Jill Wechsler
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After years of neglect, drugs and vaccines designed to treat a host of deadly diseases plaguing the poorer nations of the
world, are in development, thanks to new political, social, and scientific advances. The Bill and Melinda Gates Foundation
deserves special credit for placing vaccine development at the top of the research agenda for donor nations, nonprofit organizations,
and manufacturers. The spread of the AIDS epidemic around the world and the looming pandemic flu crisis has brought home the
threat of health problems in distant continents.
In the past, manufacturers often donated treatments for third-world diseases, but did not invest significantly in new research.
More recently, US and European governments offered tax breaks and patent extensions to "push" research for needed treatments
that have little market value in industrial states; advance purchase commitments (APCs) aim to "pull" new products to market.
But some analysts consider these tactics only minimally effective, often yielding therapies with low value for patients in
poor countries; some products still are too expensive for widespread purchase and have dosing and distribution requirements
that limit access and compliance.
NEW LANDSCAPE
Although governments and international agencies continue to back the push–pull drug development model, there is growing support
for new partnership arrangements that seek to expand drug research by reducing the financial risk for manufacturers. This
approach has altered the landscape for developing new drugs to treat neglected diseases, according to an important study by
researchers at the London School of Economics headed by Dr. Mary Moran, now based in Australia. Published in September 2005
by the Wellcome Trust (London, UK), the report documents how public–private partnerships (PPPs) in the last five years have
spurred R&D on new treatments for third-world health conditions such as malaria, tuberculosis, leprosy, leishmaniais, schistosomiasis,
dengue fever and others report available from publishing@wellcome.ac.uk
While industry developed only a handful of new drugs to treat neglected diseases in the previous 25 years, Moran reports that
from 2000 to 2004, partnerships involving large and small companies and nonprofit organizations launched 63 new research projects
that should translate into nine or 10 new drugs by 2010. This investment has occurred largely outside normal government health
funding programs, its support coming primarily from Gates, the Rockefeller Foundation, and other private donors.
In the 1990s, multinational pharma companies were closing down neglected disease research, according to Moran. Now pharma
and biotech companies are investing their own resources in this area and joining PPPs, such as Medicines for Malaria Venture,
the TB Alliance, Drugs for Neglected Diseases, and the Institute for One World Health (iOWH). Their participation may deflect
criticism over industry's slow progress in addressing global life-threatening diseases, and also help manufacturers reach
major emerging markets in India and China and tap their high-skilled researchers.
In addition, a growing number of niche biotech companies regard PPPs as prime opportunities to expand research programs. R&D
partnerships provide vehicles for small companies to parlay expertise in genomics, bioinformatics, and other innovative technologies
into new development activities, as well as gain opportunities to license intellectual property to larger partners. Relatively
small markets for many infectious diseases are similarly attractive to biotech firms as are those for orphan drug development
in the US and Europe. And both pharma and biotech companies anticipate that these low-profit R&D efforts eventually may yield
spin-off products with commercial value in the West.
REDUCING RESEARCH RISKS
A main feature of PPPs is to reduce the cost and risk of neglected disease drug development for manufacturers. The new research
model adopts a "no profit–no loss" approach that reverses traditional clinical development strategies. Partnerships encourage
manufacturers to be more involved in relatively low-cost, early-stage research to identify and run preliminary tests on promising
compounds. The more expensive and risky process of conducting clinical trials and seeking product registration in multiple
countries is assumed largely by the nonprofit partner, which has local research networks and experience navigating national
regulatory requirements. In addition to expanding the number of research projects for neglected diseases, PPPs aim to identify
those efforts best able to deliver low-cost products of high value to patients in developing countries.
