By: Alanna Shaikh
Medecins sans Frontieres (Doctors without Borders) testified before the US congress today on Neglected Tropical Diseases. The testimony, from Suerie Moon on the U.S. Board of Directors of MSF, was a valuable reminder of why we continue to fight the NTDs, and introduced some of MSF’s core principles in global health. It’s an interesting speech.
She began by talking about NTDs. Her focus was on Chagas diseases, which is a major MSF focus, but the content applies to all the NTDS. First, she pointed out that the US presidential neglected tropical disease initiative only covered 5 out of the 14 Neglected Tropical Diseases. Chagas, as MSF was quick to point out, was not included. Neither were kala azar (aka Visceral leishmaniasis) or Trypanosomiasis (African sleeping sickness).
Ms. Moon finished this section with some detail on Chagas “here is no test for cure for Chagas disease – which means that even after a course of treatment with these drugs, the patient cannot be certain that they’ve been cured. We urgently need new diagnostic tests, better medicines, a vaccine, and a test for cure to help prevent, diagnose and treat this disease.” I don’t usually learn from these kinds of testimony – they are more interesting to me for the way they make an advocacy case – but that was news to me. I had no idea there was no test for Chagas. It’s easy to forget just how neglected NTDs really are. The adjective wasn’t chosen at random.
The next part of the speech that I found really useful was the discussion of drug development. It turns out that MSF has a whole philosophy on pharmaceutical R&D. Here’s Ms. Moon’s summary “MSF believes that the key principle in evaluating and designing new incentive mechanisms should be ‘de-linkage … De-linkage refers to the idea that we can separate the market for R&D from the market for product manufacturing. On one side, we can specify the kind of R&D that we need, generate competition among researchers, and then reward the best innovator. While on the other, once the product has been developed, we can encourage many manufacturers to produce it; then, with robust competition in the production market, prices will fall to the lowest sustainable levels.”
Basically, they are trying to disconnect research and development expenses from pharmaceutical prices. It’s a great goal, but not one that is easy to achieve. MSF has several approaches that they use for de-linkage. One immediate approach is awarding prizes with a substantial prize fund, to get drug companies to compete to rapidly get to certain stages of drug development. They also want to see longer-term structural approaches to de-linkage, such as more government funded research and development.
That final goal is the reason MSF was speaking to the senate. They’d like to see the US government support more medical research for diseases where drug prices need to be low once they are on the market. I’d like to see that, too. The current system clearly isn’t working to develop drugs for the diseases of the bottom billion.
Alanna Shaikh is an expert in health consulting, writing about global health for