With our medical teams crying out for new and better medical tools, we need to work imaginatively within the constraints of the present system to promote more medical innovation.

Product Development Partnerships
Over the past few years a number of not-for-profit product development partnerships (PDPs – sometimes called public-private partnerships or PPPs) have been created to develop new drugs, diagnostic tests, and vaccines for neglected diseases. Examples include the International AIDS Vaccine Initiative, the Medicines for Malaria Venture, or the Global Alliance for TB Drug Development.

The emergence of PDPs offers an interesting new model: the costs of R&D are paid for directly and no longer financed by a pharmaceutical company, as in the current model, through high drug prices and stringent patenting. This new model will allow the resulting products to be sold at prices close to production cost. A recent report by the London School of Economics charting the new landscape of neglected disease R&D estimates that, based on their current drug pipelines and assuming standard attrition rates, PDPs could bring eight or nine new drugs to market in the next five years.

The Drugs for Neglected Diseases initiative (DNDi) founded by MSF and six partners is one of these partnerships.  In 2007, thanks to a radical new drug development strategy, DNDi brought out its first(?) product: a simple, affordable and effective anti-malarial fixed-dose combination, combining two anti-malarials (artesunate and amodiaquine) in a single pill.  

But the success of the PDPs depends on whether they can raise sufficient funds to carry these projects through to fruition. Currently, PDPs have not even secured funding for their existing projects; and as they fill their pipelines and more promising compounds move into clinical trials, their funding needs are increasing significantly.  Without this, existing new drug candidates for neglected patients will stay where they are – in the pipeline.

Prize Model
Prizes have been used as incentives for innovation for centuries. The idea is that a lump sum – which governments or employers, the same entities that pay for health insurance or public health programmes now, could contribute to – would be given as a reward to drug developers.  The greater the usefulness of a product in tackling a particular health challenge, the larger the reward would be. The advantage with prize funds is that they can stimulate R&D without relying on drug sales to fund drug development.  They also allow governments to prioritise R&D and steer it towards areas of greatest medical need.

R&D Treaty
Within the discussions currently going on at the World Health Organization, several developing countries are calling for a global R&D treaty.  Such a treaty is essentially a mechanism to ensure greater, more sustainable funding for essential health R&D. It would ensure that all governments contribute to paying for medical innovation, in a way that would guarantee availability and affordability.

Working with industry
As the current political discussions at the WHO for an alternative R&D framework discussions move forward, pharmaceutical companies will need to decide where they stand.

There are signs that some companies are willing to explore new ways to be rewarded for their investments into R&D that do not automatically shut out the world’s poor.  At an MSF symposium on tuberculosis drug development in January 2007, representatives from several major pharmaceutical companies endorsed a statement supporting the UN talks aimed at producing a new R&D framework. Such a framework would address the question of who pays for essential medical R&D, dissociating incentives from drug prices and rewarding innovation according to health care outcomes.

Companies need to engage constructively in this effort to explore new ways to reward investments into R&D that are not biased against the world’s poor. With an increasing number of patent disputes breaking out across the globe, and increasing governmental concern that the current system is failing to deliver, it is in everyone’s interest that new mechanisms are found, and soon.