Tropical Disease drug Discovery
Brazzaville, Congo, 1929. The Great Depression is nowhere to be seen; it has yet to shock the world, and change it forever. But it is not alone. At least a small number of individuals are walking around, in differing states of health, some suffering from the onset of uncommon illnesses – they have HIV. The virus that causes the disease, however, was not isolated until 1983. This meant that research into potential treatments did not begin until over half a century after it had crossed into the human population – and only once it had come to affect the More Economically Developed Countries (MEDCs).
The staggering scale of the problem
Barely a week goes by without some mention of HIV, malaria and tuberculosis, and the health problems that they pose. However, how often does one hear about onchocerciasis? Trypanosomiasis? These belong to a group of illnesses referred to as Neglected Tropical Diseases (NTDs), along with 15 others, as classified by the WHO . As the name implies, they receive disproportionately little attention, despite a disease burden twice as high as that of tuberculosis. In raw numbers, of the poorest 500 million living in Sub-Saharan Africa it is estimated that 44 million school-aged children are infected with the whipworm Trichuris; worldwide, there are approximately 800 million infected individuals .
Trichuriasis can be treated with mebendazole and ivermectin – but the majority of the NTDs are not so lucky. Given the large number of individuals affected by such illnesses, one might think that pharmaceutical companies would provide new options; actual research, however, tells a different story. Of the 336 novel chemical elements (that is, brand new drugs) approved between 2000-2011 by the United States’ FDA and the European Medicines Agency, only four targeted neglected diseases; of these four, not a single one provided fresh treatments for NTDs . Even though the pathogens are known, research is slow; drugs for illnesses that are not prevalent in the MEDCs are not worth investigating – in that regard, it is reminiscent of the history of HIV.
Potential solutions are never simple
Along with ensuring cost-effective delivery of treatment and management of the pathogen, lack of therapeutic agents is the problem that the NTDs and Antimicrobial Drugs teams hope to address with their jointly-written policy. One thing, however, is clear – the pharmaceutical companies themselves are not to blame. The average cost of bringing a drug to the market ranges anywhere between $350m-$5bn , and as Tessa Stewart has already mentioned , companies often only have around ten years of monopoly over their product. In this period, they must at the very least make up for the cost of drug development. However, NTDs affect individuals in the poorest areas of the world – even over the timescale of a decade, it is highly unlikely that any company would recoup the costs involved in R&D. In the current system, simply researching novel chemical interventions for NTDs is unsustainable.
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