Lima, Peru. Tropical disease research is the study of infections that thrive in warm, humid, and often economically marginalized regions — dengue, leishmaniasis, Chagas disease, leptospirosis, soil-transmitted helminths. The field also touches on neglected tropical diseases, vector-borne transmission, zoonotic spillover, and global health equity. For Spanish-speaking students and professionals in Peru, this is not an abstract topic. It is the difference between a rapid diagnostic test in Iquitos and a three-week wait for a result that arrives too late. In this article, I want to explain why the funding system consistently underfunds this work, what the evidence says, and what can be done without overpromising.
The Funding Gap Is Not a Mystery — It Is a Market Failure
When I teach molecular biology at the Universidad Nacional Mayor de San Marcos, I often compare research funding to the preparation of ceviche. If you have fresh fish, good limes, and a clean cutting board, the reaction is fast and reliable. But if the fish is old or the lime is weak, no amount of stirring will fix the result. Tropical disease research has the equivalent of old fish: the diseases affect people with limited purchasing power, so the commercial incentive to develop diagnostics, drugs, and vaccines is weak. Health economists call this a market failure, and it is well documented in the peer-reviewed literature on neglected disease innovation.
The World Health Organization maintains a portfolio of 20 neglected tropical diseases. Many of them are present in Peru, including Chagas disease in Arequipa, leishmaniasis in the Madre de Dios basin, and dengue across the northern coast and Amazonian cities. Yet global funding for NTD research and development remains a small fraction of funding for diseases that affect high-income countries. A 2023 analysis by Policy Cures Research found that basic research and product development for neglected diseases received less than 5% of total global health R&D funding in most recent years. That is not a rounding error; it is a structural pattern.
How the Funding System Actually Works — and Where It Breaks
To understand underfunding, it helps to follow the path of a typical grant. A Peruvian research group identifies a local problem: for example, the increasing resistance of Aedes aegypti mosquitoes to pyrethroid insecticides in Piura. The group writes a proposal, often in English, to an international funder. The proposal competes against projects from better-resourced institutions in Brazil, Mexico, or the United States. The review panel may have no member who has worked in a Peruvian field station. The grant, if awarded, lasts two or three years. Then the cycle repeats.
This system has three recurring weaknesses. First, it rewards novelty over continuity. A three-year grant can fund a pilot study, but not the decade of surveillance needed to understand seasonal transmission. Second, it rewards publications over implementation. A paper in an indexed journal counts more than a working relationship with a regional health directorate. Third, it rewards diseases with global visibility. Dengue receives attention during outbreaks, while chronic conditions such as Chagas cardiomyopathy remain invisible because they kill slowly.
The Chicha Fermentation Analogy
I sometimes explain microbial ecology to my students using chicha de jora, the traditional fermented maize drink. The fermentation works only if the microbial community is stable over time. If you keep changing the temperature, the container, or the maize variety, the community collapses. Tropical disease research is similar. Stable funding allows a research group to maintain trained personnel, calibrated equipment, and trusted community relationships. Short, unpredictable grants are like changing the fermentation vessel every week: the process never matures.
What the Evidence Says About Underfunding
The evidence base on this topic is stronger than many people assume. A widely cited study in The Lancet examined global investments in neglected disease research and found that funding is concentrated in a small number of diseases, primarily HIV/AIDS, malaria, and tuberculosis. Other NTDs, including many that affect Peru, receive far less. The authors noted that funding often follows donor priorities rather than local burden of disease. That is a polite way of saying that the people who suffer from the disease are not the people who set the research agenda.
Another useful source is the G-FINDER report, which tracks annual investment in neglected disease R&D. The report consistently shows that basic research receives less than product development, and that vector control research — essential for dengue and leishmaniasis — is among the most underfunded categories. For a country like Peru, where vector ecology varies dramatically between the coast, the Andes, and the Amazon, this gap has direct consequences. A mosquito control strategy that works in Lima will not necessarily work in Iquitos.
Peru-Specific Consequences of Underfunding
In Peru, the consequences of underfunding are not hypothetical. I have visited field sites in the Peruvian Amazon where a regional laboratory has a functioning PCR machine but no budget for primers. I have spoken with nurses in Cajamarca who can describe the clinical signs of bartonellosis but have no rapid diagnostic tests. These are not failures of knowledge; they are failures of procurement and sustained investment.
One concrete example is antimicrobial resistance in Salmonella enterica and Shigella species isolated from pediatric diarrhea cases in peri-urban Lima. Local studies have documented rising resistance to first-line antibiotics, but surveillance remains intermittent. Without continuous funding, the data arrive too late to inform treatment guidelines. The same pattern appears in leptospirosis, a zoonotic disease linked to flooding and poor sanitation on the northern coast. Outbreaks occur after heavy rains, but baseline surveillance between outbreaks is rarely funded.
What Underfunding Looks Like in a Classroom
Underfunding also shapes education. Many Peruvian universities lack access to current molecular biology databases, and students often rely on open-access articles that are several years old. When I teach about CRISPR-based diagnostics for dengue, I can show the concept, but I cannot always show the equipment. The gap between what students learn and what they can practice is a direct result of underinvestment in laboratory infrastructure. This is not a criticism of students or universities; it is a structural constraint.
