How can the pharmaceutical industry be enticed to make drugs and vaccines for infectious diseases that sicken or kill billions of people worldwide, yet offer little in the way of economic returns? Senior policy officials outlined strategies last week at a meeting sponsored by the Institute for Global Health in San Francisco. Meanwhile, President Clinton signaled his interest in launching an initiative aimed at narrowing the seemingly intractable gap in health between rich and poor countries, and last week a bill was introduced into the U.S. Senate that would incorporate many of the meeting's suggestions.
Pharmaceutical companies already have the scientific knowledge and tools they need to develop drugs and vaccines for scourges like malaria, AIDS, and tuberculosis. What's more, such drugs could save millions of lives and spur economic development in poor countries, said the panel, which included representatives from the White House, the U.S. Congress, the World Health Organization, the World Bank, the World Trade Organization, and pharmaceutical giants GlaxoWellcome and Merck. Yet these diseases attract minimal attention from the pharmaceutical industry because executives don't see a market. And even when effective drugs are available--such as the cocktail of AIDS drugs that has slashed mortality in wealthy countries--they may be too expensive for countries in Africa and Asia.
The solution, according to the panel, lies in a package of incentives that would make it worthwhile for the pharmaceutical and biotech industries to step in. One approach is for governments and multilateral organizations to push research and development by subsidizing part of the huge costs, either directly or through tax breaks. Another is to assure companies of a future market--for instance, by establishing "purchase funds" and agreeing to buy certain quantities of a product once it becomes available. The panel also lauded partnerships in which publicly funded scientists work together with industry, such as the recently created Global Alliance for Vaccines and Immunization (GAVI), as a way to speed drug discovery and development.
The Global Health Forum's approach has already found a receptive ear in Washington. In his State of the Union address, President Clinton announced a $50 million U.S. contribution to GAVI, as well as a tax credit of up to $1 billion for companies investing in new vaccines for malaria, AIDS, and TB. A delegation from the Global Health Forum was scheduled to meet with Clinton this week to present their findings and discuss Clinton's proposals, which are "absolutely on the right track," says Richard Feachem, who directs the Institute for Global Health.
Meanwhile, Senator John Kerry (D-MA) introduced an ambitious bill, dubbed the Vaccines for the New Millennium Act, on 24 February. Kerry proposed to "change the death spiral" by making childhood immunization "a major goal of U.S. foreign policy." His bill calls for donations of $150 million to GAVI and $30 million to the International AIDS Vaccine Initiative. It also proposes several tax credits for industry and a purchase fund to buy and distribute vaccines as soon as they are approved. To cover the cost, Kerry is asking Congress to set aside $100 million a year for the next 10 years. The political fate of these plans is uncertain. Even so, Feachem is encouraged by these and other initiatives in the European Union and Japan. Says Feachem, "The global awareness of this challenge is running at a level which we haven't previously seen."