By Adelia Saunders
26 March 2008 [MEDIAGLOBAL]: Awarding prizes for the development of new drugs to treat the world’s most devastating illnesses could fundamentally change the pharmaceutical industry and save countless lives, according to a panel of public health officials, advocates and experts who gathered at UN Headquarters last week to discuss new ways to motivate medical research.
Pharmaceutical companies currently have little financial incentive to develop the drugs most urgently needed by the world’s poor. Instead, they maximize profits by altering already existing medicines—and thus extending the time they can collect royalties on their production—or by developing drugs that target the ailments of those who can most afford them. Wealthy governments have been slow to fund research that would benefit the poor of other nations, and diseases such tuberculosis, malaria, sleeping sickness and a host of others have gone largely ignored, while funds are poured into honing treatments for diabetes, anxiety and sleeplessness—ailments associated with the rich.
“The current system has failed quite dramatically in Africa,” said Ahmed Ogwell, head of International Relations for Kenya’s Ministry of Health. “That is why the disease burden is in fact probably increasing in some areas.”
Tuberculosis is among those diseases, largely eradicated from the developed world, that remain startlingly prevalent in developing countries. There were 9.2 million new cases in 2006, primarily in Asia and Africa, and 400,000 of those infections have shown prolonged resistance to common treatments. “What we need is new drugs for a quicker kind of response,” Jorge Sampaio, the UN Secretary-General’s Special Envoy to Stop Tuberculosis, told MediaGlobal during a visit to the UN on Tuesday. “The drugs are 40 years old, the vaccines are no longer that efficient.”
Prizes could reconfigure the pharmaceutical economy, paying manufacturers based on the usefulness, rather than the profitability, of their drugs, transforming the world’s poorest and sickest into valuable customers. “The main idea is you de-couple the reward for R[esearch] and D[evelopment] from the price of the product,” said Jamie Love, Director of Knowledge Ecology International, a Washington, D.C.-based think tank. “You’ve got some marginal population out there—that’s actually a dream for a venture capitalist.”
Not everyone is so optimistic. David Taylor, Professor of Pharmaceutical and Public Health Policy at the University of London, described the idea of using prizes to stimulate scientific discovery as “half-baked but probably well-intended.”
“The definition of a prize is you don’t get the money unless you produce the goods,” said Taylor, who was not a member of the UN panel, in an interview MediaGlobal. He questioned whether “very large institutions are really prepared to risk very large investments for the possibility of no prize.”
Dilip Shah, Secretary General of the Indian Pharmaceutical Alliance, advocates grants rather than prizes. Grants would “encourage more and more companies and individuals to participate,” he told MediaGlobal, adding that funding is needed most during the development process, and well-placed grants could promote an “innovation culture.”
The developing world has a critical role to play in drug development, Shah said. Medical advancement is cheaper there. “Incentives could be used as a tool for enlarging the pool of innovators, for tapping R[esearch] and D[evelopment] potential in the developing regions and reducing the cost of innovation,” he said.
Ogwell agrees that bringing drug research and manufacturing to the global South makes economic sense—and bringing the pharmaceutical industry to Africa could speed the formation of knowledge-based economies in some of the world’s least developed countries. “We think it’s not impossible to be able to transfer a lot of the production into Africa and make the prizes a fraction” of the monetary amount they would need to be elsewhere, Ogwell told MediaGlobal.
Yet developing medicines for neglected diseases is not enough. The treatments must be made available, and a tangle of patent laws and international treaties often stand between crucial new medicines and those who need them.
“The prize discussion is about the pipeline for new drugs, and that’s a longer-term proposition. For existing drugs it’s an issue of compulsory license on the patent,” Love told MediaGlobal, citing Thailand’s decision last year to override patents prohibiting generic production of several critical medicines.
“For example, Plavix, a heart disease drug, was two dollars a day in Thailand before the compulsory license, and that’s about 40 percent of the income of the bottom 80 percent of the population,” Love said. “Countries, the ones that are taking action, are issuing compulsory licenses on the patents so they can get generic drugs—that’s the most important access battle that’s going on.”
Some critics of the pharmaceutical industry advocate doing away with drug patents altogether. But drug producers say they have a right to profit from their discoveries and recover the cost of their research. Taylor warns that limiting intellectual property rights will smother innovation. “If we undermine the main financial basis with which private research is funded—and the evidence is that public money has often tended to follow private money—then you will wholesale undermine pharmaceutical and biomedical research. It’s fine if people want to introduce prizes or alternative funding systems—they should be regarded as an add-on.”
For their part, tuberculosis activists would welcome an opportunity to buoy research into diagnosing, treating and preventing the disease, Sampaio said, but added that government support is also essential to the development of new drugs. As to prize money, “so much the better,” he said, stressing that the relative unpopularity of tuberculosis among researchers hasn’t stopped the disease from killing 4,500 people a day. “We have to have those who are keen on developing new research tools have the appropriate compensation,” he said.