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Research resourcesWe encourage other national governments to follow this leadand fund a broad portfolio of research in this area. Somecountries are already supporting their scientists to research themale reproductive system and develop methods to regulatemale fertility, but governments need to do more in terms offunding, networking, partnering and political support. It is nowclearly apparent that only through the combined efforts ofscientists, not-for-profit research organizations, governmentsand international organizations will the hope of greater accessto family planning through delivery of methods for men to usebe realized. We are strongly committed to this goal andencourage greater public-sector involvement and investment inthis important area of research. ❏The author is a staff member of the World HealthOrganization. The author alone is responsible for the viewsexpressed in this publication and they do not necessarilyrepresent the decisions or the stated policy of the World HealthOrganization.Kirsten M Vogelsong is a scientist in the Department ofReproductive Health and Research at the World Health Organizationin Geneva, Switzerland. She manages a portfolio of activities relatedto the research and development of new methods of contraception,with a focus on male sexual and reproductive health and fertilityregulation. Dr Vogelsong received a BA degree from Penn State anda PhD in Neurobiology and Physiology from Northwestern University.She has previously worked in academic research laboratories and inproject management at the United States Agency for InternationalDevelopment’s Office of Population.Henry L Gabelnick is the Executive Director of CONRAD and alsoa professor in the Department of Obstetrics and Gynaecology atEastern Virginia Medical School. CONRAD has as its mission theimprovement of reproductive health with emphasis on developingcountries. Dr Gabelnick received BS and MS degrees from MIT andhis PhD from Princeton University. He currently is the President ofthe Society for the Advancement of Reproductive Care. He has alsoserved on the boards of the Alliance for Microbicide Development,Biosyn, Inc. and the International Partnership for Microbicides.Eberhard Nieschlag is currently President of the German Societyof Andrology. Following his studies of Medicine in Bonn and Munichand Biochemistry in London, Professor Nieschlag worked at variousdepartments of Internal Medicine of University Hospitals in Germanyand at the Reproduction Research Branch at the NIH in Bethesda.He is specialized in internal medicine, endocrinology and andrology.He was Director of the Max-Planck Clinical Research Unit forReproductive Medicine at the University of Muenster from 1980 to1988 and has since then been Director of the Institute ofReproductive Medicine of the University of Münster, which is a longstandingWHO Collaborating Centre for Research in MaleReproduction and a training centre of the European Academy ofAndrology. For many years, Professor Nieschlag was a member of theWHO Steering Committee for the Regulation of Male Fertility andwas its Chairman from 1985 to 1990. He was President of theGerman Society of Endocrinology, the International Society ofAndrology, the European Academy of Andrology the German Societyfor Reproductive Medicine. The most recent of the many awardsProfessor Nieschlag received is the Distinguished Andrologist 2007of the American Society of Andrology.References1.United Nations Department of Economic and Social Affairs, PopulationDivision. World Contraceptive Use 2005, 2005. Available at websitehttp://www.un.org/esa/population/publications/contraceptive2005/WCU2005.htm (accessed July 2007).2.Return of the Population Growth Factor – Its Impact Upon the MillenniumDevelopment Goals, 2007. Report of hearings by the All Party ParliamentaryGroup on Population, Development and Reproductive Health, House ofCommons, London.3.The World Bank. Population issues in the 21st century – the role of the WorldBank. Health, Nutrition and Population Discussion Paper, 2007.4.Heinemann K et al. Attitudes toward male fertility control: results of amultinational survey on four continents. Human Reproduction, 2005,20(2):549-556.5.Martin CW et al. Potential impact of hormonal male contraception: crossculturalimplications for development of novel preparations. HumanReproduction, 2000, 15(3):637-645.6.ICPD Programme of Action, paragraph 12.14. Available at websitehttp://www.unfpa.org/icpd/icpd_poa.htm#ch12b (accessed July 2007).7.Gardner R, Blackburn RD, Upadhay UD. Closing the condom gap. PopulationReports, April 1999, Series H, No 9. Baltimore, Johns Hopkins UniversitySchool of Public Health, Population Information Program.8.Upadhay UD. New contraceptive choices. Population Reports, April 2005,Series M, No. 19. Baltimore, Johns Hopkins Bloomberg School of PublicHealth, The INFO project. Available at websitehttp://www.populationreports.org/m19/9.Lohiya NK et al. Vas deferens, a site of male contraception: an overview.Asian Journal of Andrology, 2001, 3:87-95.10.Sokal DC. Recent research on vasectomy techniques. Asian Journal ofAndrology, 2003, 5:227-230.11.World Health Organization Task Force on Methods for the Regulation of MaleFertility. Contraceptive efficacy of testosterone-induced azoospermia in normalmen. The Lancet, 1990, 336:955-959.12.World Health Organization Task Force on Methods for the Regulation of MaleFertility. Contraceptive efficacy of testosterone-induced azoospermia andoligozoospermia in normal men. Fertility and Sterility, 1996, 65:821-829.13.Gu Y-Q et al. A multicenter contraceptive efficacy study of injectabletestosterone undecanoate in healthy Chinese men. Journal of ClinicalEndocrinology & Metabolism, 2003, 88:562-568.14.Meriggiola MC, Farley TM, Mbizvo MT. A review of androgen-progestinregimens for male contraception. Journal of Andrology, 2003,24(4):466-483.15.Wenk M, Nieschlag E. Male contraception: a realistic