Nature Reviews Microbiology 3, 742 (2005); doi:10.1038/nrmicro1274
[57K]
LOST IN TRANSLATION
How can we ensure that the revolutionary advances in biomedical science
of recent years are applied to solving the problems posed by the world's
great neglected diseases?
The revolution in biomedical science over the past 30 years has led to
enormous health benefits for mankind. Most of these rewards, however,
have been reaped by those in the richer countries of the world. People
in developing countries — who account for 80% of the world's population
but only 20% of medicine sales — have been largely left behind. Diseases
including malaria, tuberculosis and leishmaniasis extract enormous tolls
on the quality of life, life expectancy, economic development and social
cohesion in the world's poorest countries. Yet this dire situation is
not the result of a lack of basic and applied scientific research on
these diseases. The problem lies in converting scientific advances into
marketable medical interventions for the developing world, something
which has little financial incentive for the multibillion-pound
pharmaceutical industry.
The well-known '90/10 rule' — 90% of the pharmaceutical industry's
global investment in therapeutics treats only 10% of the world's
population — highlights the lack of industry research focus for treating
diseases that are predominant in developing countries. Undoubtedly,
high-quality innovative research efforts that focus on diseases which
afflict poor and marginalized populations are being conducted, and in
recent years there has also been a considerable increase in financial
investment in combating these diseases. The fact remains, however, that
applying biomedical research to the problems posed by the world's
neglected diseases presents unique and challenging difficulties over and
above the traditional R&D challenges.
What should be done to facilitate the translation of biomedical advances
into health products for neglected diseases? The pharmaceutical industry
requires a return on capital as an incentive to discover and develop new
drugs. One way to achieve this is to create a differential pricing
structure, in which higher costs of drugs in developed countries
'subsidize' the necessary lower costs in developing countries. How this
is carried out in practice is a matter of debate at present, with
opinion in developed countries suggesting discontent about being
'overcharged' for medications. Achieving an equitable balance between
investment incentives for the pharmaceutical industry, affordability in
developed countries and access to medicines in developing countries will
be crucial.
With the costs associated with the discovery and development of a new
drug reaching the billion-dollar mark on average and taking around 15
years, plundering the medicines of the past might identify hidden gems
that could bypass this high cost and time investment. A case in point is
ivermectin. First introduced to the market in 1981 as a veterinary
antiparasitic drug, it has gone on to become the basis of one of the
most successful public-health programmes of the past century. The
development process also incorporated the world's first and largest
drug-donation programme and involved a unique association between
governments, non-governmental organizations and industry. The drug is
now being used, free of charge, in two global disease-elimination
programmes (onchocerciasis and lymphatic filariasis) that are benefiting
millions of the world's poorest people. Attention should also be given
to the abundance of scientific talent concentrated in the laboratories
of the pharmaceutical industry who are successfully tackling the R&D
issues that are crucial for progress. In particular, the industry's
extensive chemistry expertise could be harnessed though partnership
schemes that can allow chemistry experts and their currently unwanted
products to be used for the benefit of all. How industry could provide
access to this talent has been the topic of frequent discussion without
any measurable outcomes. However, recent progress, such as the
development of a synthetic form of artemisinin, clearly indicates that
industry−academia collaborations are feasible and have considerable
potential.
Ultimately, applying the benefits of innovative R&D in treating
infectious diseases requires the appropriate infrastructure on the
ground where the problems exist. The long-term sustainability and
availability of effective therapies in the world's poorest nations will
critically depend on stimulating local R&D, local manufacturing and the
establishment of local health systems. Of all the different proposals
and initiatives requiring attention, building this indigenous capacity
should be the primary focus.
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