Do Dollars Equal Concern?
The State of HBV Research Funding
How much money does the U.S. spend on hepatitis B virus (HBV) research? How
much should it spend? Both are tough questions to answer, but there is a
growing sense in the hepatitis B advocacy community that we may not be
getting enough or our fair share (figure 1).
Since we last visited the question of HBV research funding in our B Informed
Winter 2000 issue, funding levels for HBV research have remained largely
unchanged, while research funding for hepatitis C (HCV) and HIV has
increased (figure 2). Five years later, the gap has widened considerably.
The National Institutes of Health (NIH) budget office places 2005 estimates
at $40 million for HBV research, and $130 million for HCV. Compare these
numbers to the enormous $2.9 billion for HIV and $1.6 billion for biodefense
agents, and it can be seen how NIH allocations are being prioritized.
"What you're dealing with is flat funding for HBV," said W. Thomas London,
MD, senior member, Fox Chase Cancer Center, and board member of the
Hepatitis B Foundation (HBF). "HBV is perceived to be cured. More people
worldwide are infected with it, but it's simply not considered to be an
American problem, since most people now get vaccinated for it."
However, HBV remains a serious global health problem - 2 billion people have
been infected worldwide, and 400 million suffer from chronic HBV infection.
In the U.S., 12 million Americans have been infected and an estimated 1.2
million people are chronically infected.
"[HBV] is something of an epidemic that is flying under the radar, since
many people infected with HBV emigrate to the U.S. from other countries,"
London continued. "And so, they are not necessarily diagnosed. Whereas for
HCV, many people know someone who is affected, so people in Congress are
lobbying for funding because it's very high up on the public radar."
The experts agree that while it's not all about following the money, many
scientists gear their research to what is getting funded and to what is on
the public radar as important issues in science.
Another problem, posits Jesse Summers, PhD, professor of Molecular Genetics,
University of New Mexico, is that there are not enough young scientists
entering the field. "Of course you have scientists who know of HBV, but the
people who truly know it, many of them are going to be retiring in the next
10 years. I can only think of a couple of people who are in their forties
who are primary investigators on it. Probably the chief problem is that
students are not learning about HBV. They are not being introduced to the
field in postdoctoral training in large enough numbers and they are not
being encouraged to think of HBV research as a productive career. I think
the key is getting the word out that there is still work that needs to be
done in this field."
Timothy Block, PhD, HBF president, and professor of Microbiology and
Immunology, Drexel University, echoed Summers' concerns. "I'm very worried
about the dwindling number of HBV scientists. There are a number of
important issues competing for attention in the research arena. But the
progress that has been made in HBV research should make the case that this
is a problem that can be solved. It's a good investment and an important
area where a significant contribution can be made."
Unfortunately, there are many emerging diseases and a burgeoning biodefense
program that are competing with HBV for both funding and research bandwidth.
William Mason, PhD, senior member, Fox Chase Cancer Center, notes, "If you
look at the NIH database, you see that there is not a whole lot going on in
the way of new research funding for HBV - and it seems that, for the new
scientists coming up, they are following the funding, which is taking them
to other research topics. I think there needs to be more activism at the
individual level for HBV. It's really not up there in the face of the people
responsible for making the calls on budgeting matters."
While there is a good deal of success to be reported on the vaccination
side, the treatment side has been slow to turn up new therapies - a problem
that could be blamed on the limited research power in the HBV arena right
now.
Anna Lok, MD, director of Clinical Hepatology at the University of Michigan
adds, "Yes, we have a vaccine for HBV and yes, there are more options for
HBV treatment than there were, say, 10 years ago, but current treatment is
really only a stop-gap measure, to suppress symptoms. We need to do better
than that, if we really want to go forward. Research is going forward,
certainly, but not as quickly as one would like."
London adds, "The perception is that there is a vaccine for HBV, so no
further research is needed. We don't have vaccines for HCV or HIV, so these
are considered more pressing." Block concurs, "I think there is a sense of
complacency in the research community, that there's a vaccine in place, and
that we have treatments. However, we have not seen much of an advance in
those treatments in the last few years. We need to be doing more."
Block continues, "It is difficult to say how much money is needed to solve
the HBV problem. Moreover, since advances may come from other fields, it is
even difficult to completely determine which is HBV funding and which is
not. As a rule, scientists will be attracted to a field if it is important,
interesting, tractionable, and, of course, if it is funded. HBV certainly
meets the first three of those criteria."
There is, however, one troubling public health trend that underscores the
need for further aggressive research on HBV - the substantial increase in
liver cancer incidence. According to the Journal of the National Cancer
Institute, most cancers decreased over the 10-year period between 1992 and
2001. Distressingly, the incidence of liver cancer went up.
It is partly for that reason - liver cancer is on the rise, of which 80% of
cases are due to HBV - that in 2003 the NIH created the Liver Disease
Research Branch to focus and accelerate research on liver disease. Part of
its mission was to create an Action Plan for Liver Disease Research, which
was just released in January 2005, to address the challenges in the next
decade (see page 8). Jay H. Hoofnagle, MD, director, NIH Liver Disease
Research Branch, explained, "The major focus of this Action Plan is to
stimulate translation of basic research findings to practical and effective
means of prevention and control of liver diseases, including such important
conditions as hepatitis B and C.[and] liver cancer."
The primary challenge for HBV research today is to compete for the same
dollars that HCV and HIV are getting. In addition, biodefense is a new
funding consideration added since our last report five years ago. "We have
to acknowledge the budget deficit and how that will impact funding," London
said. "Right now, funding is flat, but you'll see in the next few years that
funding from the NIH is actually going to go down, and that there will be a
lot of fighting for a much smaller piece of the pie."
Published in the Hepatitis B Foundation - B Informed Newsletter (No. 42,
Winter 2005)
FAST FACT
Approximately one million people die every year from chronic hepatitis B and
its related complications, making it the 10th leading cause of death
worldwide
Figure 1.
Number of Infected Individuals
HBV HCV HIV
Chronically
Infected, Worldwide >350 million 170 million 40 million
Chronically
Infected, U.S. 1.2 million 2.7 million 850,000-900,000
Sources: Centers for Disease Control and Prevention, World Health
Organization
Figure 2.
Total NIH Funding
HBV HCV HIV Biodefense
2000 Est. $27 million $34 million $2 Billion -
2003 Act. 37.2 million 112 million 2.7 Billion $370 million
2004 Est. 39 million 118 million 2.8 Billion >1.3 Billion
2005 Est. 40 million 130 million 2.9 Billion 1.6 Billion
Source: NIH Budget Office, Dec. 2004
----- Original Message -----
From: "Joan Block"
Hi Sheree, I was wondering whether you would be willing to post this very
interesting article we included in our recent newsletter that highlights the
very sad state of HBV research funding (basically very little change in the
past 5 years since I last reported on it!!). It also includes two charts at
the end, so I dont' know how well that will translate? But the numbers speak
for themselves. Thanks Sheree!! Talk to you soon...Joan
=============================
Joan M. Block, RN, BSN
Co-Founder and Sr. Advisor
Hepatitis B Foundation
700 East. Butler Avenue
Doylestown, PA 18901
215-489-4900 (phone) / 215-489-4920 (fax)
[email protected]
Visit www.hepb.org -- The Hepatitis B Foundation is a national nonprofit
organization dedicated to finding a cure and improving the quality of life
for all those affected worldwide through research, education and advocacy. | 
发表于 2005-4-12 09:22