option? EuropeanJournal of Contraception and Reproductive Health Care, 2006,11:69-80.16.Kamischke A et al. Intramuscular testosterone undecanoate andnorethisterone enanthate in a clinical trial for male contraception. Journal ofClinical Endocrinology & Metabolism, 2001, 86:303-309.17.Kamischke A et al. An effective hormonal male contraceptive usingtestosterone undecanoate with oral or injectable norethisterone preparations.Journal of Clinical Endocrinology & Metabolism, 2002, 87:530-539.18.Meriggiola MC et al. Norethisterone enanthate plus testosterone undecanoatefor male contraception: effects of varions injection intervals onspermatogenesis, reproductive hormones, testis and prostate. Journal ofClinical Endocrinology & Metabolism, 2005, 90:2005-2014.19.Nieschlag E, Behre HM. Testosterone in male contraception. In: Nieschlag andBehre (eds), Testosterone: Action, Deficiency, Substitution, 2nd edition,1998, Springer Heidelberg, pp.513-528.20.10th Summit Meeting Consensus: Recommendations for regulatory approvalfor hormonal male contraception. International Journal of Andrology, 2007,30:63-64.130 ✜ Global Forum Update on Research for Health Volume 4
Research resourcesA new landscapeof partnershipsArticle by Stefanie Meredith (pictured) and Elizabeth ZiembaOver the last few years, partnerships between publicand private sector organizations have become agrowing phenomenon. These partnerships grew out ofa need to fill gaps in the health systems of developingcountries and have become an increasingly commonmechanism to address some of the diseases of the poor indeveloping countries.The ultimate goal of most of these partnerships is toimprove and increase access to treatment, particularly for the“neglected diseases”, and many also express the goal ofcontributing to the alleviation of poverty.The need for such partnerships is explained by a failure ofthe public health system – the inability of the public sector toprovide the public goods entirely on its own due to lack ofresources; competing priorities for the limited resourcesavailable; management issues; conflict and post-conflictsituations, etc. There is also a failure on the part of the privatesector when there is little or no commercial incentive for thedevelopment of diagnostics and medicines for most of thediseases endemic in developing countries and affectingmainly the very poor.IntroductionEvery year, approximately US$ 70 billion is spent in healthresearch but only about 10% of funding is targeted to thediseases that account for 90% of the global disease burden.The unavailability of medicines to people in developingcountries results in enormous human and economic costs 1 .During the past ten years, the global health community hasidentified gaps in research and development of medicines toprevent or cure diseases that are primarily associated withextreme poverty and its attendant lack of access to cleanwater, adequate nutrition, and basic sanitation 2 . Whilediseases such as malaria, tuberculosis and others that areeven less well known are rampant in developing countries;they are of lesser or no consequence in developedcountries 3,4,5,6 .There is little or no economic incentive to developpharmaceutical products 7,8 for these diseases as well as otherissues including: “distribution challenges in countries withpoor infrastructures and lack of awareness about thesediseases in more developed countries” 3 , “liabilityconsiderations, inadequate science base, andunderestimation of the disease burden” 9 . As a consequence,compared with other diseases, minimal research on diseasesaffecting the poor has been conducted. To address thisenormous and widening gap in availability of medicines, theinnovative approach to address this problem has been theformation of Public-Private Partnerships (PPPs) 10 .The PPPs bring together skills, knowledge, and resourcesfrom a variety of sectors including academia, nongovernmentalorganizations, philanthropists, not-for-profitorganizations, government and intergovernmental agencies,as well as members of the for-profit private sector such aspharmaceutical and biotech companies to create a uniqueapproach to solving a global health issue. From 1986 whenthe first such PPP for health was created until the end of2003, 91 such partnerships have been instituted, 78 ofwhich are still in existence 11 . Each partnership has its ownseparate legal status, broad range of goals, combinations ofpartners from the public and private sectors, managementstructures, and strategies 11 .Many partnerships reflect a mix of representatives from thepublic and private sectors on their boards of directors, someof whom represent a particular institution while others sit inan individual capacity; however, it remains unclear whichmodel is optimum for ensuring success.The nature, variety, and individuality of public-privatepartnerships make definition difficult 12,13,14 . For a workingdefinition, Public-Private Partnerships for health can bedefined as “arrangements that innovatively combine differentskills and resources from institutions in the public and privatesectors to address persistent global health problems” 15 .Although the philosophy behind PPPs includes shared risk,using complimentary skills and expertise from each partnerorganization and equal input from public and privateorganizations, the reality is that many of these so-called PPPswould be better described more classically as partnerships oreven collaborations due to the traditional division of financialand technical roles of the organizations.Global health partnerships frequently use the term“neglected diseases” when referring to a group of diseasesaffecting developing countries. According to the Drugs forNeglected Diseases Initiative (DNDi) 16 , “neglected diseases”can be characterized as diseases that:✜ kill millions each year, primarily in the poorest areas of132 ✜ Global Forum Update on Research for Health Volume 4
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