Mending the Gap

Last week, September 10-11, I attended a local meeting on global health, thanks to the organizers, as a media representative.  The meeting was the Medicines for Neglected Diseases Workshop (Workshop) organized by a new group, Mind the Health Gap (MTHG).  MTHG is an all-volunteer organization based in Boston with the goal to “harness untapped social and creative potential to bring the full economic, cultural, and scientific power of the global community to bear on the critical health problems facing our community’s most marginalized people.”  Although the MTHG website doesn’t provide specifics on accomplishing this goal, it seems the group intends to aggregate and connect people (funding?) to worthy projects in other countries.  The lack of a specific plan aside, MTGH, and more specifically its founders, Mike Gretes, Shala Yekta, and Andrew Gray, earn my praise for getting the funding (the Kauffman Foundation, Boston University, and the RI School of Pharmacy) and a roster of well-known national experts for the meeting.  On the flip side though, its the primary premise, as a workshop to posit answers to specific questions (Questions), was not fully realized.  It’s above my pay grade to give the workshop a fair, balanced, and thoughtful analysis, so here is my impressionistic spin.

The meeting started with an evening keynote address by Thomas Pogge of Yale University who spoke on his plan to reward the development of global health products through annual awards based on health impact, as a counter-balance to the incentives provided by the current market monopoly-driven system (Health Impact Fund).  Prof. Pogge has spoken widely on this plan since its proposal in 2008, and, although a number of valid objections have been raised (one being how and when to measure impact), Prof. Pogge did not address these nor offer modifications.

The next day began with introductory remarks, followed by three panel presentations and discussion with audience questions; unfortunately, the presentations greatly outweighed the discussions.  The first panel on affordable drugs, diagnostics, and vaccines was loosely moderated by Els Torrele of the Open Society Institute and would have benefited from more moderator direction.  For example, Dennis Liotta (director, Emory University Institute for Drug Discovery) noted that the Institute was participating in the BIOVentures for Global Health (BVGH)-managed Pool for Open Innovation (Pool), but not how the Institute will test, manufacture, and market new products.  James Love, known for his policy analysis at Knowledge Ecology International (KEI), said access to knowledge is important but not much more than that.  Jerrold Ellner of BU’s Medical Center was closer to the topic, describing the NIH Tuberculosis Clinical Diagnostics Research Consortium (CDRC) which he coordinates.  Yves Ribeill, CEO of the for-profit medchem company, Scynexis, was more helpful and talked about how the company was making its drug discovery information management platform, HEOS (HEOS), freely available to neglected disease product development programs (PDPs).

The second panel was to address collaborations between industry and the not-for-profit PDPs, but speaker coordination could have been better.  David Cook, the moderator and COO at the International AIDS Vaccine Initiative, pointed to the need for new hybrid business models for product development built on better knowledge of markets and sources of purchasing power, and Una Ryan CEO of Diagnostics for All (DFA) described DFA’s business model in general which includes funding product development with proceeds of licenses to companies from its for-profit subsidiary.  Jean-Pierre Paccuad, business development director for Drugs for Neglected Diseases Initiative (a PDP for malaria, visceral leishmaniasis, sleeping sickness, and Chagas disease), listed their challenges:  access to compounds and know-how (identification and cost), lead optimization, participation of a larger scientific community, and pricing of products.  Interestingly, Melina Moree, CEO of BVGH, an organization whose raison d’etre is industry involvement in global health, offered generalities but no specifics of BVGH’s programs for facilitating for- and not-for-profit collaborations.

Unfortunately, the speakers on the third panel on funding for product-driven research, the one of most interest to me, replicated information that can be found on line and did not speak to the panel’s objective.  Javier Guzman reported on the G-Finder database that lists who is spending what on which diseases (G-Finder), but not how they got the funding they have.  John Rogers of the NIH spoke on funding for academic research from the NIAID, and Neil MacDonald of the Gates Foundation noted the Foundation’s exploratory research program (Grand Challenges).  Kevin Outterson, BU professor of law and one of the meeting organizers, described a plan to delay antibiotic resistance by paying originator companies for appropriate use (over which they have little control) (Health Affairs article) which didn’t seem related to funding at all.  Unfortunately there was no discussion on finding funding for the critical product development and commercialization step, a need noted by other speakers, like Una Ryan of DFA, George Whitesides of Harvard University, and Bill Rodriquez of Daktari Diagnostics.

To me one of the best aspects of the conference was the questions asked by members of the audience, although some of the answers could have been more pointed.  Manuel Navia, a biotech pioneer (founding scientist at Vertex) and now executive in residence at the venture capital firm, Oxford Biosciences, asked Dr. Pogge how prize plans address the upfront cost of a capital in drug development (they don’t) and the second panel about how regulatory approval process (Dr. Ryan said through the WHO).  Warren Kaplan, former biotech IP attorney and now assistant professor at BU’s School of Public Health, asked this panel about how to get experienced biotech/pharma managers into PDPs and into developing countries which was partly answered by Denise Spero, one of the panelists and director of the Institute for Immunology and Informatics at the University of Rhode Island, (her Institute’s training programs, Triad).

Overall, I found it refreshing that most of the speakers were aware of the need and were trying or inventing new ways to address drug and product development of global heath.  Too often academically-initiated meetings over-represent the academic view point (“just give me more grants and everything will be all right”) or student activist view point (”just make companies give away their drugs and everything will be all right”).  Innovation is needed in addressing global health problems and the meeting’s speakers represented a valuable cross section, but, if MTGH wants its future workshops to “harness untapped social and creative potential,” they will need to herd the cats better and have less presentation, more debate, and specific outcomes.

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