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

Research resourcesways. For instance, by providing greater access to in-housecompounds; provision of platform skills such as portfoliomanagement or regulatory support to PPPs; or encouragingand supporting senior staff to participate in PPP ScientificCommittees or Advisory Boards.Finally, we would like to pose a challenge for our owncommunity of experts, the international public healthcommunity. One of the concerns about PPP drugdevelopment organizations is that, since there is generallyonly one PPP working on each disease, patients are at themercy of that one group and its performance, or lack thereof.(Others, in particular governments, complain that there aretoo many PPPs and that they should be rationalized!) Inresponse, there have been suggestions that we need to havea more competitive market for new neglected disease drugs,with multiple products being developed by different groups,thus allowing developing country patients the kind of choicethat patients in developed countries have come to expect.This may well be true, but it also raises a number ofquestions. How many new products can developing countryhealth systems absorb in each disease area? How many newArtemisinin Combination Therapies do we need in the nearfuture (we currently have five additional adult formulations indevelopment)? What about diseases that are largely managedthrough national control programmes (e.g. DOTSprogrammes for TB, or India’s planned leishmaniasiseradication programme?) Could national TB programmescope with a new product every five years, in the happy eventthat this were possible? Will the previous private marketing ofmiltefosine, our first oral anti-leishmanial, help or hinderIndia’s plans for a controlled roll-out of the drug as part of itsleishmaniasis programme? Would it be better to hold backnew anti-malarial products until resistance has appeared orto market them as they became available? Who would beresponsible for a decision to hold-back or the timing of a newrelease, or the task of dealing with producers keen to seerapid returns on their investment? Is it better to have one PPPmanaging a disease portfolio (allocating R&D investments,balancing the portfolio between discovery and developmentprojects, and controlling product registration and release) orto have several groups independently pursuing products thatcould each be made available to patients as soon as it wasready? Given the paucity of funds, should R&D for eachdisease be planned and integrated (through a PPP orotherwise) or should we rely on more traditional competitiveapproaches?We stress that we do not know the answers to thesecomplex questions. The lack of neglected disease R&Dactivity for many decades means we have never before hadto face the question of product management for neglecteddiseases – for some diseases, we were lucky to have anyproducts at all. As a result, there has been little publishedand little open discussion of these issues. We raise them nowonly because they sometimes seem to be the elephant in theroom – and elephants are ultimately very hard to sweepunder the carpet. ❏Mary Moran trained as a medical doctor, working for 13 years inEmergency Medicine in Australia. A postgraduate degree ininternational relations and politics at University of NSW andMonash University (1995) led her into a diplomatic career withthe Australian Department of Foreign Affairs & Trade, including aposting to London where she focused on climate changenegotiations and international trade. Dr Moran subsequentlyworked for three years with Médecins Sans Frontières, initially asDirector of the Access to Essential Medicines Campaign inAustralia and later as a Europe-based advocate on a range ofissues relating to access to medicines for neglected patients. In2004, she founded the Pharmaceutical R&D Policy Project(PRPP) at the London School of Economics & Political Science andsubsequently moved the unit to Sydney, Australia, where it wasconsolidated as the Health Policy Division (HPD) of The GeorgeInstitute for International Health in 2006. The HPD maintains aLondon office as part of the new International Development Centrein Bloomsbury and is associated with the London School ofHygiene and Tropical Medicine.Javier Guzman trained as a medical doctor and worked in theplanning and implementation of primary health care projects inthe Colombian countryside for several years. He mainly worked inearly detection and treatment programmes of endemic infectiousdiseases such as tuberculosis and Chagas’ disease. Dr Guzmanmoved to the UK in 2002, where he worked as a PostgraduateClinical Fellow in Paediatrics at the Royal London Hospital. In2004, he obtained his MSc in Health Policy, Planning andFinancing from the London School of Economics and the LondonSchool of Hygiene and Tropical Medicine. In August 2004,Dr Guzman joined the PRPP where he has worked mainly on theperformance of different R&D models and pipelines. He moved toAustralia in April 2006 and now heads the HPD research team atThe George Institute, Sydney.Anne-Laure Ropar originally trained and worked as a mechanicalengineer. After completing a master’s degree in political economyand international relations at the University of Chicago, sheworked for a number of years as a consultant specializing inEuropean and developing country health systems and policies. Herclients have included the EU-based pharmaceutical industry,philanthropic organizations (Rockefeller Foundation, Bill &Melinda Gates Foundation), and government bodies (DFID,USAID). Anne-Laure Ropar’s project experience spans drugprocurement policy in sub-Saharan Africa, market-basedmechanisms to reduce the price of essential drugs in Ghana, todrug reimbursement policies in European countries. She joinedthe PRPP at its creation in 2004, where she has managedresearch on Product Development Partnerships and thepharmaceutical industry’s involvement in neglected diseases, andworked on incentive proposals for both large pharmaceutical andsmall biotechnology firms. Anne-Laure now heads the HPDresearch team in the London office of The George Institute.Global Forum Update on Research for Health Volume 4 ✜ 145