Developing new medications for the world’s most neglected diseases. Challenging pharmaceutical companies and governments to treat health as a human right. These pursuits - just some of those occupying Professor Vis Navaratnam - are not, he believes, the work of an activist.
Rather, as an expert in addiction and infectious diseases at the University of Science, Malaysia, Professor Navaratnam (Vis or Nava to his colleagues) describes himself as conservative. His personal mission, he says, is a push for social medicine. ‘I don’t subscribe to the aid mentality. If you make drugs to meet need, and make them affordable, you make them accessible.’
As part of that push, he and his colleagues at Médecins Sans Frontières are setting up the Drugs for Neglected Diseases initiative (DNDi): a public-interest company that will initiate research and development of the types of drugs presently ignored by the world’s largest pharmaceutical manufacturers.
Only 10 per cent of global health-research money is presently devoted to conditions that account for 90 per cent of the global disease burden. Yet most diseases killing more than 12 million people a year are preventable or treatable. Leishmaniasis (a skin disease caused by a parasite) is presently the most neglected. An estimated half-a-million people will be killed by it unless they are treated. Nevertheless, of the money spent on researching cures for this disease, more is presently spent on strains that kill dogs in the North than kill people in the South.
Nava explains that this is because the purchasing power of people in the Minority World rather than the pressing needs of the Majority World presently defines the drug-research priorities of the world’s leading pharmaceutical manufacturers (‘Big Pharma’). ‘At a conference in 2000, Big Pharma got up and said: “Look, we intend to put our efforts into cancer, heart disease and diabetes because that’s where our clientele is. We will help you, but it’s not a priority.”’
Warm and witty, Nava is careful and detailed when he starts to explain the DNDi project. ‘We are not going to have multi-storeyed offices and we are not going to have labs. We are not going to pay multinational salaries.’ What Nava and his colleagues are building is a ‘virtual’ pharmaceutical company: a management company that will co-ordinate projects in a way that will improve the capacity of countries in the South to manufacture and distribute drugs themselves.
‘If you look at individual countries, then they might not have the capacity, but if you network them and combine their resources, they will. One country can provide a production manager to manage the process. He or she will then ask another country to do the toxicology. Yet another country - one affected by the disease - can do the clinical tests. So far, Thailand, Brazil, India and Malaysia have said that they’ll provide laboratories and scientists. Brazil and India have some manufacturing capacity. As for Singapore, they will offer raw materials and facilities to make the drugs at cost price.’
The South seems much more generous than the North in offering assistance to the DNDi. After talking to all private pharmaceutical companies in India, these companies have agreed to produce selected life-saving drugs at cost. But the North? ‘I look at it and say “Why the hesitancy?” Certainly, the project is about developing drugs for neglected diseases. But it’s also about making drugs available at a very affordable price. If we succeed, then the question will be asked in developed countries “Why not do it for diabetes?”
‘We’re developing two combination products to fight resistant malarias: one for Africa and the other for Southeast Asia. We reckon we’ll get it on to the market for $3 to $4 million. Add on what it takes to screen and select [the identification and safety assessment of new molecules]… double the development costs as a consequence and that’s $8-$10 million. That’s far short of the $100 to $200 million that Big Pharma say they need to spend to get a drug product on to the market.’
‘I don’t want to sound moral. I believe that any company has to recover its costs. To a certain extent, Big Pharma have to recover R&D costs of investments that have failed. They’re paying for a whole apparatus as well marketing costs. PR. big conferences for pitching their products to doctors.’
Here, Nava hesitates, then starts to laugh. ‘In fairness to them, we don’t have to market. We have our market. Our target market has no choice. It is a case of “Do you want this drug or do you want to die?”’
The DNDi idea - the brainchild of Dr Bernard Pécoul, Director of Médecins Sans Frontières - came to life at a 1999 conference. A working group was set up. Nava was invited to join. ‘The founding members of the group are about to meet to identify those diseases where drug research and development is most urgently needed and to decide how to incorporate the organization. .We’re being very careful. We can’t fail. If we do, then we’ll be pointed at as if to say, “Accept the profit model.”’
And after 20 years of working in social medicine, Professor Vis Navaratnam is not about to do that.