Because there will never be enough donor money to fund all desired clinical research, the global health community is testing
the stimulus power of market-based "pull" mechanisms, such as Advance Market Commitments (AMCs), which guarantee prices for
new vaccines and drugs with low profit potential in the West. This approach is being used to fight malaria by subsidizing
the purchase of artemisinin-based combination therapies (ACTs) that are effective, but too costly for most third world health
systems. The Global Fund to Fight AIDS, Tuberculosis & Malaria recently launched the Affordable Medicines Facility–malaria
(AMFm) to make ACTs available in Africa and Asia at nominal cost. The subsidies apply to fixed-dose combination ACTs, and
aim to drive older, ineffective products out of the market.
Another AMC project supports development of new pneumococcal vaccines that can protect against pneumonia and other diseases
that claim millions of lives each year. A broad donor coalition has committed $1.5 billion to guarantee a $3.50 price for
pneumococcal vaccines suitable for Third World use, encouraging pharma companies to invest in research and expand manufacturing
capacity for more effective products.
FDA's priority review voucher program offers another inducement for manufacturers to support R&D on neglected diseases. The
program provides a voucher to sponsors seeking approval of a treatment for one of 16 neglected tropical diseases. The voucher
is good for a priority six-month review (instead of the usual 10 months or more), which should be highly valuable to any company
seeking market approval for a new medicine with large sales potential. The first review voucher was recently awarded to Novartis
in conjunction with approval of its anti-malarial product Coartem. The move drew some criticism because the drug already was
available in most of the world. But this decision gets the program going while FDA develops guidance and weighs whether to
expand the list of topical diseases that qualify for review vouchers. Several manufacturers are poised to file applications
they hope will produce priority vouchers they can use or sell.
Vaccines to prevent infectious diseases are the holy grail in fighting Third World diseases—and there's been some good news
on that front. The PATH Malaria Vaccine Initiative is launching Phase III trials on a promising malaria vaccine developed
by Glaxo, and the Aeras Global TB Vaccine Foundation has several drug candidates in early clinical trials. Rotavirus vaccines
recently received a strong push from a WHO recommendation to include the product in national childhood immunization programs.
Vaccine development also is strong in the US, as new preventives for HPV, rotavirus, and shingles hit the market last year,
and several important products are currently in the review queue. The agency anticipates a slew of license applications in
coming months, which could be a problem if they coincide with filings for the new pandemic H1N1 (swine flu) vaccine that manufacturers
are testing and producing as fast as possible. The US expects to spend some $8 billion for nearly 200 million doses from Glaxo,
Novartis, Sanofi Pasteur, AstraZeneca's MedImmune, and Australia-based CSL Ltd. Other nations are mapping similar plans. (See
"Speeding Flu Vaccine to Patients".)
Speeding Flu Vaccine to Patients
This escalation to meet demand for flu vaccines is a bonanza for vaccine makers. Sanofi, Glaxo, and others are opening new
manufacturing facilities in the US and abroad while foreign manufacturers—such as Sinovac Biotech in China—are gearing up
production, and a number of small biotech firms are developing new vaccine production and testing methods. Novel antigens
are in the works, and vaccine makers are moving forward with long-discussed cell-based manufacturing technology.
Squeeze on Funding
Yet despite significant increases in funding for global health over the past decade, international programs now face major
budget cuts. A May 2009 Institute of Medicine report recommends nearly doubling US financial commitments to global health
to reach $15 billion a year by 2012, but that's not likely to occur. The Obama administration has proposed a $63 billion,
six-year global initiative to combat AIDS, as well as TB, malaria, and other Third World health problems. That's less per
year than Bush's $48 billion, five-year funding plan for PEPFAR (the President's Emergency Plan for AIDS Relief), which has
been praised for slowing the growth of AIDS in Africa and other poor nations.
The funding decline is squeezing resources at public–private partnerships just as they are poised to harvest rewards from
over a decade of research. A 2007 Dalberg study estimates that full testing and registration of those projects in PPP pipelines
would require $8.3 billion in funding, but that less than $1 billion is available. One solution may be for newly industrialized
nations, such as China and India, to invest more in infectious disease research that would benefit their populations directly.
Jill Wechsler is Pharmaceutical Executive's Washington correspondent. She can be reached at email@example.com