Why the Problem Persists Despite Awareness
One might ask: if the problem is well documented, why does it persist? The answer involves several overlapping factors. First, tropical diseases are often endemic rather than epidemic. They cause steady, chronic suffering rather than sudden, dramatic outbreaks. Steady suffering does not generate headlines. Second, the affected populations are often rural, poor, and politically marginalized. Their health needs do not translate into electoral pressure. Third, the research ecosystem rewards publications in high-impact journals, which are often based in high-income countries. A Peruvian researcher who publishes in a local journal may be doing more for local health but less for their career.
There is also a linguistic barrier. Most high-impact journals publish in English. A Spanish-speaking researcher who writes a detailed epidemiological report in Spanish may reach the people who need it but not the funders who could support the next study. This creates a double bind: the work is either locally useful or globally visible, but rarely both.
What Can Be Done Without Overpromising
I want to be careful here. I am not going to claim that a single policy change will solve the problem. The evidence suggests that several partial solutions can help, but none is sufficient alone.
First, sustained core funding for regional laboratories would help more than another round of short, competitive grants. Core funding allows a laboratory to maintain equipment, train technicians, and build longitudinal datasets. The World Health Organization has argued for this approach in its road map for neglected tropical diseases, and the logic is sound. But core funding is less attractive to donors because it does not produce a single, citable result.
Second, research partnerships between Peruvian institutions and international groups should include explicit capacity-building components. A partnership that only extracts data and leaves no local infrastructure is not a partnership; it is a field trip. Some collaborations, such as those between Universidad Peruana Cayetano Heredia and international tropical medicine centers, have shown that long-term, equitable partnerships can work. But they require patience and trust, which are hard to measure in a grant report.
Third, open-access publishing in Spanish and Quechua, where relevant, can reduce the linguistic barrier. A field guide to sandfly identification written in Spanish and Quechua may not be indexed in a major database, but it can be used by community health workers in the Andes. That is a different kind of impact, and it deserves recognition.
Confidence and Uncertainty
I want to state clearly what I am confident about and what remains uncertain. I am confident that tropical disease research is underfunded relative to its burden of disease. The G-FINDER data and multiple peer-reviewed analyses support this. I am confident that the funding system rewards short-term, high-visibility projects over long-term, locally embedded work. I have seen this pattern repeatedly in Peruvian institutions.
I am less confident about the best policy response. Some argue for a global fund for neglected disease research, modeled on existing mechanisms for HIV and malaria. Others argue for strengthening national research systems so that countries like Peru can set their own priorities. Both approaches have merit, but the evidence on which works better is limited. I would not want to overpromise on either.
A Note on Language and Access
This blog exists because I believe that molecular biology and tropical health research should be discussed in Spanish and English, with Quechua common names where they help. When I write about Lutzomyia sandflies, I also mention the Quechua term titira, used in some Andean communities. When I explain enzyme kinetics, I use the example of ceviche preparation: the acid in lime juice denatures fish proteins in a time- and temperature-dependent manner. These analogies are not decorative. They are a way of making science legible to people who live with these diseases.
Underfunding is also a language problem. If research findings are locked behind paywalls and written only in English, they do not reach the people who need them. Open-access publishing helps, but it is not enough. We also need plain-language summaries, bilingual abstracts, and community-facing materials. That is a role this blog can play, even if it is a small one.
Frequently Asked Questions
Why is tropical disease research underfunded compared to other diseases?
Tropical diseases primarily affect low-income populations in warm, humid regions. Because these populations have limited purchasing power, there is little commercial incentive for pharmaceutical companies to invest in new diagnostics, drugs, or vaccines. Public and philanthropic funding partially fills the gap, but it remains far below the level needed. The G-FINDER report and analyses in The Lancet document this pattern consistently.
Which tropical diseases are most relevant to Peru?
Peru faces a diverse set of tropical diseases, including dengue, leishmaniasis, Chagas disease, leptospirosis, bartonellosis, and soil-transmitted helminths. The distribution varies by region: dengue is common in northern coastal and Amazonian cities, leishmaniasis in the Madre de Dios basin, and Chagas disease in southern departments such as Arequipa. Each disease requires different vector control and diagnostic strategies.
What would sustained funding actually change?
Sustained funding would allow regional laboratories to maintain equipment, train personnel, and conduct continuous surveillance. It would support long-term studies of vector ecology and antimicrobial resistance. It would also reduce the gap between what students learn in university and what they can practice in the field. The change would be gradual, not dramatic, but it would be real.
Can open-access publishing help with underfunding?
Open-access publishing can help by making research findings available to researchers, clinicians, and students who cannot afford journal subscriptions. It does not directly increase funding, but it can increase the visibility and use of research from low- and middle-income countries. Bilingual and community-facing summaries can extend that reach further.
What Comes Next on This Blog
This article is the first in a series on the economics of tropical disease research. In the next piece, I will look at a specific case: the history of bartonellosis research in Peru, from the work of Daniel Alcides Carrión to current molecular diagnostics. That history shows both the strengths and the vulnerabilities of Peruvian science. If you have questions or field experiences to share, I welcome them. The goal is not to complain about underfunding, but to understand it well enough to change it.