The World Health Organization (WHO) kicks off its annual meeting in Geneva next Monday, and one of the most contentious issues on the agenda will undoubtedly be a proposed agreement to fund the development of drugs for diseases that overwhelmingly afflict the world’s poor. The proposal, outlined today in PLoS Medicine, would require the WHO’s 193 member states to commit to increase government funding for global health initiatives from the $3 billion or so spent worldwide today to more than $6 billion annually in the near-future.
To raise that money, the authors of the report, which include global health economists, industry executives and patent experts from the WHO’s Consultative Expert Working Group on Research and Development (CEWG), call for every member nation to contribute at least 0.01% of its gross domestic product (GDP) for research and development (R&D) into neglected diseases—a percentage currently paid by only one country: the US.
“Money is the new focus of this debate,” says James Love, an advocate for affordable medicines and director of Knowledge Ecology International, a social justice nonprofit based in Washington, DC. “Now that it’s about funding, governments have to start talking to each other.”
Importantly, big pharma appears to be on-board—which may pave the way for successful passage of the treaty at next week’s World Health Assembly. “We’re hearing from industry a need to reform the current system,” says CEWG chair John-Arne Røttingen, a health economist at the University of Oslo’s Institute for Health and Society who coauthored the report. Similar proposals were put forward by coalitions of member states and non-governmental organizations in 2005 and 2009, but both efforts failed to even make it to a vote after drug companies lobbied hard against proposed patent reforms that would have opened the door to more generics for a wide variety of medicines. In contrast, the current draft treaty only calls for less patent protection of treatments for diseases commonly found in the developing world, such as malaria, Chagas disease and dengue fever.
Paul Herrling, head of corporate research at Basel-based Novartis and a member of the CEWG, also notes that the proposed convention includes some incentives for the pharmaceutical industry. For example, it aims to arrange sustainable financing for companies to further develop early-stage products for neglected and tropical diseases that the firms already have in their pipelines. “Industry is willing to contribute resources to early stage R&D,” Herrling says. “But to bring those products all the way to the market, they need more than private donors can give.”
Global health experts agree that, with pharma largely behind the initiative, the ball is now in the member states’ court to rally around the cause. “Now we need firm financial commitments from governments,” says Røttingen, who concedes that setting aside 0.01% of GDP will be a difficult for leaders to finagle amidst widespread austerity. In addition to the enormous challenge of agreeing who will contribute what, the problem of how to turn talk into action remains unsolved. “Obviously, there is no international police force to enforce financial commitments,” says Suerie Moon, an international health policy researcher at the Harvard School of Public Health in Boston, who coauthored a commentary, also published today in PLoS Medicine, in support of the recommendations. “We will have to figure out how to build in incentives to make countries comply.”
Despite the challenges, Moon and others say today’s proposal represents an enormous advance, and they are hopeful that at next week’s WHO meeting, a committee will be formed to draw up a formal convention based on the CEWG recommendations. “A global R&D agreement used to be a crazy idea,” says Love. “Now it looks more and more inevitable.”
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