Infectious diseases that leave victims with cognitive deficits or malnutrition instead of killing them do not typically elicit fundraising galas or research dollars, especially when the illnesses disproportionately impact the poorest of the poor. But a new coalition of funders is now trying to throw these neglected diseases a financial lifeline.
Although the Bill & Melinda Gates Foundation and the governments of the U.K. and U.S. have moved to help address these issues, research in this area lags well behind research into more lethal and common diseases. This year a new public-private partnership jumped into the fray. The government of Japan partnered with the United Nations Development Program, the Bill & Melinda Gates Foundation and several Japanese pharmaceutical companies in April to announce that it was forming a new fund to attack neglected diseases and illnesses most impacting the poor. It soon paid out about $1 million to support early research and development for new drugs. Since then the fund has been quietly accepting proposals for such work and today it rolled out its first large installment of cash, with more than half of the funding going toward shoring up malaria drug research.
BT Slingsby, executive director and CEO of the Global Health Innovative Technology (GHIT) Fund spoke with Scientific American’s Dina Fine Maron about the need to address neglected diseases, antibiotic resistance and what Japan brings to the table.
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[An edited transcript of the interview follows.]
In April the GHIT Fund said it had about a $100 million over five years. How much of that comes from the Japanese government?
It’s actually over $100 million with the exchange rate—it’s about $120 million. About $60 million is coming from the Japanese government from two ministries: the Japanese Ministry of Foreign Affairs and the Japanese Ministry of Health, Labor and Welfare.
When you launched GHIT the focus was on poverty-exacerbating diseases prevalent in developing nations—HIV, malaria, tuberculosis and neglected tropical diseases such as leprosy and Chagas disease. Why is that so important?
They are the diseases that have the most unmet medical needs. They are the compilation of diseases that lack innovations of technology. There hasn’t been a new drug developed for Chagas disease for over 30 years so it’s the significance of the unmet medical need there that drove our focus to our diseases.
You’ve talked about how more than two decades ago the World Health Organization highlighted the serious lack of biomedical innovation and access to medical devices, particularly for developing countries. Why hasn’t more been done?
It’s the lack of a market mechanism. The majority of new drugs and vaccines are developed within the private sector and they are developed as commercial goods so there is a lack of a public mechanism to advance R&D of new technologies. That's the reason why public-private partnerships like ours are set up. They use the resources and innovations from the private sector and pull from the public sector for funding.
What unique contributions can Japan make in this area?
In terms of R&D capacity, you are looking at a country whose pharmaceutical industry provides the second-most chemical entities in the world [after] the U.S., in terms of actual new medicines that have been developed.
The question is how do we bring more of the Japanese innovation to this goal of global health and that’s what we are here for.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, a public-private partnership backed by the U.S., France, Japan, the Gates Foundation and others, has had some recent funding troubles and allegations of corruption, and it recently underwent some major restructuring. How do you see the role of that fund versus your own considering your overlapping missions?
The disease scopes are overlapping and the vision is the same, to eliminate these diseases and to try to better control them. The focus of each of the funds is very different. We are primarily and only focused on global health R&D to try to advance the R&D of drugs, vaccines and innovations for these diseases. Conversely, the Global Fund is set up to improve the access to those drugs once they are developed. Once a drug is developed and on the market what the Global Fund does is try to improve access to that drug for the poorest of poor by using advance purchasing or using commitments to try to ensure the availability of that drug on a large scale.
What sort of milestones are you looking for, given that pharmaceutical research is prone to starts and stops?
We focus on development more than discovery. We are more interested in late phase projects. If we take a product that has yet to go into human clinical trials and we can look at it maybe over a two-year span, that first milestone would be regulatory approval to take it into the first human clinical trials.
Getting a new product, getting a new innovation to the patients and populations that need innovations as quickly as possible [is our goal]. So given the breadth of diseases that we are facing our priority is not going to be disease-specific but rather on quickly reaching a new innovation for the people who need it regardless of the disease.
Assuming cures or treatment are forthcoming, the next hurdle would be enabling populations to afford them. What is your fund’s take there?
When we fund a proposal we look at the potential cost of that technology once it is developed. For a vaccine it’s what can be delivered for under a dollar per vial. So that cost is assessed very early in the R&D process to ensure portability and availability once the product is developed.
Today you are announcing grants totaling $5.7 million to six global partnerships working on innovative drugs and vaccines against malaria, tuberculosis (TB) and Chagas disease, with almost half of the money going toward malaria research. What sort of breakthroughs are you hoping to support with this cash infusion?
[Some] will go toward the development of two new drugs for malaria. And these drugs have a mechanism that will allow us to better control and eliminate malaria if they are developed.
How much money has already been doled out from the fund?
Within two months of our launch we announced 13 partnerships for three chemical compounds for drug discovery. Those [were] about a $1 million in total. As part of drug discovery, one of the earlier stages is you take a huge library of chemical compounds and you screen them with an assay for malaria or TB and you see if that chemical compound kills the parasite or bacteria.
Another issue with pharmaceutical funding has been the lack of development of new classes of drugs in response to the growth of antibiotic resistance. Does your fund have any interest in moving into that space?
No, not necessarily. That is a huge issue and we are very cognizant of it and that’s a global issue, but we are focused on this constellation of diseases.
However, you are seeing the exact same phenomenon in the treatment of malaria and of TB, where it is the resistance to current treatments that is a major risk to elimination and control. So in essence we are tackling the same problems, but the focus of our diseases is a bit more narrow.
Are you looking at creating any entirely new classes of drugs?
In the case of malaria and TB we are most definitely looking for new classes of drugs.