Can product-development partnerships deliver?

Public-private partnerships in drug development were intended to marry the business savvy and deep pockets of big pharma with academic rigour. But this morning representatives from the biggest partnerships – including the International AIDS Vaccine Initiative (IAVI) and the Global TB Vaccine Foundation – gathered to convince us their presence hasn’t been for nought.

In 2004, PDPs were responsible for 75 per cent of R&D in neglected diseases. It’s hard to quantify, however, how much of the R&D boost over the past decade or so has been due to PDPs and how much to a rising profile of global health issues.

What struck me most was the desire of several of the PDPs to “move beyond product development”.  At the conference so far, there has been much talk of moving away from short-term goals of rolling out antiretrovirals to a more holistic long-term approach to ensuring health systems are equipped for big health programmes to parachute in.

But surely if any organisation could be forgiven for focusing solely on a product, it would be a product-development alliance? It’s commendable that, as IAVI’s Holly Wong said, some PDPs share clinical site capacities and help build capacity. But their primary goal must be to develop urgently drugs for TB and neglected diseases.

Most PDPs are relatively young . It’s still a little too early to question whether they have fulfilled their promise but in a few years they will need to be accountable. In the meantime, they must concentrate on getting products to market.

Priya Shetty, www.scidev.net, priya4876@gmail.com

The last dance and parting shots

The 11th TWAS general conference came to an end today with Jacob Palis, the president of the organisation, extending a greeting from another Jacob; Zuma, the president of South Africa.

Meeting Palis and his colleagues in Cape Town yesterday, Zuma promised that if TWAS was to organise another conference in his country he would attend in person. Oh well…

It has not just been hard work. Last night, TWAS members and staff were dancing on tables in a casino where the final party of the week took place. Unfortunately, your correspondent did not attend with her camera, otherwise this post may have had more interesting images to go with it.

The conference signalled a deepening collaboration between TWAS and South Africa, which is going to set up a regional chapter of the organisation.

It may also mark the end of an era. Mohammed Hassan, TWAS executive director, is expected to retire at some point. This could be his last general conference. But then again, it might not…

Even if Hassan retires, he is unlikely to sever his ties completely with the organisation, according to sources in TWAS. Like a certain Russian president-cum-prime minister, he is likely to stay involved for some time to come. Which, in this case, isn’t a bad thing!

Linda Nordling, SciDev.Net

It’s not what you know, it’s what you do with it

Next stop: Tunis in 2011

There’s a famous line in Moliere’s play Le Bourgeois Gentilhomme where the lead character expresses both surprise and pleasure at his discovery that he has “been speaking prose all my life, and [I] didn’t even know it!”

At the end of three days of intensive discussions, a significant proportion of the 300 or so delegates attending this week’s meeting in Dakar, Senegal, may well be returning home with the same feeling about the concept of “knowledge management”.

Some of the presentations to the 3^rd Knowledge Management Africa (KMA) meeting applied the term to the new opportunities to put science and technology to productive use that are being opened by, for example, novel communication technologies (including both the Internet and mobile telephone).

Others, however, pointed out during the meering that in areas such as health and food production, finding ways of putting medical and agricultural science to use has been a central concern of development programmes for several decade.

But despite – or perhaps because of — the continuing lack of a precise definition, the meeting ended not only with a consensus that improved knowledge management, within both the public and private sector, is vital for Africa’s future prosperity, but also agreement on steps that will hopefully help this to happen.

One of the most concrete will be setting up of a new foundation, based at least initially in South Africa, that will seek to become a hub for Africa-wide efforts to boost knowledge management, while at the same time providing support for practical activities aimed at this goal in different parts of the continent (See story here).

Importantly, the foundation will provide a mechanism through which a range of African banks will be able to explore ways in which their lending policies can be broadened to include not only conventional investments, but also those aimed at building up Africa’s scientific and technical capacities.

(To be continued)

David Dickson, SciDev.Net

A voice of experience

M'Bow: "Africa must act quickly"

Few participants in the Dakar conference on knowledge management can have had more experience of the challenges facing science in Africa than Amadou-Makhtar M’Bow, a former education minister of Senegal, and director general of UNESCO from 1974 to 1987 — the first black African to head a major UN organisation.

