In Japan, a man is walking near a Tokyo golf course and puts a soil sample in the plastic bag he always carries in his wallet, ready to send to a friend in the United States. In China, the growing threat of malaria sends the country into an intensive search for a treatment, and a woman looks for the answer, not in state-of-the-art labs, but in thousands of records of ancient Chinese remedies.
From these beginnings came two of the world’s most important drugs. Tu Youyou’s research into traditional Chinese medicine produced the compound artemisinin, the world’s leading anti-malarial treatment, while the sample Satoshi Ōmura picked up and sent to William Campbell contained the progenitor of ivermectin, an anti-parasitic drug crucial to treating onchocerciasis — also known as river blindness — and lymphatic filariasis.
These scientists were awarded the 2015 Nobel Prize in physiology or medicine. Their stories are fascinating, and their contributions well worth honoring. But the bigger lesson from their triumph is the need for governments, the private sector and others to invest and work together in developing world-changing discoveries.
Changing the world, one discovery at a time
The drugs these scientists discovered have changed the world. Treatments based on artemisinin have been at the core of a global malaria control effort that has saved millions of lives, while the widespread use of ivermectin is allowing people in Africa and Latin America to return to the villages and farms they abandoned in fear of the black flies that carry river blindness: 100 million people are receiving treatment every year and an estimated 40,000 cases are prevented annually by the program. River blindness transmission has now been stopped in four of the six affected countries in Latin America and in nine regions in five African countries.
This enormous impact took more than just three brilliant researchers. Dozens of people in multiple private, for-profit, and public organizations dedicated time, effort, political will and critical research and development funding to turn their scientific discoveries into life-changing medicines.
The tremendous social return when society invests in R&D has been shown time and again: R&D investments in vaccines, medicines and diagnostic tools have contributed to huge improvements in child health overall, with 6 million fewer child deaths overall in 2012 than in 1990. The $26 million invested in the development of a polio vaccine by the “March of Dimes” campaign in the 1950s has saved about $180 billion in treatment costs and R&D into artemisinin, rapid diagnostic tests and insecticide-treated bednets has contributed toward a 60 percent decline in malaria deaths over the past 15 years.
Despite this social return, the expected commercial return that tends to drive public and private R&D investments is relatively low for health issues that affect the poorest around the globe. This means we still lack adequate prevention and treatment tools for issues like tuberculosis and neglected tropical diseases and to fight against antimicrobial resistance.
Until we develop these products, these health challenges will impose a huge health and economic burden and trap families and communities in poverty. Without the new tools R&D can provide, we will not be able to achieve the ambitious 2030 targets for health of the recently announced Sustainable Development Goals.
More funding is critical; a report in The Lancet medical journal this year estimates that we need to at least double our current levels of public and private R&D investments into these disease areas to make the impact we need. Last month, the United Kingdom and the Bill & Melinda Gates Foundation announced the launch of the 1 billion pound ($1.49 billion) Ross Fund, more than 20 percent of which will be dedicated towards new R&D for infectious diseases, including malaria, tuberculosis and neglected tropical diseases. We need other funders to step up and join these groups to fully fund the R&D gap.
And beyond funding, we need to generate an enabling environment where the current and future generations of researchers — the successors to Tu, Ōmura and Campbell — are motivated and have the economic incentive to invest in innovation and new discoveries to control and eliminate the diseases that end lives and keep communities in poverty.
Partnership is the cornerstone
No one individual or institution can tackle these issues on their own. Public and private sectors must unite to create partnerships that leverage their unique strengths, multiplying their investments into R&D and ultimately their impact on global health.
Product development partnerships — nonprofit organizations that combine a public health mission with the best of private sector management practices — have proven extremely effective in bringing together public and private expertise and capacity to solve specific challenges. For example, in response to a devastating series of meningitis A epidemics, the World Health Organization, PATH and the Bill & Melinda Gates Foundation partnered with the Serum Institute of India and public health officials to bring an affordable vaccine tailor-made for use in the meningitis belt of sub-Saharan Africa. Mass campaigns have reached more than 217 million people in 15 countries with the new vaccine, saving thousands of lives.
Tackling another pressing global health challenge, a consortium of eight pharmaceutical companies and seven nonprofit and academic partners formed the TB Drug Accelerator in 2012. This consortium aims to speed up the discovery of TB drug candidates by pooling resources and expertise, laying the groundwork for new TB drugs that can shorten treatments and save lives. Current TB treatments require at least six months — the goal is to create a regimen that cures patients in one month.
The fight against neglected tropical diseases is also benefiting from this kind of innovative partnership. The Drugs for Neglected Diseases Initiative, a not-for-profit R&D partnership between the public sector, pharmaceutical companies and the international research community, has brought to market improved treatments for malaria, Chagas, and visceral leishmaniasis. DNDi also has a new oral treatment for sleeping sickness, developed in partnership with Sanofi, in phase three clinical trials. Each of these deadly diseases overwhelmingly affects the world’s poorest people.
Partnerships like these accelerate the progress of scientific research and the creation of tools that save lives.With the full commitment of governments of both donor and affected countries, the pharmaceutical sector, civil society and others, we are capable of transforming the health and well-being of not only their countries, but also the world.
The 2015 Nobel Prize in physiology or medicine honors breakthrough discoveries that have saved millions of lives. From basic science to delivering drugs to isolated villages, let’s celebrate — and not neglect — the investments and commitments it takes to make that impact.
Hannah Kettler is an economist and senior program officer on the Global Health Advocacy team at the Bill & Melinda Gates Foundation. She is responsible for overseeing a portfolio of grants and projects to foster innovation in new medicines, diagnostics and vaccines for developing countries. Before joining the Gates Foundation, she led a project on biotechnology and international health at the University of California, San Francisco, and worked as the senior industrial economist for the Office of Health Economics in London.
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