In a recent talk at Santa Clara University, Dr. Regina Rabinovich of the Gates Foundation spoke of shocking disparities in global disease. For example, only ten percent of global health research is dedicated to conditions responsible for ninety percent of the worldwide burden of disease. Addressing these global problems will require consideration of three key issues.
First, there is the great challenge of developing pharmaceuticals for diseases that predominantly affect the third world. Research and development (R&D) for pharmaceuticals to address third world diseases has high risk and low expected return due to poverty and market failures in developing countries. As pharmaceuticals cost between $800 million $1.7 trillion to develop, pharmaceutical companies are less likely to invest in products for third world countries that often do not cover R&D expenses, and rarely lead to profits. Pharmaceutical companies have a responsibility to their shareholders, and cannot keep developing new drugs unless they turn a profit.
To address these problems, there are several existing and proposed mechanisms to align economic incentives with scientific innovation to develop pharmaceuticals for the third world. These include Public-Private Partnerships (PPP) between philanthropy, government, biotech companies, and academia; the FDA’s Priority Review Vouchers (PRV) that reduce time and cost of a standard FDA review for drugs designed for the developing world; and ideas to restructure the patent track to reward innovation in proportion to its effect at reducing the global burden of disease. Although these steps are promising, much still needs to be done to make it economically feasible and profitable for pharmaceutical companies to develop drugs for the third world.
Yet, once drugs are developed to help the third world, how will they be distributed? A second key issue in global health is building an infrastructure in developing countries to effectively and efficiently distribute pharmaceuticals to those in need. The World Bank estimates that for every $100 spent by African governments on pharmaceuticals, only $12 worth of medications reach patients. Poor quality roads and weak public transportation systems in developing countries prevent patients, health care providers, and medicines from reaching health facilities. Such barriers can cause interruptions in patient treatment regimens that lead to severe medical consequences. For example, if a patient positive for tuberculosis is not consistent with his medication regimens due to poor compliance or medical supervision, he may develop multi-drug resistant tuberculosis (MDR-TB), which is far more difficult to treat. To prevent the spread of MDR-TB, Partners in Health hires community health workers in developing countries to make daily home visits to patients to supervise them taking their medication. This is one way to ensure the continuity of medical care in areas that have poor access to health care professionals.
Lastly, there is the challenge of combining world aid with sustainable in-country solutions. World support to provide, develop and distribute medications to the developing world can only go so far. Health problems in the third world are compounded by the lack of a clean water supply, electricity, sewage treatment, and overcrowded housing. Poor social support systems and corrupt governments exacerbate these problems. In order to sustainably improve health in developing countries, the nation’s infrastructure, leadership, and social systems must be reformed.
Bill Gates said that “there is no bigger test of humanity than the crisis of global health. Without compassion, we won’t do anything. Without science, we can’t do anything.” It is our generation’s turn to unite science and compassion. By aligning scientific innovation with economic incentives and improving health delivery infrastructures to provide access to drugs, we can reduce the immense disparities in global health.
July 2010