With Indonesia facing economic crisis and political instability, Christopher Zinn meets Sangkot Marzuki, a scientist who is trying to keep research there alive
Professor Sangkot Marzuki, who heads the distinguished but currently impoverished Eijkman Institute for Molecular Biology in Jakarta, Indonesia, is the first to admit that the medical research in his own country and in other tropical nations has been terribly neglected.
The broad brush figures—showing that only 10% of the global health research budget is devoted to diseases that cause 90% of the world's disease burden—ring horribly true to this much honoured researcher. But, he says, the problem is less one of pure funding than the lack of scientific culture and capability on what he calls the per capita basis.
“That's more serious in terms of the cause of the gap than the fact the funding is not there. The funding will not come unless you have a good research activity in place. It's a sort of chicken and egg situation,” he says.
“If suddenly the developing nations get a lot of money they still cannot do anything because the manpower is not there.”
He and 75 scientists at the institute are looking at the molecular and genetic levels for ways to reduce the suffering caused by infectious diseases such as malaria, hepatitis B, tuberculosis, HIV infection, and, increasingly, dengue fever.
Another specialty is the study of thalassaemia. This disease is prevalent in many Indonesian islands and is believed to offer resistance to malaria, but it is also responsible for many deaths.
But Marzuki faces a major problem with the cruel international economics of health. “There's no money in producing a cure for these diseases because they are the diseases of the poor nations, so basically the research has to be done relying on money coming from international organisations, such as the World Health Organization.”
Professor Marzuki, aged 56, is temporarily back at his second home in Melbourne—where he spent many years studying. He is trying to write up work and is also reflecting on the huge health divide between 20 million Australians and their nearby neighbours of 200 million Indonesians.
He says that available funds for vaccine and other research have increased because of the WHO's tropical disease research programmes and the role of philanthropists like Microsoft's Bill Gates and other foundations.
Yet the Eijkman Institute has hit hard times as a result of the Asian economic crisis that struck three years ago and the ongoing political and social instability in Indonesia.
Marzuki had planned on having 150 scientists at work by 2000, but the total remains capped at half that number. The facility is almost totally funded by the Indonesian government, and its annual budget equivalent of £3.6m ($5m) has been reduced to £700000 by the collapse of the rupiah.
“We are struggling with the economic situation just to stay alive let alone to do good work. You can always get dollars to do research work but the main problem to keep the institute alive is that you need salaries which compare on an international scale to avoid poaching of staff, and salaries are not usually covered by research grants.”
The irony is that the institute played a proud part in the development of tropical medicine. It was founded by Dutch colonialists in 1888, and its first director, Christiaan Eijkman, discovered the link between vitamin B-1 deficiency and beriberi, for which he won a Nobel prize in 1929. The centre went on to do pioneering work on tropical medicine but was closed amid the economic and political turbulence of the 1960s.
It was during the 1960s that Professor Marzuki, the son of a high school teacher, inspired by a class diary which included biographies of pioneers such as Edison and Fleming, decided to go to medical school. While he was there, he found that research, then as now, was not a priority.
Because the number of doctors was so small, medical education was focused on community medicine, he said. “That was good, but it was done at the expense of good quality medical science.”
He graduated as a medical doctor from the University of Indonesia and went on to study in Bangkok before spending 17 years at the department of biochemistry at Melbourne's Monash University.
In 1992 he was invited back to rebuild the institute amid the government's boom in interest in biotechnology, and he went on to continue in his specialty of biogenesis of energy transducing membranes and associated human genetic disorders.
Now he sees the centre's priorities as looking at the molecular basis of malaria and hepatitis B and also taking advantage of the wide genetic diversity of the many different races who inhabit the archipelago.
He says there are several excellent facilities in the region, including three in Thailand, that would benefit directly from overseas funding, but in a global sense the issue remains one of the level of scientific ability. He believes it is crucial that, despite the higher costs, more research is done in each country by the nationals living there. He thinks that the best model is to bring in top scientists to work alongside locals.
The institute already has links with the Walter and Eliza Hall Institute in Melbourne and is looking at the molecular basis for resistance to antimalarial drugs and the pathology of malaria.
It also has a joint project with the US Navy investigating the factors in malaria infection by tracking 1000 migrants from a remote valley in Indonesian Papua to the coast.
“This model brings top scientists to the institute and gives them access to field materials. Hosting them at the institute also develops the right international environment.”
But the professor says that he is dealing with a political process in which everything has to be justified by its economic benefits.
“At the moment you cannot avoid the global inequality becoming greater. You can make a case to your own government and the answer is, ‘we understand but we don’t have any money to do it.'
“The priority is short term; the priority is whether the people can eat. The health care of the nation is focused on now rather than the future even if that's only five to 10 years away.”
Without funds you cannot carry out good research, but without good research you cannot attract funds
“The priority is whether the people can eat”
Figure.
Professor Marzuki: “We are struggling…just to stay alive”