3Qs: Health care for neglected populations

For the first time in its nearly two decade his­tory, this year’s World Health Report — issued bian­nu­ally by the World Health Orga­ni­za­tion intended to help coun­tries, donor agen­cies, inter­na­tional orga­ni­za­tions and others make policy and funding deci­sions — will focus on the theme of research for better health. In antic­i­pa­tion of the report’s release, the Public Library of Sci­ence pub­lished an essay last week enti­tled “Inno­va­tion and Access to Med­i­cines for Neglected Pop­u­la­tions: Could a Treaty Address a Broken Phar­ma­ceu­tical R&D System?” We asked Michael Pol­lastri, asso­ciate pro­fessor of chem­istry and chem­ical biology and an expert in neglected dis­eases, to explain the issue and the pro­posed solu­tions put for­ward in the essay.

 

Associate professor of chemistry and chemical biology Michael Pollastri is an expert on neglected diseases. Photo by Mary Knox Merrill.

How is the pharmaceutical R&D system broken with respect to neglected populations?

The current paradigm of health-care research is to fund the costly R&D process with financial returns from product sales. The end result of this is that the discovery of new drugs for those who cannot afford to pay a premium for them is disincentivized. Neglected tropical diseases are one group of debilitating or fatal diseases that have limited therapies available for them because of this disincentive. For example, parasitic diseases that affect the poorest people in the world, like malaria, sleeping sickness, Chagas disease and lymphatic filariasis [commonly known as elephantiasis], fall into this category.

 

What is the magnitude of the overall problem — how many people are affected by NTDs worldwide and why is it important to the global community?

The impact of NTDs is staggering. There are an estimated 1.4 billion people who are infected with one or more NTDs, with twice that number at risk of contracting them. That means one-third of the world’s population is at risk of one or more of these diseases, for which the drugs and treatments are woefully inadequate. Most of those who are at risk are very poor, and these illnesses are a huge burden for them, adding to suffering of entire families, communities and nations. I believe that those of us in the highest income countries in the world have an obligation to work toward alleviating this kind of suffering.

What are the strategies put forward in this essay to help deal with the issue?

This new report makes recommendations for changing the paradigm of incentivizing the discovery of new products for NTDs. The report recommends establishment of an international treaty, brokered by the World Health Organization, to improve affordability in four ways: removing the linkage between research costs and product pricing, which would help provide equitable access to medicines; increasing sustainable methods for financing R&D by obliging world governments to contribute; improving efficiency in innovation by creating a framework for open-source discovery; and by rewarding research in ways that are aligned with the magnitude of health impact, rather than with the size of the market that can pay top dollar.

Developing such a treaty will be very complex, as it will require new ways of thinking about how new ideas are generated and translated into new therapies — the current patent and reward system simply doesn’t fit the bill for NTDs.

Small changes can have a big effect. Consider the fact that around $150 billion is spent on drug research annually; governmental and nonprofit organizations provided global funding of about $3 billion for NTD research. This relatively small investment has resulted in around 140 products in development. Thus, though the investments made in NTD research have been small relative to the overall research spending, those dollars have been quite effective in translating improved products for NTDs. Here at Northeastern, we’re hoping to become a bigger player in driving this global conversation. We’re doing this by developing a global health institute, which will have a research component for drug discovery and a policy component for development of new ideas about access to medicines and innovative ways to incentivize research.

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