Cockburn, 2001). Such appropriate technological change has enabled Indian
pharmaceutical firms to export 60 per cent of their vaccine output to other
developing countries (Srinivas, 2006:1756). In 1988 there were 350,000
reported cases of polio and endemicity in 125 countries, and elimination of
polio now seems likely, with 1997 reported cases in 2006 and endemicity
affecting just four countries by 2008 (Taylor et al., 2009).
The development of a vaccine for malaria and even its physical delivery to
developing countries will be just the start. The development of oral rehydration
therapy to treat diarrhoea was a very low-cost, simple and appropriate technol-
ogy but diarrhoea remains a significant cause of infant mortality. Other
cheaply treated significant causes of mortality include tuberculosis and respi-
ratory infections (Kremer, 2002:107; Cutler et al.,2006) and diarrhoea, partic-
ularly in infants. Up to 50 per cent of children in some developing countries do
not receive the basic vaccinations that are part of the World Health
Organization’s (WHO) Expanded Programme on Immunisation and three
million lives are lost annually. In some countries (Congo, Nigeria and
Somalia) coverage rates of the most basic vaccines declined dramatically over
the 1990s (Bloom et al., 2005). Approximately 25 per cent of people world-
wide suffer from intestinal worms,though annual or biannual treatments with
virtually no side effects cost less than $1 per year (Kremer, 2002). As discussed
in Chapter 6 there is a pervasive problem in translating even (very low) public
expenditure and programme objectives into real health gains in developing
countries (Chaudhury et al.,2006; Filmer et al., 2000: 208–11). While a large
majority of urban household heads in one surve y of urban-slum India under-
stand the purpose and role of cholera vaccines,a substantial minority still
never boil water (Whittingdon et al., 2009:402). Education, information and
persuasion remain crucial.
Despite these gloomy prognostications global malaria deaths were reduced
by an estimated 38 per cent between 2001 and 2010. Ten African countries as
well as most endemic countries in other regions reduced malaria cases and
deaths by more than 50 per cent. The key behind this unexpected success was a
huge increase in donor financing of relevant R&D and related delivery systems.
In December 1998 the Roll Back Malaria (RBM) Partnership was launched
with leadership from the WHO, UN Children’s Fund, World Bank and UNDP.
Between 2000 and 2009, 84 from 100 endemic countries worldwide received
donor assistance for malaria control. This changed the nature of incentives
facing health care research, dissemination and health care providers. Massive
donor funded investment in related R&D has provided relevant technology for
developed countries de-linked to small low income markets. Newly developed
insecticide treated bed-nets (ITNs) are now far longer-lasting and in need of
less re-treatment. UNICEF became one of the largest net procurers of bed-nets
and globally purchased 164 million nets between 2000 and 2010. As a result of
this guaranteed demand global annual production of nets increased fiv e-fold
from 30 to 150 million between 2004 and 2009. By the end of 2010, 19 African
countries received enough nets to satisfy 80 per cent + of their estimated need.
112 Sources of Growth in the Modern World Economy since 1950