To the Editor:

Eye Health

Buchan et al. note that cataract is the leading cause of global blindness [1], largely in low- and middle-income countries, and call for research funding to be allocated accordingly.

In 1998, about 19 million people were blind worldwide from cataract, and in 1999 it was estimated that in India about 3.8 million people become blind each year [2].

The barriers to cataract surgery are high cost, low number of ophthalmologists, and poor quality outcomes in low volume units [2].

The costs of treating one eye of four million cataract blind people, at about US$50 per case [3], are about US$200 million per annum.

India is a country which spends about US$5000 million each year on maintaining its existing nuclear weapons [www.icanw.org/diversion_of_public_resources]. Less than 5% of this budget would clear most of India’s cataract blindness.

It is worth noting that 2019 figures show that there are about 138 Indian citizens whose wealth exceeds US$1000 million each, and their collective wealth is about US$440,000 million. If only 100 of these individuals donated as little as 0.25% of their wealth each year, India’s cataract blindness would be largely eliminated.

Across Africa >40% of the population live in poverty, yet corruption costs about 25% of the national incomes of African countries. More than 25% of citizens pay bribes to access public services.

More than US$148,000 million are lost to corruption in Africa each year, to the profit of the international banking system and international businesses [4]. Only small improvements in governance could result in significant improvements in health care, given the large sums currently lost to corruption.

Social and political policy choices contribute substantially to the burden of untreated diseases in poorer countries. To the extent that research in applied sciences, and particularly medicine, does not engage or confront questions of significant inequity where encountered, it fails. No amount of research funding will correct this.