Combining health and social protection measures to reach the ultra ...

Research resources12010080604020Products currently in discovery and development for neglected diseases106 products in discovery, development or registered since 200085% of current projects driven by PPPsIOWH 3TDR 14GATB 17DNDi 22MMV 34industry alone 1601Figure 3: Products currently in discovery and developmentdiseases has shown that many of the long-held beliefs on theactivity of development of drugs for neglected diseases are nolonger valid or accurate and product development since 2000has increased substantially (Figure 3). However, despite thepublic-private label, 80% of the drug development is throughprivate philanthropy and the industry institutions are largelyself-funding. Moran et al point out that although the productdevelopment PPPs have proved to be a good conduit fordirecting public funding to industry and academia, they couldcollapse if there is not more public support.The access partnerships and drug donation programmeshave raised the profile of the diseases involved, kick-startednational disease control programmes and improved deliverysystems to those at “the end of the road”.However, there remain many gaps that the partnershipshave not been able to address which raise the concern ofsustainability – systemic problems in health systems andinfrastructure, capacity and human resources, long-termoperational funding. The clinical trial capacity is limited andunder-funded at present and mechanisms for “after researchand development” are not being addressed – i.e. how to getthe products to the people that need them.Overall, a better coordination between the partnershipsis needed, and integrated approaches to addressing theneglected diseases which would maximize efficient useof resources.The research needs in this area include: operationalresearch on sustainable delivery methods; implementationpractices/opportunities for collaboration across diseaseprogrammes; bringing new products to markets and targetcommunities and finally, how to “harmonize the partnershipswith health systems”.ConclusionPublic-private partnerships have changed the landscape ofdrug development for medicines for neglected diseases andthe delivery of medicines for some neglected diseases in thedeveloping world. Stemming from market and governmentfailures as well as ineffective legislative incentives, PPPs havebrought together participants from all sectors in an attempt tomaximize the skills and resources of those participants totackle complex issues of drug development and distribution.Whilst the product distribution and disease controlprogrammes are filling a gap and improving access totreatment for specific diseases, many issues concerning longtermsustainability remain.The product-development PPPs are relatively new entitiesand have not yet brought a product to market so it remains tobe seen if this innovative approach to drug development willreally succeed. They have introduced innovative and creativesystems and processes for drug development outside thetraditional for-profit pharmaceutical model. PPPs arechallenging governments, industry, academia, and non-profitorganizations to face urgent public health issues.Product-development PPPs face the challenges presentedby the risks inherent in the costly and time-consumingprocess of drug development especially for diseases wherebasic science and research has been dormant for decades.The cost of drug development is high and PPPs are optimisticthat sufficient funding will be available as drug candidatesmove through each stage of the development process. Itremains to be seen if the optimism is justified.As yet, most of those affected by the diseases that thesepartnerships were developed for are not yet benefiting. ❏Stefanie Meredith is currently Director of Public HealthPartnerships at the International Federation of PharmaceuticalManufacturers & Associations, having worked before in diseasecontrol partnerships, operational research, design andimplementation of health interventions in Africa.Elizabeth Ziemba is President of Scientists for Health andResearch for development (SHARED), a Massachussetts based notfor-profitfocused on improving access to medicines in developingcountries through strategic partnerships designed to fill gaps inhealth care delivery systems. She consults on issues related topublic-private partnerships as well as access issues.Global Forum Update on Research for Health Volume 4 ✜ 135