Nudging Big Pharma’s Tropical Neglect

When will profits-hungry drug companies finally widen their attention from treating complex lifestyle-related diseases affecting citizens in wealthy countries, to the technically simpler task of curing infectious diseases threatening billions of poorer people in the developing world?

Never – if you believe the liberal media or some NGOs that regularly lambaste listed pharmaceutical companies for their focus on cancer, immune deficiency, neurodegenerative or cardiac diseases in markets where insurance markets underwrite the huge cost of patent-driven drug research.

By contrast a whole category of Neglected Tropical Diseases (NTDs) punches far below its weight in research terms, even though they affect 1.4 billion people worldwide. In fact, research by Médecins Sans Frontières (MSF) has shown that although NTDs comprise 10 -12% of humanity’s global disease burden, over the last 40 years the percentage of medication used to tackle them has risen from 1% to 3.8% of all approved drugs

However, since 2010 when the WHO first brought the issue into the public spotlight, progress is indeed being made. Non-profit organisations and funds are now giving drug companies a powerful “nudge” in the right direction by funding their basic research into 17 NTDs including malaria, schistosomiasis, Zika, Ebola, Chagas disease, Guinea Worm, elephantiasis, and West Nile Fever.

While there is no substitute for the stock market-funded research labs of Basel when it  comes to the drug patents race, a number of initiatives — including  research by middle income developing countries like  Brazil – could fill part of the gap.

Screen Shot 2013-03-21 at 18.13.28

Chagas disease is transmitted by this “barbeiro” crawling insect.

Organisations such as the Drugs for Neglected Diseases initiative (DNDi), the Bill and Melinda Gates Foundation, the Innovative Medicines Initiative, and even government support such as the UK’s £450 million initiative that would provide drugs for over 200 million people in Africa, are all making it easier for drug companies to please their shareholders. This shows Big Pharma can indeed be prevailed upon to accept its responsibilities.

Not least because NTDs simply won’t stay put in poorer developing countries. Scares with ebola-infected aid specialists carry infection back from Africa to Europe, with Zika-infected mothers in Texas and Florida, show this is now a major challenge for global epidemiology.

Today there are three driving forces to the campaign against NTDs which is well summarised in this PLoS article.

The first is named “preventive chemotherapy” and comes from pharmaceutical companies donating or selling older drugs combating parasites that cause disease. The WHO estimates that one third of the one billion people living in poverty globally, have received some basic treatment for schistosomiasis and other parasites with drugs like albendazole, mebendazole, and praziquantel.

The second is the organising principle of Open Innovation Drug Discovery to find new drug solutions. Here, pre-competitive consortia of research organisations and even drug companies put the principle of intellectual property on one side to pool their resources.

Because the secrecy-bound race for competitive exploitation starts at a later phase, scientists deliver much more early stage drug discovery for the same or less money. You can read a comprehensive paper by the Oxford Martin School about organisations such as the Structural Genomics Consortium (GSC) and Eli Lilly’s Open Innovation Drug Discovery program by clicking here.

Already at work in Campinas, GSC forms the nucleus of a pharmaceuticals cluster for Brazil. You can read SFB articles about its operations here and here.

The third solution is for advanced developing countries to go solo or work in tandem  develop their own NTD drugs, by conducting the research that international pharmaceutical companies still hang back from.

That’s exactly the case of a Brazil-Senegal initiative. Brazil, which in addition to its own endemic NTDs such as Chagas disease, leishmaniasis or dengue fever, has recently witnessed a shocking influx of imported tropical diseases such as Chikungunya, a disease that originated in Africa in the 1950s.

Dengue-bearing mosquitoes (Foto Wikimedia)

Dengue-bearing mosquitoes. West Nile fever is also transmitted by mosquitoes attacking both humans and birds (Foto Wikimedia)

Brazil’s own Society of Tropical Medicine (BSTM)  is working with DNDi on decentralized and collaborative partnership model, in liaison with public and private sectors. This work covers all research and development chain, from finding new molecules, to pre-clinical and clinical research, ensuring equitable access conditions so the patients’ needs are met.

Yet thanks to migration and global travel patterns linked to sporting events such as the 2014 World Cup and the 2016 Olympic Games, new diseases are popping up all the time. Faster perhaps, than even consortia can address them.

That’s certainly the case of West Nile Fever, an arbovirus transmitted by mosquitoes, and now threatening Brazil, where scientists are already working on vaccine precursors in partnership with  counterparts in Dakar, Senegal.

The disease can have significant neurological consequences, affecting the central nervous system, causing meningitis, encephalitis, and in extreme cases, acute paralysis that leads to death.

During the 1990s West Nile virus was spread by birds migrating from Africa into Europe and via France to Russia. More than 20,000 cases have been reported with outbreaks in Canada (1999-2007), the US (1999-2012) and Mexico (2003).

Birds are vectors of  West Nile Fever. New research helps to deconstruct the  virus they carry

Birds are vectors of West Nile Fever. New research carried out in Brazil and Senegal helps to deconstruct the virus they carry

It is transmitted by mosquitoes that bite migratory birds as well as humans. As large numbers of birds migrate between Americas north and south annually, it is only a matter of time before the infection comes to Brazil, according to virologist Paolo Zanotto, head of the Molecular Evolution & Bioinformatics Laboratory (LEMB) at the University of São Paulo’s Biomedical Science Institute (ICB-USP).

Zanotto contributed to a new paper published in PLoS Neglected Tropical Diseases. It is the result of collaboration among virologists at Institut Pasteur de Dakar in Senegal, the University of São Paulo and the Federal University of São Carlos, São Paulo State, Brazil. The study was supported by FAPESP, Brazil’s National Council for Scientific & Technological Development (CNPq) and the European Union.

The research behind the paper shows that that lineage 8 of the West Nile virus, isolated in 1992, is not very virulent and could provide the building blocs for development of a new vaccine. This would use a methodology similar to that deployed by the commonly-used vaccine for the  ‘flu virus, which teaches the body’s immune system to defend itself against invasion by a similar but more virulent strain.

Such initiatives point the way to a multi-valent “nudging” of drug companies to get their policymakers to attack NTDs with more vigour, as a result of research initiatives by consortia and targeted  projects in countries like Brazil. After all, there’s no disputing there are plenty of people need treatment globally – and once the research risks have been reduced for shareholders, no chief executive of a competitive pharmaceutical company can afford to miss out on a potential  disease bonanza.

To read the article about Brazil/Senegal research into: “Biological and phylogenetic characteristics of West African lineages of West Nile virus” click here:

To read an article about Brazilian research on West Nile Fever by Brazilian reporter Peter Moon click here.

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