Male baldness v malaria?
What drives research and development in the health sector? Or determines which new drugs and treatments are prioritized for development? ‘Need’ would seem to be the most obvious answer. Surely, whether it’s government funding for basic research or transnational pharmaceutical companies developing new drugs, ‘demand’ must drive research towards the diseases and ailments that affect the largest numbers of people, or for which the greatest gaps exist in available treatments.
Sadly, there is often very little correlation between levels of investment in health R&D and actual need. The Lancet reported in 2013 that just one per cent of global health research and development funding was being spent on what are known as ‘neglected diseases’ – a group of over 30 diseases, ranging from HIV/AIDS, malaria, and diarrhoeal disease to leprosy, trachoma and rheumatic fever, that disproportionately affect people in the Global South.1 This phenomenon is part of a wider problem that also includes insufficient research into finding replacements for failing antibiotics, or into so-called ‘orphan diseases’ which have significant impacts but on only a relatively small number of people.
There is little correlation between investment in health R&D and actual need
About 60 per cent of all health R&D funding comes from the private sector and is, therefore, focused on products that will produce the best financial return. This means research on products for markets in wealthier economies, but can also lead to ‘innovation’ of only marginal worth: drugs that offer little additional therapeutic value but provide a good financial return because their development costs are relatively low. The perverse effect of the marketplace led even Bill Gates to complain that it was easier to get funding for research into male baldness than for a malaria vaccine!2
Other barriers exist. The purpose of Intellectual Property Rights (IPR) is to encourage innovation by giving the innovator a monopoly to exploit commercially the fruits of their research for a limited period of time, in order to recoup their investment. IPR often serves to prevent access to affordable new medicines rather than promote it. The inclusion of IPR in international agreements under the World Trade Organization (WTO) effectively extended the mandate of (mainly US and European) pharmaceutical companies’ patents to developing countries, blocking the manufacture of cheaper generic drugs locally. In the early 2000s the cost of a year’s antiretroviral treatment for HIV/AIDS using Western brand-name drugs was, for someone in the Majority World, an astronomically unaffordable $10,000, whereas a generic medicine might have cost less than $200. This led economist Joseph Stiglitz to declare that, when trade ministers signed the WTO agreement in Marrakesh in the spring of 1994, ‘they were in effect signing the death warrants on thousands of people in sub-Saharan Africa and elsewhere in the developing countries’.3
A new approach to technology innovation is needed if we are to see an end to this injustice and advance in fields that really matter. Marketplace economics alone cannot drive innovation in the right direction when affordability is an issue. A greater reliance on grant financing for R&D, the use of competitions and prizes to stimulate research, and the introduction of what are known as Advanced Market Commitments (where a funder promises to purchase a quantity of a new drug, once developed, at a higher than market price) have all been suggested as ways to drive R&D in the right direction. But a recent approach sponsored by the Indian government – the Open Source Drug Discovery (OSDD) initiative – is perhaps one of the most interesting.4 Developed to create new drugs to treat tuberculosis and malaria, the OSDD draws its inspiration from the collaborative experience of innovation in the open-source software industry. Swimming against the tide, OSDD aims to ensure that all the drugs it develops will be made available in generic form, without any intellectual property restrictions, ensuring affordability for those who need them most.
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