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Seven ways to heaven

From local African research to Indian pharma’s aim at a “five-billion” – person market, to radical R&D proposals to the World Health Assembly: what’s happening to world health research?

(March 06)

In a series of interviews, features, news and papers, over the next two issues RealHealthNews reflects on seven strikingly different ways health research is now being tackled, in and for developing countries.

Would you have predicted ten years ago that in a decade there’d be so much excitement and variation in research on developing country health as there is today, from Big Pharma eyeing the market to NGOs using research for evidence? We certainly wouldn’t, so to get a better feeling for what’s happening, RealHealthNews is taking an inside look at just a few of the strategies at work.

We begin at the frontline of health for the poor, and that’s certainly where you’ll find Nduku Kilonzo (page 3). Research Director of Liverpool VCT and Care, she studies the performance of government HIV/AIDS testing and care teams in Nairobi, working directly with their clients. But she also keeps a close eye on the health bureaucracy and government in Kenya, and international HIV/AIDS programmes and policy, and links research directly with helping health system managers effect real change.

Responding to the challenge of last year’s Indian patent law, which respects international intellectual property and so puts generics companies in doubt, Smita Piramal (page 6), Director of one of India’s fastest growing indigenous pharmaceutical companies, tells RealHealthNews she’s aiming for the market of the “five billion people in the world who do not have access to [high-price] drugs”. And she’s doing it with cutting edge research. Maneesh Nerurkar, Head of Pharmaceutical R&D at her company is one of her “acquisitions”, an example of the “reverse brain drain”, in which developing country scientists are returning to middle-income countries to create a new world of research back home. His objective is to create a “mini-Merck”, to help the economic growth of India. While new Indian molecules will certainly be cheaper for

the coming trillion-dollar middle-class Asian pharmaceuticals market, will the real health needs of the poor be met? The question is open.

Then Regina Keith (page 13), Global Health Advisor for the charity Save the Children – and an Editorial Advisor to RealHealthNews – tells us why she spends two-thirds of her time on research and evidence. Keith’s approach represents a growing trend for major NGOs to turn to research to strengthen their advocacy. She has a strategic vision, that clear, objective evidence on successful, government-funded health systems can change global policy on user fees and health insurance. So she is helping to find that evidence across the world by uniting local and respected Western research institutions.

And in a paper (p. 14) Jamie Love, Director of the Consumer Project on Technology (CPTech), takes a dramatic new angle. Indirectly, he’s been feeding WHO’s own debate on health R&D. He argues passionately that pharmaceutical companies are far from the most efficient way to create health products for the world, and proposes a global health R&D treaty to revolutionize health R&D funding and intellectual property. So for us he takes stock of the January 2006 Executive Board meeting of WHO, which after submissions by Kenya and Brazil has promised fundamental debate on something close to the CPTech line at this year’s WHA.

In the next issue, in time for WHO’s World Health Assembly, we look at change in some of the more familiar bodies in R&D for health.

Lakshmi Sundaram of the Global Forum for Health Research will review the now dozens of public private partnerships (PPPs) at work for world health. How are they doing? Are they facing a major problem with the looming cost of clinical trials? The jury is still out. Mike Harper of the Global Microbicides Project – which could create a tool of direct relevance to Nduku Kilonzo and so many women in Africa and elsewhere at risk of HIV/AIDS – reveals the Project’s hand to RealHealthNews, and we’ll also hear from Anna Wang at the Medicines for Malaria Venture about the state of their pipeline.

Then Jamie Guth of the long-respected Tropical Disease Research programme (TDR) will report for us TDR’s brand new strategic plan, completed this February, which with its wide portfolio including some of the most neglected diseases, will keep TDR among the many new players like the PPPs and the Bill and Melinda Gates Foundation.

And finally Robert Walgate, Editor of RealHealthNews, will report on the recent appointment of Tadataka (Tachi) Yamada, the present Chairman of R&D at GlaxoSmithKline credited with a revolution in the company’s fortunes, to direct the Global Health Programme of the Bill and Melinda Gates Foundation, and on what it might mean for both the Foundation and GSK – whose commitment to TB, HIV/AIDS and malaria has, up to now, been significant.

Plus on later pages of each issue and on our website we cover some of the most important news, including in this issue: with the fatal H5N1 bird flu strain already in Nigeria, the extraordinary prospects for a genetically engineered bird flu vaccine (tuned swiftly to whatever pandemic human strain may hit); and the striking decline in HIV infection rates in parts of Zimbabwe (attributed to a change in sexual behaviour).



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