Neglected diseases

The recent announcement that a dozen drug companies have joined forces to tackle 17 “neglected” tropical diseases is to be welcomed both in terms of efforts to reduce the burden of disease in developing countries and as an indication of more creative thinking from the pharmaceutical industry with respect to R&D strategies.

The alliance, which includes the US and UK governments, the Bill & Melinda Gates Foundation and the World Bank, is combining drug donations with fresh funding and research, with the aim of easing the burden of diseases that kill 500,000 people a year and affect 1bn in the world’s poorest countries, costing an estimated $10bn in economic growth.

The actions include inter-company R&D collaboration (e.g. to develop an anti-worming pill to tackle river blindness and lymphatic filariasis) and increased donations of a drug to treat schistosomiasis.

However, there has been intense debate over the value of preventative large-scale “mass chemotherapy” to prevent and treat diseases such as schistosomiasis. Concerns have been raised over drug resistance and there are questions over how easily the approach could be extended to other diseases. Potentially there are more effective and cheaper alternative or complementary strategies (e.g. improved sanitation, water quality and vector control) that should also be implemented.

Nonetheless, such collaborations between pharmaceutical companies are to be encouraged and it is to be hoped that they will be extended to other neglected diseases. A prime candidate is infectious diseases where drug-resistant bacteria have become a critical medical issue. According to the Centers for Disease Control and Prevention in the US almost 2m patients contract an infection in hospital annually, and almost 100,000 of them die each year as a result of drug-resistant infections - making this the sixth leading cause of death in the US.

Despite the huge unmet need, a significant number of pharmaceutical companies have closed their anti-infectives R&D programmes and the number of novel products in development is tiny. The reasons are largely commercial – a novel agent more powerful than those currently used would probably be held in reserve for only the most stubborn infections. Also, anti-infectives usually are given as an acute-care regime for a few weeks or months, limiting their sales potential in comparison to drugs used to treat a chronic condition such as diabetes.

The magnitude of the problem of drug-resistant infections suggests that this is another area where innovative alliances, similar to the one announced for “neglected” tropical diseases, need to be encouraged and nurtured.