We are excited to share the first of its kind global overview of activities and impacts of product development partnerships (PDPs), commissioned by the UK’s Foreign, Commonwealth & Development Office (FCDO, formerly DFID). The study entitled “Accelerating global health R&D: the role of product development partnerships” assesses development of new medicines and technologies for 35 poverty-related and neglected diseases, including HIV/AIDS, malaria and tuberculosis. To capture the scale of this humanitarian crisis, out of the total $240 billion spent globally on health R&D, less than 2% ($4 billion) is channeled towards neglected populations. Our findings and recommendations will help shape future investments and activities in this field for the UK government and other major government donors and philanthropies including The Wellcome Trust and The Bill & Melinda Gates Foundation.
This important project comes at an evolutionary time when the world is experiencing unprecedented challenges battling the Covid-19 pandemic. When markets and systems fail, all sectors – governments, industry and the civic sector – need to collaborate in new ways for the common good. Collaborations across sectors and systems leadership are essential to accelerate much needed innovation and improve access to technologies towards reaching the Sustainable Development Goals.
The study looks at a range of innovative non-profit multi-stakeholder organizations, called product development partnerships (PDPs). PDPs work as virtual orchestras by acting as R&D systems facilitators, aggregating funding and technical expertise from public, private, academic and philanthropic sectors to develop vaccines, drugs and other technologies for diseases of poverty. They include Medicines for Malaria Venture (MMV), TB Alliance, Drugs for Neglected Diseases initiative (DNDi), Foundation for Innovative New Diagnostics (FIND), PATH, (International AIDS Vaccine Initiative (IAVI), European Vaccine Initiative (EVI), International Partnerships for Microbicides (IPM), Innovative Vector Control Consortium (IVCC) and Tuberculosis Vaccine Initiative (TBVI), among others. They were formed 20 years ago to address the so-called 10/90 gap which strikingly still persists today. This gap shows that only 10% of worldwide resources devoted to health research are put towards health in developing countries, where over 90% of all preventable deaths exist, according to the findings by the Forum on Health Research for Development in 1990.
This gap in funding has represented not only a woeful market and government failure in development of new products for diseases of poverty, but it also reflects a failure to respond to the humanitarian needs of the disenfranchised. Nearly 2.6 million people die annually from the three biggest infectious diseases – HIV/AIDS, tuberculosis and malaria. This number is growing due to the pandemic. Despite marginal annual increases in public and private investments for the three, funding has remained disproportionate to the burden experienced. Furthermore, neglected tropical diseases such as leishmaniasis, chagas disease, sleeping sickness and others, are endemic in 149 countries and impact over 1.4 billion people – mostly the poorest and most vulnerable, including those in poor urbanized areas in high income countries. These challenges are further amplified by the dual burden of noncommunicable diseases.
The participatory study assessed the rapidly changing global health landscape, emerging collaborative models and the role and potential of PDPs to address complex challenges. It engaged over 60 key global influencers and experts from 46 organizations representing 8 stakeholder groups. The findings, outlined in six key messages, confirmed that the PDP experiment has been one of the most successful in accelerating the development of products and technologies for poverty related and neglected diseases. Five of the key assumptions that were the basis of the PDP model when it was established 20 years ago – market failure for poverty related diseases, a portfolio approach to product R&D, capacity building in LMICs, cost-effectiveness, and access towards health impact – are still highly relevant today. Since their inception, the ten PDPs assessed in the study have collectively brought 85 new products to market, including 3 vaccines, 27 therapeutics, 50 diagnostics or health technologies, and 5 vector control tools. Partnership management for an effective product portfolio approach is essential across all phases of R&D and is key strength of PDPs. However, collaborations with research organizations, governments, industry, patients and communities in low- and middle-income countries should continue to be strenthened. The study identified three specific areas that could substantially improve the effectiveness of PDPs and the systems in which they operate: (1) strategic development of access partnerships (an end-to-end approach), starting earlier in the R&D process, (2) improved coordination and a more joined-up approach among all stakeholders throughout the R&D process, and (3) strengthened product prioritization mechanisms to inform priority setting and funding allocations across the entire portfolio of poverty related and neglected diseases. These changes must be supported by effective and transparent data sharing and leveraging of key tools and technologies. The evidence clearly supports a need to increase, sustain and better coordinate R&D funding for poverty related diseases through PDPs, utilizing flexible modalities. This would contribute to addressing funding gaps to develop existing and missing products in the R&D pipelines, with benefits to health systems and beyond. This is particularly relevant given the renewed interest by public and private stakeholders in health innovation to promote global health security and is essential to achieve the Sustainable Development Goals. Learning from the pandemic, governments investing in PDPs now have an opportunity to shift from a “market-correcting role” to rethink how public value is imagined, practiced and evaluated to achieve public purpose. This can only be achieved in collaboration with other stakeholders, and will require more of a systems thinking approach.
The project was led by Barbara Bulc in collaboration with Rohit Ramchandani of Antara Global Health Advisors. We thank the FCDO and the PDP Funders group for their inputs. We are indebted to all participating PDPs for their extensive contributions, and to DNDi in particular for collaboration and development of the network maps. We would also like to thank all interviewees; our research assistants, Ogooluwa Fayemiwo, Katerina Pagura and Cameron Kukla; as well as Marcel Tanner, Flavia Bustreo, Kathryn Dinh and Jenny Blair for their valuable advice. Editorial support was provided by Adam Bodley of Impact Factor Editing. Designed by Raj Ghatalia of Creará. We are looking forward to sharing the findings and contributing to a shift towards an emerging health R&D system for better and more equitable public health outcomes.
Photo: Pediatric HIV medicines are saving children’s lives. (Paul Kamau, DNDi, Nairobi, Kenya)
Citation: Bulc, B. and Ramchandani, R. (March 2021). Accelerating global healing R&D: the role of product development partnerships.
This report was funded by the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO). The views expressed in the report are those of the authors and do not necessarily reflect those of the funder.