M’Bow reminded his audience that, despite the economic challenges facing the African continent, little had happened over the past 20 years to meet them. “Africa’s share of world trade fell from 5.8 per cent in the early 1960s to 2.8 per cent in 1987,” he pointed out.

“But we are still at roughly the same level as we were in 1987,” adding that a series of brain-storming meetings held under UNESCO’s auspices 20 years ago “had the same concerns as today”.

Although now well into his 80s, M’Bow maintains much of the fiery commitment that led him on a collision course as head of UNESCO with both the United States and the United Kingdom in his promotion of a new world information order.

He acknowledged that progress in promoting science and technology on the continent has been slow. “If the capacity for scientific creativity and technology development is measured by the number of engineers, technicians and researchers, Africa remains far from a minimum threshold,” M’Bow said.

“Too often, African countries maintained a technological dependence on other countries, but also suffered from a lack of modernisation, for example in its agricultural system.”

“That is the situation of Africa today, despite the progress that has been achieved since independence,” M’Bow said. “The causes lie in the fact that Africa has not been able to draw on the enormous possibilities that are offered for its development by scientific and technological knowledge.”

Despite this, he remains optimistic. “Everything is possible if we have the will power, and are bold enough to pull together African intelligence and expertise to do what others can do.” 

Collaboration between African countries to promote science and technology was essential “for the destiny of the African people and the future of the continent”.

The solution, said M’Bow, also lay in changing attitudes towards education, and especially in training a new generation of managers “who are proud of being Africans”. It would then be up to these people “to build a new Africa capable of both resolving its own problems, and contributing solutions to the problems faced by the rest of the world”.

But speed is essential. “The African continent must act, and must act quickly, to change the course of history.”

David Dickson, SciDev.Net

Have we left pharma out in the cold?

The contentious topic of the role in industry in research to strengthen health systems was the hot topic at this morning’s plenary session.

Bamako 2008 was billed as an opportunity for policymakers, researchers, industry and civil society organisations to get together for discussion, but representatives of pharmaceutical companies have been in short supply, as both speakers and participants.

And Merck’s Mark Feinberg may have wished he’d stayed away. His assertion that pharmaceutical and other sectors need to find more creative ways to collaborate and partner, and a reference to the sometimes adversarial nature of the relationship between such sectors was met with questions about the trustworthiness of big pharma.

Feinberg added that pharmaceutical companies have an important role to play in the research for health dialogue and presented numerous examples of where Merck has made a big difference by providing free or cheap drugs, while maintaining that the pharma industry has a very specific role to play.

But it was Mark Walport, director of the Wellcome Trust, who was more forceful. “Blind attack [of pharmaceutical companies] has no value,” he said. “At the end of the day, it’s pharmaceutical companies that make drugs, not academics.”

A representative of the Global Forum for Health Research stated that within a year it will have provided a platform on which researchers, industry and civil society can communicate.

Katherine Nightingale, SciDev.Net

Funding available

There is one area of health research where you don’t have to fight for funding.

As Dr Roger Glass, chair of the session on Implementation/Operational Research held on the second day of the meeting, said, ″When have you ever attended a conference where you have three organisations saying there is funding available [for research]?″

So, people interested in conducting operational or implementation research (or as the World Bank calls it: impact evaluation), put in that proposal now to The Global Fund, the World Bank and USAID.

And the best part is, all three groups encourage incorporation of training schemes for local personnel in the field in the proposal for funding, so that meets capacity building agendas as well. This is especially important as most of the ground personnel are usually community workers, and not trained researchers.

However, participants who regularly work on the ground brought up the very relevant fact that although the funding bodies say there is flexibility in funding to include operational research, the reality is many people on the ground are either not aware of this flexibility or those in charge of the funds are not themselves that flexible.

Another interesting observation brought up was the continued usage of paper and pen in conducting surveys when most field workers would have a ″pocket computer″ with them in the form of their mobile phone. Time to bring surveying techniques into the 21st century?

Shiow Chin Tan, SciDev.Net

Let’s stop and take stock

The halls have been ringing with calls for more in the last couple of days. More research, more capacity to do that research and more focus on the kind of research that should be pursued, whether it be basic, clinical, health systems or implementation research.

