Facing up to Neglected Diseases

The incredible medical advances of the past few decades promise an even more exciting future to tackle disease – for some. Shocking healthcare disparities continue to exist on a global level and many people lack access to even basic healthcare. In underserved populations, diseases have a severe impact on health outcomes and this is compounded by poor infrastructure, lack of resources, inefficient delivery of services, and corruption. Unfortunately, we are witnessing all these factors at play in the response to the current Ebola outbreak in Africa.

The World Health Organization (WHO) has estimated that more than one billion people suffer from one or more neglected diseases (1); another sad truth is that neglected diseases further worsen poverty over the long-term since they often affect children, restricting their school attendance and educational outcomes.

As neglected diseases do not promise a high return on investment, most companies have been reluctant to work in this area. It is this general lack of commercial interest from the private sector that has led to the exploration of other models, such as public–private partnerships (PPPs). As the name suggests, PPPs draw on the expertise of the public, private and academic sectors, with each party contributing according to their own area of strength; importantly, the costs and risks are shared. And though PPPs have made a difference in stimulating research for neglected diseases, getting products to market and into effective use remains a challenge.

Many believe that regulatory authorities should play a more prominent role, perhaps creating more attractive regulatory mechanisms to encourage drug development for neglected diseases or offering companies special incentives. But in practice, it has been hard for regulators to put forward ideas that find universal acceptance; for example, the FDA can now award a priority review voucher (PRV) to a company that obtains approval for a product that prevents or treats a neglected disease. PRVs can then be used to accelerate regulatory approval of another drug in any disease indication. Eliminating months from the standard FDA review allows earlier market entry, but some aspects of the PRV mechanism, such as the fact that vouchers are transferable and can even be sold to another company (2), have led to concerns over the commercial intentions of companies seeking them. In any case, the existence of this regulatory mechanism has not led to a surge of drug development activity for neglected diseases.

And though there is a clear need for the pharmaceutical industry to develop new drugs for neglected diseases, this alone will not help solve the basic healthcare problems facing communities in developing regions. In many cases, straightforward and effective strategies are actually available to control and eventually eliminate many of the health conditions affecting underprivileged populations, but access even to those medicines is a huge problem, as discussed in an interview with Access to Medicine Foundation CEO Wim Leereveld here.

Any progress in developing drugs for neglected diseases will only translate into better healthcare for communities if operational and infrastructure issues are also addressed. Furthermore, all efforts must be aligned with improvements in complementary development areas, such as poverty reduction, nutrition, water and sanitation, women’s empowerment, and education.

Initiatives to reduce healthcare disparities in developing regions require long-term financing, provision of healthcare resources, educational programs for communities and health workers, collaboration between different stakeholders and political commitment. The pharmaceutical industry has an important role to play, but it alone cannot provide all the answers.