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New Ideas to Improve Access to Medicines

New approaches, partnerships and more resources are needed to improve existing initiatives and increase access to medicines in developing countries. That was the cautiously optimistic message delivered by experts from different backgrounds, including academia and the pharmaceutical industry, at a public meeting in London. They explored the prospects and challenges facing drug research and development (R&D), and recognised the merits of sharing knowledge during the event at Portcullis House, Westminster, on 23 February. The discussion was jointly organised by LIDC, the Africa All Party Parliamentary Group and the Royal African Society.
New landscape
Dr Javier Guzman, of the George Institute for International Health and the London School of Hygiene and Tropical Medicine, emphasised the rapidly changing context for R&D concerning neglected diseases. Since 2000, collaborations and industry institutes have been created to generate new drugs, and the sector has benefited from the “unprecedented generosity of philanthropists.”  Product Development Partnerships are based on a new public health-oriented and not-for-profit business model and are making significant progress, being responsible for 143 candidates in the drug development pipeline. However, Guzman warned about the high costs of completing the lengthy R&D process through to registration, and the consequences of “innovation pile-up.” He cited the estimate of the global development advisory firm Dalberg, which has claimed that US $6-10 billion is needed to mature the 2008 neglected disease drug portfolio over the next 10 years. Guzman also highlighted the concentration of funding within the sector; 80 per cent is provided by 12 funders and 60 per cent of these monies are funded by the US National Institutes of Health, and the Bill and Melinda Gates Foundation. He raised the importance of sustainable financing and improving the absorptive capacity of developing country health systems.

Dr Hannah Kettler, of the Gates Foundation, reiterated the growing impact of philanthropy. She charted how the Gates Foundation has grown exponentially since its first global health disbursements totalled US $10 million in 1998; by 2008 this figure was US $1.8 billion. Kettler spoke of the Foundation’s priorities (including treatment for HIV/AIDS, malaria, TB and diarrhoeal diseases), as well as the focus on access to medicines as the ultimate health outcome. One  challenge involves ensuring the enthusiasm and progress of the past decade persists. She also spoke of the desirability of new mechanisms involving the private sector and developing countries.

A perspective from industry
Jon Pender, of GlaxoSmithKline, detailed the company’s activities regarding diseases which disproportionately affect the developing world, such as not-for-profit pricing on anti-retroviral drugs for people living with HIV/AIDS since 2001, and progress towards a malaria vaccine expected to be filed for registration in 2011 or 2012. He also mentioned GSK’s increasingly transparent approach, including:
• an open laboratory for non-GSK scientists and academics to join their GSK colleagues to study diseases including malaria, sleeping sickness and chagas disease
• data being made more accessible via scientific websites
• greater flexibility with GSK’s intellectual property through the creation of a patent pool

However, Pender added that there would be “no quantum leap” without the investment needed to convert findings into action.

Treating HIV/AIDS
Dr Peter Piot, of Imperial College, London (formerly Director of UNAIDS), charted the history of the HIV/AIDS epidemic and treatment for the disease, complete with its advances and setbacks. Whereas 10 years ago there were only 200,000 people on anti-retroviral drugs in low- and middle-income countries, this figure has now reached four million and there certain African countries are close to universal access, including Namibia, Botswana and Rwanda. Yet many millions of people remain untreated. Treatment was held back by former South African president Thabo Mbeki’s denial that HIV causes AIDS, and operational problems persist. Testing needs to be improved as people living with HIV/AIDS often only ask for help once their immune systems are weak and there remains an urgent need to invest in training and education to improve health services. Piot called for more investment in the delivery sector and requested a more joined-up approach. He added: “Whenever we have made progress it is because of a synergy between scientific development and political momentum.”

Stephen O’Brien MP, Shadow Minister for Health and Social Care, also backed more collaborative working and said partnerships between academics, industry and philanthropists are “key.”

By Guy Collender, Senior Communications Officer at LIDC
Further reading
Accessing Medicines in Africa: Prospects and Challenges, Presentation delivered by Dr Javier Guzman, of The George Institute for International Health, at Portcullis House, London, 23 February 2010
Neglected Disease Research and Development, G-FINDER Report, The George Institute for International Health, 2009
Registering New Drugs: The African Context - New Tools for New Times, Report by The George Institute for International Health, Sponsored by Drugs for Neglected Diseases Initiative (DNDi), 2010