Stephen Matlin, executive director of the Global Forum, said in an interview that the vast majority of research funds are used to produce treatments for the lucrative markets of developed countries.

"There is a massive under-investment in research for the needs of developing countries," Matlin said.

This disparity has been called the "10/90 gap," a term coined after a commission in 1990 provided research showing that only approximately 10 percent of the resources spent on health research go to the problems afflicting 90 percent of the world's population.

And while the exact percentage may be different today, Matlin says the "10/90" phrase has become "a rallying cry to pay attention to very neglected health problems." This week in Mexico City, the Geneva-based Global Forum will bring together hundreds of health researchers, policy makers, and donors to discuss how to reach ambitious goals set by the United Nations to significantly improve health care for the world's poor by 2015.

The Global Forum meeting runs parallel to a summit of health ministers and officials from more than 50 countries hosted by the World Health Organization.

Nations are working to meet the so-called Millennium Development Goals, set up by the United Nations in 2000 with the aim to cut extreme poverty in half by 2015. However, everyone from free-market economist Jeffrey Sachs to rock star Bono say countries will not meet targets for reductions in malnutrition, deaths from treatable diseases, and other indicators used to measure poverty.

INCREASED FUNDING

In preparation for the meetings, the Global Forum published an 105-page study titled "Monitoring Financial Flows for Health Research."

The report shows that global spending on health research has grown from around US30 billion in 1986 to just under US106 billion in 2001, the most recent year studied.

The report attributes the rise partly to new major sources of funding from private organizations and public-private partnerships such as a fund to fight AIDS as well as significant increases in U.S. congressional appropriations for the National Institute of Health.

The share of global spending in 2001 was 48 percent by the private for-profit sector, 44 percent by the public sector, and 8 percent from private, non-profit foundations.

WORLD?S POOR ARE BENEFITING LESS

Still, despite the rise in worldwide health research expenditures, the world's poor have benefited less from the products of health research and continue to suffer high, and often growing, levels of ill health and premature death, said Richard Feachem, head of the Global Fund to Fight AIDS, TB and Malaria.

"Many of the reasons for this can be traced to failures to use knowledge or to deliver products that are already available. In turn these can be linked to issues such as inadequate finances, lack of political will, weak infrastructures and missing human resources," Feachem said in a statement.

Matlin said much of the important research is needed not just to develop new drugs, but to show "how to reach the poor in the most cost-effective way." "There is a lot of knowledge out there, but applying it in different situations, in different countries or culture, requires research," Matlin said. "We have to translate what we know at the global level to the country level."

INVALID DISTINCTION

In the past, the "10/90 gap" was seen in the pharmaceutical industry's focus on producing drugs for non-communicable diseases like high blood pressure and cancer that tended to afflict the populations of developed countries. The amount spent to address those health concerns towered over the funds directed toward the infectious and parasitic diseases that plague poorer nations.

But the Global Forum's report notes that this distinction is no longer valid.

"High income countries are experiencing new waves of infectious diseases, such as drug resistant infections, HIV/AIDS and SARS, while lower- and middleincome nations are seeing increases in non-communicable diseases," Matlin said.

He suggested that the private drug industry was not adequately responding to this shift.

Matlin said consolidations in the global drug industry during the past decades dozens of major companies have merged into less than 10 transnational giants today appears to have led to less innovation within the companies.

"The biggest black box is how the industry spends their money," Matlin said. Pharmaceutical companies justify their unwillingness to provide details of their research spending on the grounds of free market competition and keeping their competitors from knowing what they have in the pipeline, he said.

APPLYING PRESSURE

Matlin hopes the pressure of groups like the Global Forum will persuade the industry to become more open.

After joint-opening ceremonies on Nov. 16, the WHO summit and the Global Forum conference will run till Nov. 20.

In order to meet the Millennium goals, developed nations need to raise their aid donations to at least 0.07 percent of GDP, according to the U.N. The United States currently lags developed nations by this measure, channeling around 0.02 percent of GDP.