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 LANDSCAPEAlthough 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 firstname.lastname@example.org
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.