I was recently contacted by an Andrew Paul of the UK, alerting me to the International Society for Neglected Tropical Diseases, a global health organization he has founded, and its inaugural congress (ISNTD) (thanks for finding my blog, Andrew). As I understand it from the group’s website and his email, the goal of the Society is to build a network among scientists, industry, government, and “the groups whom seem to be missing from the usual discourse: SMEs [small-medium enterprises], entrepreneurs, professional advisory services, local health practitioners and administrators” with the goal to “influence policy makers leading to sustainable healthcare provision in the developing world.” As I noted in my reply to him, I am generally skeptical of the need for another global health organization but agree with him that getting more players and ideas from the for-profit (economically sustainable) world is good direction for global health in general. Andrew asked for my ideas about content for the congress, particularly around three questions that are worthy more discourse than I was able put into my reply email. So here is a bit more.
What are the latest developments in sustainable provision of treatment in NTDs (neglected tropical diseases)? As I noted in my post “Brother, Can You Spare a Dime (or Five)?” of 2/24/11, treating the NTDs is tremendously cost-effective (cheap drugs are available that reduce disability and mortality) and that the primary problem, according to several experts and their studies, is that, while the pharmaceutical companies have donated and are willing to donate billions of doses of the needed drugs, three of responsible parties (governments, WHO, and advocacy organizations) have not developed a workable plan for their delivery. As an example of well-meaning but tepid program, I cited the Global Network for Neglected Tropical Diseases (NTDGN) and its End the Neglect 2020 campaign (ETN 2020). The campaign’s goal is “to galvanize support around the formation of regional NTD trust funds and cross-regional working groups, designed to form financing mechanisms to raise and efficiently disburse funds to affected communities,” but, despite being in business since 2009 and $34 million from the Gates Foundation, as far as I could tell, there’s been no progress. I noted that one of the experts I cited in my blog, Prof. David H. Molyneux, Centre for Neglected Tropical Diseases Liverpool School of Tropical Medicine, will be speaking at the Congress. So, good question to ask Dr. Molyneux, Andrew.
What, if any, evolution has there been in the PDP model? PDPs (“product development programs”) are mostly grant-funded neglected disease drug development organizations that have made some progress in getting drugs and new combinations of drugs tested but not deployed. My general impression is that they have shallow pipelines, are overly influenced by academics promoting their own agendas, are risk adverse, and don’t get enough for-profits involved in a meaningful way. I have also kvetched on their lack of accountability and performance measurement (“PDP Performance Measurement” 2/11/10), and criticized one of the largest, PATH, which has received more than $1 billion in Gates funding and receives about $200 million annually from other foundations and the US government, for its lack of reporting on progress and effectiveness (“Where Does This PATH Lead?” 2/25/10). In another post, I compared the PDPs to the Cystic Fibrosis Foundation, which is promoting development of drugs for its neglected disease, and wrote: “My recommendation is that PDPs do a better job of business development by pitching the value of drugs for neglected disease, both to society at large and to companies’ bottom lines, and by offering term sheets that engage and motivate companies.“ (“Skin in the Game” 4/28/11). Perhaps Andrew should invite Jean-Pierre Paccuad, business development director for Drugs for Neglected Diseases Initiative, to speak on the evolution of the PDP model. I have heard him speak a couple of times but not on this topic (e.g., “Mending the Gap” 9/16/10).
Can current structures be improved to bring in more enterprising SMEs to help solve these problems? SMEs are small- to medium-sized companies that have revenues (as different from growth-stage companies developing or launching new products) so are willing to take on more risk and interested in new markets and product extensions, more so than the large multinationals. Good examples are the generic or specialty pharma companies in India and to some extent China and South Africa who are adapting and creating products specific to the under-served regional markets or for the public sector buyers. I’ve rambled on this topic in several of my postings (“Fio Cruise” 7/15/10, “Healthy, Wealthy, and Wise” 9/23/10, “Deal of the Year 2011” 3/24/11, and “Generics Play” 9/15/11).
As for improved structures, I have noted efforts to create markets by aggregating buyers and funders for vaccines (“Creating the Upside” 1/21/10) and have postulated that the USAID as a major purchaser could create a market and encourage SME involvement (“USAID: Rhetoric or Reality?” 7/14/11). I have also thought that a program that gets SMEs access to pro bono business advisers may help (“Peloton Partnering: A Friend for FRIND” 12/3/09). The main driver though is getting investors to invest (or better yet banks to loan) capital for expansion and new product development and that requires publicizing success stories, showing where and how companies can make money in the emerging healthcare markets. A group that is publicizing success in developing world markets but this for the mostly multinationals and some SMEs and specifically not for the global health market, is Business Call to Action (BCTA). Perhaps, Andrew would like to invite a person I know there, Christine Ribeiro, to speak at the Congress. Finally, I see SMEs as excellent partners and sources of funding for al those now cash-deprived US biotech companies, at least those willing to think outside of the big pharma box and get smaller deals for ROW markets, but both sides need to realign their business development efforts. Personally, I think the topic of global health business opportunities is worthy of its own society and congress, to do what BIO Ventures for Global Health said it was to do, but hasn’t. So, Andrew, another suggestion.