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Research resources181614No. of PPPs1210864201986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003the developing world, such as malaria and tuberculosis;✜ are seriously disabling or life threatening, for whichtreatment options are inadequate or do not exist such asleishmaniasis and Chagas’ disease;✜ could be cured or prevented with the currently availablescience and technology, but for which research anddevelopment has ground to a standstill;✜ do not constitute a valuable enough market to stimulateadequate research and development of new medicines;✜ governments have failed to redress market failure.To redress the imbalance in availability of medicines todeveloping countries, PPPs are used as a means to gatherresources and funding to be applied to solving this problem,as by the 1990s, both the private and public sectorsacknowledged that “a pure market mechanism generally doesnot work” 12 where medicines are involved and newapproaches needed to be developed.Millions of people globally die or become disabled fromdiseases for which there are inadequate or no medicines andthe free market had no incentive to develop such medicines.From 1975 to 2004 only 1.3% of the 1556 new chemicalentities marketed were registered for tropical diseases andtuberculosis despite the fact that these diseases account for12% of the global disease burden 17 . Partnerships and morespecifically, PPPs were created to fill this void.Barriers to access to products andtreatments for diseases of the poorThe barriers to access to products and treatment for diseasesof the poor that these partnerships have been created toaddress can be classified under the following six groupings.1. Lack of affordable, effective safe diagnostics, medicines, orvaccines.2. The cost of the products, medicines, and vaccines (to boththe National Health Service and to individuals).YearFigure 1: Number of Public-Private Partnerships created between 1986 and 2003Source: Extracted from data found on the website for Initiative on Public-PrivatePartnerships for Health, www.ippph.org. Accessed week of February 1-8, 20063. Lack of a reliable supply of products, medicines, orvaccines.4. Weak/fractured health systems.5. Cultural perceptions and beliefs.6. Political will.The majority of PPPs were formed in the past seven yearsas illustrated in Figure 1, corresponding to interest and energyfrom private foundations, particularly the RockefellerFoundation and the Bill & Melinda Gates Foundation.Kinds of partnershipsIn general, public-private partnerships can be broadlycategorized into the following areas: (1) product distributionor disease control programmes; (2) product development;and (3) policy, advocacy, or health systems issues 18 .1. Disease control programmes/product distribution.Certain PPPs are designed to improve access totreatment in developing countries by improvingdistribution of medicines or medical products to preventor treat specific diseases. The disease controlprogrammes are mainly through drug donations; thereare now four major drug donations for annual masstreatment: Ivermectin, MSD, for onchocerciasis (Merck &Co. Inc.); azythromicin for Trachoma (Pfizer);Albendazole and Ivermectin for lymphatic filariasis (GlaxoSmith-Kline, Merck & Co. Inc.), mebendazole for soiltransmitted helminthes in children (Johnson andJohnson) and two for individual treatment; leprosy(Novartis) and sleeping sickness (Aventis, Bristol-MyersSquibb).2. Product development. The majority of partnerships focuson the development of medicines, vaccines, or products foruse in the treatment or prevention of neglected diseases 19such as the Medicines for Malaria Venture (MMV), TheInternational AIDS Vaccine Initiative (IAVI) and the GlobalAlliance for Vaccines and Immunization (GAVI Alliance).Global Forum Update on Research for Health Volume 4 ✜ 133
Research resources13 + 1*- HIV/AIDS (see Global Fund below)12 + 1*- Malaria (see Global Fund below)8 Health policies and systems7 Chagas’, leishmaniasis, trypanosomiasis, lymphaticfilariasis – individually or in combination with each other6 Microbicides5 + 1* Tuberculosis (see Global Fund below)5 Vaccines of the poor4 Onchocerciasis and/or trachoma3 Micronutrients/Vitamin A3 Reproductive health2 Dengue1 Communicable diseases – prevention through handwashing with soap1* The Global Fund to Fight AIDS, Tuberculosis and Malaria1 Guinea worm1 Hookworm1 Lassa fever1 Leprosy1 Meningitis1 Polio1 Schistosomiasis1 TetanusSource: Extracted from data found on the website for Initiative on Public PrivatePartnerships for Health, www.ippph.org, accessed 1-8 February 2006.Table 1: Number of partnerships with associated disease or issue3. Advocacy and policy. The third type of PPP concentrateson health policies and systems and advocacy. Most ofthe partnerships that fall in this advocacy and policycategory however, also have some technical, access, orproduct development component as well for example,GAVI, Drugs and Neglected Diseases inititative (DNDi),Global Alliance for Improved Nutrition (GAIN), SIGN.Of the 78 active partnerships, the number of partnershipsthat focus on certain diseases or health policy issues is set outin Table 1. Categorization is not an exact science aspartnerships may deal in any combination with productdistribution, product development, and/or policy and healthsystems issues between or among various diseases.Twenty-four public-private partnerships devote the majorityof their efforts to developing medicines, vaccines, ordiagnostics for diseases of developing countries includingmalaria, tuberculosis, HIV, leishmaniasis, and otherscollectively referred to as “neglected diseases” (see Figure 2).Of the 24 PPPs for Product Development, 9 are devoted todeveloping medicines and/or microbicides, 11 are committedto vaccine development, one is focused on diagnosticproducts, and three are involved with the development of acombination of medicines, vaccines and/or diagnostics. Fivepartnerships focus exclusively on reproductive health issues,four focus on malaria and two are committed to tuberculosisand HIV/AIDS respectively.Current situation with regard to PPPs forhealthThere were early perceptions and criticism that thesepartnerships would lead to distortion of national policies andpublic health funding, parallel systems of drugs supply etc.However these have been largely dispelled throughprogramme evaluation and assessments which have shown apositive impact – although it is true to say that many of thepartnerships are still too young to measure real impact.The raised awareness and stimulation of research anddevelopment on drugs/prevention for neglected diseases hascertainly changed the field over the last seven years. There isnow a very crowded landscape of PPPs, particularly in a fewsectors as illustrated by Figure 3, which has changedconsiderably since the early partnerships were formed. Mostof the neglected diseases are addressed by at least one PPPproviding research and development, drugs and technicalsupport and/or some funding.The recent analysis of drug development for neglected5432101984 1986 1988 1990 1992 1994 1996 1998 2000 2002 20041984–2004Figure 2: Number of Public-Private Partnerships for Product Development created by year from 1984 to 2004Extracted from partnership database found on website for Initiative onPublic-Private Partnerships for Health, www.ippph.org, accessed varioustimes December 2004.134 ✜ Global Forum Update on Research for Health Volume 4
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthStrengthening healt
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Access to healthReferences1.Further
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Access to healthMaking human rights
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