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Research resourcesSmall scale businessMultinational not-for-profitSmall and medium Western firms,developing country firms,academics/public45%Within PPPs25%Alone25%TDR**Unable to verify details for three TDR projectsFigure 1: The drug R&D landscape for neglected diseases (Dec 2004): 63 active drug development projectsstudied most closely.)The organizations themselves are private groups not publicprivatepartnerings and are majority funded from privatephilanthropyAlthough they are entirely focused on forwarding the publicinterest in promoting developing country health, as opposedto a private interest in generating profit, and though theyinclude extensive public health expertise on their Boards,Steering Committees and staff, these PPPs are neverthelessnot public entities but are independent private not-for-profitgroups with a public health focus.By accident, rather than design, they are alsopredominantly funded from private philanthropic sources (seeFigure 2).The failure of government donors to step up to the tablemeans that private groups such as The Bill & Melinda GatesFoundation and Médecins Sans Frontières continue to providethe bulk of funding for these PPPs and their activities, and tobe the main auditors of their performance and outputs.The unintended outcome of this situation – and we note* Excludes TDR3% Philanthropic organizations2% Private sector16% Public sector79% UN agenciesFigure 2: Total cumulative PPP funding by type of funder (as of April 2005,including forward funding committed by that date)*that most of these PPPs had hoped for, and sometimesplanned on, having far more substantial government funding– is that, in practice, they are more “private” than “public” inboth their funding, auditing and accountability. This situationhas led to oft-voiced concerns that “Bill Gates is runningworld health”, however both private donors and PPPsthemselves would strongly prefer a healthier public-privatefunding mix, and the greater public responsibility this wouldbring. Nevertheless, until this happens, these PPPs willcontinue to be predominantly privately-funded privateorganizations – they do not stand-in for public participation inthe neglected disease field.PPPs fund academic and developing country R&D activityas well as private industry R&DThese PPPs do not primarily channel public funds to privateindustry activity (often multinational companies), as thebroad brush classical model would suggest. It is not only thatPPP funds largely come from private philanthropic groups, asseen above, but that these funds are distributed to optimalR&D partners in both the public and private sectors and inboth the developed and the developing world.In practice, around one third of PPP R&D grants goto public sector groups (academic drugdevelopment); around one third to private or not-forprofitcompanies, including companies in thedeveloping world and small- to medium-sized drugfirms; and one third to multinational drug companies(see Figure 3).This funding distribution reflects the fact that thesePPPs not only develop promising industry leads butalso work to actively generate new leads, many ofthese from the public academic sector. The role thisplays in translating basic academic research intoapplied research that results in new neglecteddisease compounds is often overlooked.PPPs are not simply funders. They play a centralmanagement role in the R&D process, closely akin tothe role played by Venture Capital (VC) firms ormultinational drug companies in commercial areas.PPPs do not operate as a passive channel of fundsto either their academic or industry partners, i.e. theydo not provide grants in the more “hands off” wayGlobal Forum Update on Research for Health Volume 4 ✜ 141
Research resourcesthat many public donors may be used to. This is a veryimportant point to understand. As discussed below, inpractice effective PPPs operate more like a cross betweensocial-VC funders and multinational drug company (MNC)divisions.Just as VC firms do when looking for optimal new productsto take forward from a commercial perspective, the PPP alsoassesses the field to hone it down to a shortlist of the mostpromising R&D projects from a public health perspective.The PPP raises the funds, bears the risks, finances thechosen groups, provides support to get their products acrossthe line, and finally reaps the (social) dividend. Likewise, thePPP plays a VC-like role in setting milestones, monitoringprogress against these and making go/no-go decisions basedon how well each project performs. PPPs are assisted in thistask by their Scientific Advisory committees, composed ofexperts (often world-leaders) in industry pharmaceuticaldevelopment and developing world health needs. Watchingone of these committees grill R&D groups on their projects isa fascinating exercise in how public health and industryexpertise can work together to ensure that the target productsare not only possible from an industrial perspective, but alsooptimal in terms of affordability, suitability, efficacy and safetyfor the target developing country populations.This VC-like role is often unacknowledged, which is a greatpity since it is an area where government funders of R&Dprojects (for example, via grant programmes) are often mostexposed to the risk of poor investments and failed decisions.Shifting these decisions to PPPs with industry and publichealth expertise represents a clear bonus for governmentfunders. If allied to additional government funding of PPPs, itcould also help provide the magical formula of increasedpublic involvement and accountability, but decreased publicrisk. An important proviso is that the PPP must, of course,have sufficient industry and public health expertise – somegroups are stronger on this than others, an issue that isaddressed through proposals set out elsewhere .PPPs also play a role that we have loosely categorized as“MNC-like”. In other words, they provide smaller or lessexperienced drug development partners with technical andscientific skills that they may lack and, importantly, provideoverall management of the lengthy and complex drugdevelopment process. MNCs often play a similar role whenworking with small biotech companies. For instance, PPPscan supplement their partner’s skill gaps by arranging (andoften funding) outsourcing to Contract ResearchOrganisations (CROs), by finding industry partners for furtherdevelopment, or by putting together manufacturing deals withother firms. These activities closely mimic the modularapproach that MNCs increasingly take to drug development,keeping core activities in-house but outsourcing other jobs tocontracted groups who can do them more cheaply.PPP assistance of this nature can be invaluable foracademic groups, developing country firms with limitedexperience of registering novel drug products (as opposed togenerics) or biotech firms who are strong in drug discoverybut have limited, if any, experience of regulatory approval orlarge-scale manufacturing and distribution. In each of theseinstances, the PPP can contract in the necessary skills to fillthe gap (e.g. a CRO skilled in toxicology or regulatoryapprovals; a developing country company with experience inlarge-scale manufacture) and provide overall management ofPPPsCumulative directR&D spendUS $76m*34.8Academics30.2SMEs/CROs/DC firms35%Big pharmaOne thirdtranslationof researchinto drugleadsTwo thirdsto industry* – Covers period 2000-2004– PPP R&D spend only (total PPP spend was Us$112 million)– TDR figures are excludedSMEs: Small- and Medium-sized Enterprises, CROs: Contact Research Organisations DC: Developing CountriesFigure 3: Resource allocation by PPPs 2000-2004142 ✜ Global Forum Update on Research for Health Volume 4
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Editorial Advisory Board:Luis Gabri
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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 healthTraining more healt
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Access to healthimperative for acti
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Access to healthReferences1.Further
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Access to healthDeterminantsAvailab
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Access to healthThe authors are inv
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Access to healthCombining health an
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Access to health100%Availability of
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Access to healthhypothesis that an
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Access to healthMandatory clinical
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Access to healthWhile there are som
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Access to healthReferences continue
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Access to healthintegrating individ
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Access to healthA social determinan
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Access to healthemployment conditio
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Access to healthMaking human rights
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Access to healthResources outsideth
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Access to healthReferences1.McCoy D
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Access to healthand financial burde
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Access to healthDiscrimination as a
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Access to health“Two months ago I
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Access to healthsocio-cultural and
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Access to healthIntergovernmental P
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InnovationTowards the development o
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InnovationMajor classificationMajor
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Innovation60% of enterprises5040302
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