease-endemic countries should contribute to research priorities.
TDR is in a position to make these voices heard in setting the priorities. Although
TDR has had successes assisting in the establishment of PDPs, it has not fared so
well in partnering with other donor agencies, and as such may be moving toward marginalization
at a time when it could be playing a critical role in filling important research,
training, and implementation gaps.
The establishment of business lines is intended to functionally decentralize TDR and
make it more responsive to its stakeholders. It will be important, however, to see
how the business line concept is functionalized, how lines are initiated and terminated,
how funding priorities are made across business lines, and what metrics will be established
to measure the progress toward each business line's objectives. Are the business lines
repackaged programs, or are they truly a new means of setting and managing research
priorities?
TDR's strengths and successes will need to be better marketed, and its credibility
as a major player in the donor community will have to be strengthened. It will need
to actively seek to establish better and more effective means to partner with others.
It will need to identify those areas where it is uniquely positioned to make a significant
impact and determine the measure of that success, both in terms of its longstanding
and broad reach in partnership with the developing world and its ability to extend
the impact of the efforts of other donors.
The global health community and external landscape have changed dramatically since
the establishment of TDR in 1978. TDR has made positive contributions to these changes.
One thing is certain: the landscape will continue to change as research provides new
opportunities to extend and improve the lives of those in the developing world; as
innovations transition from bench to bedside; as new and exciting partners recognize
the importance of contributing to the gargantuan effort needed; as new scientists
from the developed and developing world enter into the scene; and as the priorities
of the developing world change. TDR must be given the strength, flexibility, and resources
to play a major role in extending progress in tropical disease research and training.