Can the governments of both developed and developing countries be persuaded to back a paradigm shift in the way that research into novel treatments for the diseases of the developing world is funded?
This is the challenge being thrown down by supporters of a proposed international convention on the funding and co-ordination of health research that is being proposed to the World Health Assembly next month (see my recent editorial).
As described to a session of Forum 2012 devoted to the proposal, the case for change is clear. Carlos Corea, a member of the WHO’s Consultative Expert Working Group on Research and Development (CEWG) which draw up the proposal, outlined three reasons that change was needed.
Firstly, he said, although investment by pharmaceutical companies has increased significantly in recent years, product innovation – measured by the number of new drugs emerging – has gone down.
Secondly, despite increased investment in research and development for diseases in developing countries, a lack of incentives means that this remains insufficient. And thirdly, “there is little co-ordination [in drug research]. Global efficiency is not very high.”
Michelle Childs, of Medecins sans Frontieres, put it more pragmatically. “We are interested in the proposed convention because of the frustration of our medical teams that many of the tools that they need are unavailable, un-affordable, or ill-adapted to the situations they face on the ground.”
The reason, she suggested, was that drug industry relies on recouping the costs of research and development through high prices on the resulting products, which it is able to charge through the exercise of patent rights.
At the core of the proposed treaty would lie a fundamental break with this principle. Namely, the costs of R&D on new drugs would be de-linked from the costs of providing the drugs to patients.
James Love of Knowledge Ecology International, one of the original architects of this novel approach, described the challenge. “How do you change the paradigm and come up with something new that reconciles the needs for innovation and access.”
Why was this controversial? “Because it challenges current thinking about how R&D is financed”. Furthermore, the principles on which it is based “are seen as a threat to existing business models”.
But Love argued that the treaty model “should not be considered that controversial, since it focusses on areas where the market is not working, and where the access issues are particularly acute”.
The fate of the proposal at next month’s meeting of the WHA is uncertain. “Some people may try to delay the decision for a year,” says Love. “But you don’t want this report to sit on the shelf.
“What is needed is for the WHO to create an intergovernmental body to move this thing forward. We need to open the door that allows people to start discussing this proposal.”
Francisco Songane, the chair of the Forum 2012 steering committee, warned that for even this to happen, it was important that delegates to the WHA should be fully informed about the proposals.
Otherwise there might be last-minute attempts to block progress not out of disagreement, but out of a lack of knowledge.
Others added that it was not just health ministries that needed to be involved, but other ministries with a stake in the outcome. In particular this included finance ministries, since the treaty has potentially significant financial implications.
Despite the challenges in generating the necessary paradigm change, there was an air of optimism in the discussion in the Forum 2012 session.
“The world we live in today is different from the world in which we will live in 20 years’ time,” said Love. “You have to find a path to change things. The R&D treaty is an attempt to build a different future.”
This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012.