HIV and AIDS, malaria, tuberculosis, and the numerous lesser-known infectious diseases of poverty affect more than 1 billion people globally, and result in the deaths of more than 6 million people in low- and middle-income countries every year. Ending these disease epidemics is critical in order to achieve the Sustainable Development Goals, and yet this will likely be impossible without new tools to diagnose, prevent and treat these diseases.
But with no commercial market for such products, which benefit the poorest and most marginalized populations, public and philanthropic funding of global health research and development is absolutely essential.
The European Commission is an important funder of research and development for poverty-related and neglected diseases, providing 794 million euros ($889 million) in R&D funding between 2007 and 2014. It channels most of its funding through three mechanisms: the Framework Programs for Research and Innovation; the European & Developing Countries Clinical Trials Partnership; and the Innovative Medicines Initiative.
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And yet despite the substantial funding it provides, the commission does not have a global health R&D strategy; it funds R&D for poverty-related and neglected diseases in much the same way as it funds R&D for other diseases.
But the nonprofit nature of these diseases means that what is suitable for diseases with commercial markets can be problematic for R&D on poverty-related and neglected diseases.
SEEK Development studied the commission’s funding mechanisms, and have five recommendations for how it can improve its investments:
1. Develop a clear funding strategy for global health R&D.
The commission currently pursues conflicting aims with its health R&D funding. On the one hand, it is guided by its global health strategy, which seeks to promote global health and recognizes the need for new medical tools. On the other hand, its research strategy focuses on economic competitiveness and growth.
To overcome these conflicting aims, the commission should develop a comprehensive funding strategy for global health R&D, with clear objectives and an implementation plan, and a focus on delivering appropriate and accessible new health technologies to achieve its global health aims.
2. Fund the entire research cycle.
The commission places a strong focus on basic research, and largely acts in much the same way as a typical national science and technology funding agency. Such an approach is primarily designed for a market-based system, which aims to create knowledge and promising leads, with the assumption that the private sector will take over and fund late-stage development and commercialization.
But while this may hold true for diseases for which there is a commercial market, it doesn’t for poverty-related and neglected diseases, which need public or philanthropic support throughout all stages of the research cycle. The commission should strengthen its funding of late-stage research for poverty-related and neglected diseases, ensuring that candidates it has supported in the early stages can move forward.
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3. Relax eligibility requirements to support product developers with necessary expertise.
Product development is very complex and demanding. It requires collaboration of research institutes, industry, nongovernmental organizations and academia. Yet the commission’s key funding mechanisms have very restrictive eligibility criteria, requiring a specific organization type or form of cooperation, particular co-funding arrangements or a specific geographic origin. Such narrow selection criteria limit the involvement of many product developers with valuable expertise, such as product development partnerships.
Because commission funding is focused on individual projects, it has limited scope to fund product development partnerships, which work to advance a portfolio of candidates. To ensure that it makes use of the expertise that is available globally, the commission should relax some of its eligibility requirements, including restrictions on the location of consortia members.
4. Ensure new health tools will reach patients and achieve impact.
To achieve global health impact, new technologies need to be appropriate, affordable and accessible. Yet the commission funding mechanisms fail to demand and monitor this. There are no mandatory conditions on affordability, accessibility and suitability in the governing documents, work programs, strategic business documents or calls for proposals — a massive shortcoming. Without mandatory provisions on access, the goal of reaching the people in greatest need cannot be achieved. The commission should therefore work to entrench binding access requirements into all of its programs and calls.
5. Leverage the public-private partnership model of IMI.
Despite ostensibly being a key mechanism through which the commission funds R&D for poverty-related and neglected diseases, the IMI has in fact provided very little funding for this purpose. This is perhaps unsurprising, given that its main objectives are to address health challenges in Europe and to strengthen Europe’s competitiveness.
However, its business model could in principle be a very suitable mechanism to create new health tools for diseases of poverty. IMI is a PPP that can leverage the comparative advantages of different players, and in particular large pharmaceutical companies.
These companies already play a major role in global efforts to develop new neglected disease products, but are not well engaged by the commission for this purpose. Major changes would be required at a strategic level though: the commission would need to be involved more strongly in the priority-setting of IMI in order to ensure a stronger focus on poverty-related and neglected diseases.
Doing so, however, would leverage the resources of the pharmaceutical industry in support of R&D for poverty-related and neglected diseases, and open up a funding mechanism that has been underutilized for global health benefits.
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