When pharma company Sanofi Pasteur was criticised last month for ceasing its production of Africa’s only snakebite anti-venom, the spotlight fell once again on the industry’s apparent lack of interest in the developing world.



“It didn’t fit with their business model,” explains Katy Athersuch, medical and innovation policy advisor at Médecins Sans Frontières (MSF), which she says favours higher margin drugs. An alternative supplier has been found but won’t be ready until at least 2017. That could mean two years of unnecessary deaths (which some estimate run to 125,000 a year).

An underfunded problem

Snakebites are classed as a neglected tropical disease (NTD), alongside dengue, chagas and African sleeping sickness. Nearly 1 in 6 people worldwide will require treatment for at least one NTD.

According to the Lancet Commission on Investing in Health, much of the burden posed by NTDs could be prevented for an annual cost of between $300m and $400m. It’s not a huge sum in global terms – the global pharma industry is worth $300bn – yet current efforts fall well short.

In fact pharma research and development investment in NTDs actually fell by $193m (£127m) in 2013. And pharma companies have been accused of “not pulling their weight”, contributing just 12% of global funding, a decrease of $74m since 2010.

“We have a problem across the board of R&D,” says Athersuch. She refers to Pfizer’s withdrawal from all anti-infective R&D in 2012 and the 2014 closure of Astrazeneca’s Bangalore plant which had focused on tuberculosis (TB). Athersuch blames the consolidation of the pharma industry through mergers and acquisitions, pushing companies to compete “for the mega-bucks of blockbuster drugs sold in the US, Europe and Japan”. As a result, “NTDs look less commercially attractive”.

According to Bernard Pécoul, executive director of the Drugs for Neglected Diseases initiative (DNDi), the statistics back this up.“There is a 10:90 gap – only 10% of R&D investment goes in to 90% of global health needs”, he says, with rest going to developed world drugs.

Whose responsibility?

According to Dr Mary Moran, executive director of Policy Cures, the failure of investment in developing world diseases “lies solidly at the door of governments”. It’s not the role of companies to make non-profit medicines, she argues.

Pécoul agrees. “[Governments] need to create the environment and incentives, funds and mechanisms, to stimulate R&D. Intellectual property may have stimulated innovative products in profitable markets, but when you are in a non-profitable market this is no incentive.”

Currently the biggest impetus for dealing with NTDs seems to come from partnerships.

In 2012 a coalition of cross-sector partners, including pharma companies, government agencies, NGOs and academics, came together to form Uniting to Combat NTDs for the London Declaration on NTDs, stating that 17 priority NTDs would be controlled or eradicated by 2020. Progress has been made, but the most recent status report reflects the difficulties of meeting ambitious timelines.

Then there are product development partnerships – such as the TB Alliance or the International Aids Vaccine Initiative – which aim to correct the market failure around NTDs, bringing organisations together to pool resources for R&D.

DNDi, a partnership which focusses on 10 NTDs, has delivered six new treatments with 15 new drugs currently in development, working with an annual income of around €30m. All of this is done without a laboratory, but rather through collaboration across over 40 countries, 20 pharma and biotechnology companies, and 50 universities and institutes.

These partnerships now account for more than 70% of the new neglected disease products registered since 2000, and over half of the 500 product candidates now in the pipeline, says Moran. Yet even Pécoul admits that partnerships alone are not the solution. “The magnitude of the problem is much bigger,” he says.

There is some evidence to suggest the pharma industry uses partnerships to absolve itself of responsibility. Major companies are closing down their NTD R&D operations while opening up their compound libraries to partnerships, such as Novartis to the TB Alliance.

“We should be careful what we ask for,” says Moran. “Advocates have long asked for industry IP to be handed over to the public [made open-source] but, to be honest, we were probably better off when Novartis had the IP and provided millions of dollars and a team of scientists to work with the TB Alliance to develop it.”

The solution for NTD drug R&D may not be partnerships alone, but must include cross-sector collaboration. Dr Julie Jacobson, chair of the stakeholders working group of Uniting to Combat NTDs, says “One approach is sharing research findings – on successes and failures – which can accelerate the drug development … which product development partnerships then carry through clinical trials, often in collaboration with their industrial partners.”



The Sanofi snakebite anti-venom failure is a warning of what can happen if each sector waits on the other to act.