Cure for Neglected Diseases: Funding

Melinda and Bill Gates during a 2003 visit to the Manhica Health Research Center in Mozambique.
Melinda and Bill Gates during a 2003 visit to the Manhica Health Research Center in Mozambique. (Barb Kinney -- Bill And Melinda Gates Foundation)
By Justin Gillis
Washington Post Staff Writer
Tuesday, April 25, 2006

Drug and biotechnology companies have launched more than 60 projects in recent years to discover new treatments for a wide array of neglected diseases, a report has found, and the result could be nine or 10 drugs by the end of this decade with the potential to improve the lives of the world's poorest people.

A global push to tackle neglected diseases such as malaria and tuberculosis is gathering steam, the report found, largely because of an influx of charity money to subsidize the work of the drug companies. Though this push is only five years old, many of the projects are reaching advanced stages, and a string of new products could get licensed by 2010.

It is far less certain, however, that the world's poorest governments and the rich countries that donate money to them will come up with ways to get the new drugs to those who are suffering, said the report, by researchers at the London School of Economics and Political Science. Already, some drugs for neglected diseases are languishing because of inertia and lack of funds.

And the work could stall even before tests on the new drugs are finished, unless rich countries' governments start contributing more heavily to an effort that has been led so far by charitable foundations, the report warned.

The report cited a wealth of donations and leadership from the Bill and Melinda Gates Foundation, Doctors Without Borders, the Wellcome Trust and the Rockefeller Foundation, all designed to create a new landscape for work on diseases afflicting poor countries. Governments, including that of the United States, have started to help with modest donations.

But more than half the nearly $255 million contributed as of April 2005, the most recent available figure, had come from the Gates Foundation. The U.S. government has contributed $16 million, putting it ahead of other governments, but contributions from all the world's governments put together have been dwarfed by the Gates Foundation's $159 million, the report said.

"Who's actually funding this is essentially Bill Gates," Mary Moran, principal author of the new report, said as she presented some of its findings yesterday at the Brookings Institution in Washington. "Now we need the public to step in and take it to the next stage."

Historically, drug companies have been reluctant to invest in diseases mainly afflicting poor countries because the people there don't have money to buy the products. So even though millions of people die from ailments such as malaria and tuberculosis, it made more business sense for the companies to develop products that could yield returns in wealthy countries, such as pills and lotions for heart disease, impotence, even baldness.

But the drug companies were stung in the late 1990s by global criticism of their failure to help with the AIDS crisis. As they struggled to repair their reputations, the Gates Foundation and other donors came along with new proposals -- and fresh money -- for work on neglected diseases.

The donors funded a series of ventures, some based in the Washington area, to focus on vaccines and treatments for specific diseases. Those entities, with names such as the Medicines for Malaria Venture and the Global Alliance for TB Drug Development, have in turn come up with strategic plans and signed deals with pharmaceutical and biotechnology companies to jump-start research. In many cases, the ventures have offered tens of millions of dollars to the companies to subsidize drug-development work.

Most of the effort has come from European pharmaceutical companies, the report found, reflecting "historical company involvement in tropical diseases as well as Europe's long-standing links with Africa." The count of more than 60 projects covers only drugs, which treat disease; Moran's group didn't study vaccines, which prevent disease, but the same mechanisms are being used to fund a slew of vaccine projects.

GlaxoSmithKline PLC of London has received considerable attention for its recent work on drugs and vaccines for poor countries, but the report noted that other pharmaceutical companies have made significant commitments. GlaxoSmithKline, AstraZeneca PLC and Novartis AG have set up special research institutes designed to focus on neglected diseases.

This is good public relations on the part of the companies, the report said, but it's not just a PR exercise -- the creation of charity-funded ventures to share costs has meant the companies can lend their scientific expertise to global health efforts without spending huge sums of their own and thus aggravating shareholders. Some of the companies have said they'd be willing to produce the drugs for poor countries at little markup once they're licensed.

While this new push has been successful at jump-starting research, the report noted that it is far from certain the efforts can be sustained given how expensive they are likely to become as drugs enter the large, final stages of testing, work that could cost several billion dollars. The amount could exceed even the funding ability of Gates, Microsoft Corp. founder and the world's richest man, whose charity totals some $1.4 billion a year. (Melinda Gates, who plays an active role in running the Gates Foundation, is a board member of The Washington Post Co.)

To put the work on sounder footing, Moran called on rich countries to pledge money for a special fund that would be used to supplement charity-led efforts. If governments in rich countries each contributed $7 million every year, the result would be a $200 million in annual funding. "If you can't get $7 million a year, we should just stop having these conferences and say we don't really care" about the suffering of the poor, Moran declared at Brookings.

An even bigger issue is whether the international community will come up with a plan to distribute the drugs once they're ready. For instance, effective treatment for tuberculosis has been available for decades, but it remains expensive and difficult to administer. Health systems in poor countries are so weak that the treatment reaches only a minority of the people who need it, and an estimated 1.7 million people die of the disease every year.

© 2006 The Washington Post Company