The scarcity of R&D for the developing world is not a new problem. It has been 50 years since we had a new TB drug – because the issue has been addressed in the developed world. A decade ago the Global Forum for Health Research named the 90/10 problem, pointing out simply that 90% of health research addresses 10% of the world’s population. This may no longer be entirely true as my colleagues Sebastien Mazzuri and Matt Rehrig have noted in recent blogs that the epidemiological trends are actually bringing the needs of the developing and developed worlds closer together as chronic disease now accounts for 60% of global deaths with many more deaths occurring in the developing world. However even with this shift in disease distribution I see two significant gaps in our global investment in R&D: first, there is a lack of investment in new products for neglected diseases like Chagas Disease or African Sleeping Sickness. Second, there is a less recognized opportunity to develop new products for chronic diseases —not only delivering access to existing medicines, but developing new products like pacemakers for Africa. While some companies have started to address these issues, there is much to be done, I believe, especially in light of the article on the concept of shared value that FSG co-founders Mark Kramer and Michael Porter discuss in Harvard Business review this month.
What can be done by biotech firms to overcome this continued inequity? Pharmaceutical, diagnostic and medical device companies provide some good examples for the industry:
- Invest in R&D for neglected diseases: An investment in R&D for neglected diseases can take many forms. Drawing from work by FSG partners, Alnylam donated its RNAi patents to a patent pool to allow researchers in universities and non-profits to use their intellectual property. Medtronic is creating a business initiative to retool its business to create low-cost heart devices. Pfizer has invested in for-profit joint ventures and donated to not-for-profit R&D collaborations both to deliver product to the developing world.
- Train a new generation of innovators: Develop capacity in the developing world to create new products to address local markets. Merck has supported Hilleman Laboratories in India, alongside Wellcome Trust, in order to both address neglected diseases like Chagas and build capacity for innovation globally.
- Create a new business: A few companies have identified product needs in the developing world and are going after these markets aggressively. For example Daktari Diagnostics, run by FSG Global Health Affiliate Bill Rodriguez, developed a portable CD4 counter which can be in the treatment and monitoring of HIV patients worldwide.
Ten years after the 90/10 report the landscape is also much more complex – there is a broader context for the innovation we need. For example in order to pull the field into investing there are new incentives- promises of revenues from Advance Purchase Commitments by donors, prizes for R&D challenges are being considered and the US Food and Drug Association has created regulatory incentives for companies to invest in neglected diseases. FSG Global Health Affiliate Paul Wilson has written beautifully about the broader landscape of vaccine access and R&D, and for more ideas about how this applies to biotech, BIO Ventures for Global Health and WHO/Tropical Disease Research and Universities Allied for Essential Medicines are great resources.
Despite these efforts, few biotech companies have engaged in R&D. What more can be done? If universities have been able to carve out provisions for developing country access, why shouldn’t they also be able to divert some of their royalties from US or EU sales into a fund for neglected diseases? As the epidemiology converges between developing and developed world, will we see more start-ups targeting globally needed technology as a part of core-business? As the US health system becomes increasingly cost-conscious, will the rest of the world benefit?