Quadruple the developed world's donations to the developing world to improve health. Double the aid by governments, charities and industry money devoted to R&D on diseases that particularly affect poor countries. Increase by whole percentages of GNP the funds spent by developing countries on their own peoples' health. And sustain these levels of support for the next two decades.

These are no small recommendations. They come from the hopefully influential Commission on Macroeconomics and Health, set up two years ago by the head of the World Health Organization, Gro Harlem Brundtland. What is depressing is how implausibly challenging those goals seem — and yet how essential, if combating the disease burdens of the great majority of the world is to be seriously addressed.

We have been here before. As long ago as 1980, the Brandt Commission on International Development Issues called for much greater support from “the North” for (among other things) health in “the South” by 2000. Over a decade ago, the Global Health Forum highlighted the fact, still uncomfortably true, that only about 5% of what is now $60 billion per year spent globally on biomedical research is directed at diseases affecting the poorest 95% of the world's population. How can one persuade a reluctant world to accept yet another set of recommendations addressing that huge imbalance?

One of the new report's main strengths (see http://www.who.int) is its attention to the reality of healthcare delivery. It identifies the need for enhanced research into operational aspects of healthcare, as well as the more traditional areas of epidemiology and basic biomedical research. It highlights the pitifully small degree of success by those in developed countries in raising funds for research in major diseases that kill millions every year — even malaria and tuberculosis have attracted a fraction of what is needed for research into drugs and vaccines.

The challenges are not only financial but also organizational, both in healthcare delivery and research. Indeed, one of the report's messages for agencies funding biomedical research is relevant to issues closer to home — the need to coordinate expertise internationally and to capture data in a way that ignores national boundaries, as well as the need to help young researchers. With these goals in mind, national biomedical funding agencies need to standardize their application procedures and peer-review processes, and increase the entitlement of foreigners to apply for funds. But the commission also recommends setting up a Global Health Research Fund with an annual budget of $1.5 billion. Progress already made by a similar organization, the Consultative Group on International Agricultural Research, adds weight to this proposal.

The commission displays excessive casualness towards one aspect of research. It gives due attention to the need to mobilize funds while allowing pharmaceutical companies to protect their interests through the patent system. In contrast, it also urges the free instantaneous distribution of scientific information without acknowledging the demonstrable obstacles to such a course of action — an area where some fresh economic insights could have been helpful. Nevertheless, the underlying message needs to be heeded: publishers, like pharmaceutical companies, can do more than they already are to enhance access to the literature by researchers in the developing world, through imaginative partnerships and targeted pricing.

The commission's analysis highlights the possibilities for both developed and developing countries to do more. It also identifies the economic incentives for them to do so. Its recommendations if implemented would, it says, save eight million lives per year by 2010, or 330 million “disability-adjusted life years”, which would directly release at least $180 billion of earnings, plus a move away from the poverty trap and a substantial consequent growth in economies and international market opportunities.

Researchers and policy-makers can do more than some might imagine. One thinks of scientists who recruited the downtime of people's desktop computers to hunt for extraterrestrial intelligence or, more relevant, potential targets for drugs; or policy-makers who conceived programmes to foster scientific collaborations between politically divided nations. But there is also a message that is both moral and self-interested for developed countries. To quote the report: “Governments and agencies who help stimulate and nurture these actions will be providing a specific antidote to the despair and hatred that poverty can breed.” Who could say anything but “Amen” to that?