So it was something of a surprise when one speaker called for a one-year moratorium on research in a session on social and technological innovation for health. “We should see what we’ve got and how it can be used,” she said. Whether she was serious or not, it raises an important question – do we already have enough research? Should we not be concentrating more on what that research has found and making sure that the right people know about it?

The problem is that no one can say whether we have all the research we need for now, because no one person has access to it all. Language and publication barriers, and no trend in students publishing their research is leading to a lot of research ending up in the so-called ‘grey literature’, inaccessible to the global and sometimes local communities and rendering other researchers incapable of determining whether they are “reinventing the wheel”.

There was much debate on the HR4D-net discussion forum before the conference about the need to create repositories and such for less visible research. Maybe I’ve missed it, but there doesn’t seem to have been much discussion here – which seems like a missed opportunity.

Katherine Nightingale, SciDev.Net

Wanted: TB test for US$100mil

Create a quick, accurate test for tuberculosis (TB) that can be administered with minimal training and resources, and you might just win yourself US$100 million in prize money.

Of course, you would have to allow the test to be sold at cost – meaning no extra royalties from sales; and you’ll only get the money after it has been proven effective over a period of at least seven years.

This prize fund is one of the new ways of stimulating research and development in TB mentioned by speaker Tileman-Dothias von Schoen-Angerer of Doctors without Borders during the session on Tuberculosis Research.

If that amount of time seems too long even for US$100 million, fear not, there is also a suggestion that smaller sub-prizes of maybe US$10 million be given out for important developmental goalposts in the research for such a test with only a two-year proving period needed.

So, any bright ideas for a quick ID on Mycobacterium?

Shiow Chin Tan, SciDev.Net

Global health’s ′Cinderella′

Described as the ″Cinderella″ of global health by chair Richard Horton, editor-in-chief of The Lancet, the session on non-communicable diseases (NCD) certainly shared the topic’s luck.

Technical problems struck first when a video from Ala Alwan, WHO assistant director-general of non-communicable diseases and mental health, on ″After Bamako: Taking the agenda forward″ was unable to be played.

Noise from a couple of rooms off the back of the hall where the session was being held also plagued the talk, although the sharp questions that were asked during Q&A showed that the audience hadn’t allowed that to distract their attention from the speakers.

Horton also pointed out that ″if NCD is Cinderella, mental health is the ugly stepsister″; for while WHO has recently developed a programme for tackling NCDs, mental health is still not being given the attention it deserves. Especially when depression is among the top three causes of disability around the world.

One of the speakers, Sania Nisthar, president of non-governmental agency Heartfile, Pakistan, also brought up the interesting situation where researching NCDs in her country has indirectly led to the improvement of the health information system.

For example, morbidity surveys are based on assessment of risk factors rather than actual cause of death as overlapping diseases make it difficult to accurately define the cause of death.

Data on these risk factors are integrated into general demographic surveys due to resource constraints. Researchers using this data have discovered gaps in the data collection, which has resulted in them reviewing and refining the methods of national health data collection in order to facilitate their own research into NCDs, thus improving the health information system.

Shiow Chin Tan, SciDev.Net

Getting it out there

Given the choice, would the average scientist prefer to find a cure for tuberculosis or find a really effective way of getting it to people? It is the concentration on the former that Ok Pannenborg, a senior health advisor at the World Bank, highlighted this morning at Bamako 2008 in a plenary session on research for health challenges.

Health systems research, he said, is unsexy. Health systems are seen as “amorphous, abstract and vast”. How can anyone go about researching such things?

The key, he said, is not to see it as disease versus health systems research, or even disease research alongside health systems research – but focusing on better health systems for the treatment of disease.

Research, he said, is an indispensible tool for improving health systems, from identifying and understanding problems to developing and evaluating new ways of doing things.

But it’s not just in health systems that finding out how to best deliver things to people is key. Health is not just about healthcare, said Michael Marmot, chair of the WHO Commission on the Social Determinants of Health, in a video presentation during a later session.

Research into the social determinants of health has shown what can lead to poor health. It’s acting on this evidence which is the next step, said Marmot. We know that clean water is good for people’s health, let’s find a way of getting it to people.

Katherine Nightingale, SciDev.Net