Need to develop drugs for the most neglected diseases

There is a chronic lack of effective, affordable, easy-to-use medications for neglected diseases. Drug research and development (R&D) for tropical diseases is at a virtual standstill. The past two and a half decades have seen the pharmaceutical industry develop only four new drugs, out of 1,223, for the treatment of tropical diseases responsible for millions of deaths annually. The recent initiatives have been focused on stimulating further interest in the development and provision of drugs for the world's top three killer infectious diseases like AIDS/HIV, malaria, and tuberculosis. In contrast there are the "most neglected diseases" (where there are no affordable, effective, easy to use medicines available) such as human African trypanosomiasis (sleeping sickness), Chagas disease and visceral leishmaniasis (kala azar), which continue to cause significant morbidity and mortality in the developing countries. There is a need to stimulate R&D activities for these neglected diseases. Only 10% of expenditure on health research is on them while they account for 90% of the global burden of disease. The existing treatments for killer infectious diseases are increasingly ineffective due to poor diagnostic options, growing drug resistance, unaffordability, poor distribution, and inadequate health systems. The lack of scientific knowledge is not a major constraint to drug development nor does the gap lie with technology, which has greatly benefited from recent advances. Policy issues seem to be the main obstacle. While basic scientific research takes place mainly in the university or government laboratories, drug development is done by the pharmaceutical industry. The selection of promising drugs by the pharmaceutical companies is based on potential profits for the company and not the global public health concerns. This system thus obviously fails to meet the needs of the poor and the developing countries. The need of the hour is to define a needs-driven research and development agenda to assist policy makers, funding agencies, and the research community in setting priorities to address effectively the needs of the developing countries. Public private partnerships (PPPs) are another, currently popular, "enabling environment" for neglected disease research and development. The vast majority of R&D occurs in developed countries, but emerging economies such as Thailand and India have the ability to do research from early development through production. The governments of the developing countries must show greater commitment and root out corruption, and western governments must devote far more resources towards neglected diseases, to actively undertake R&D activities, and to help build upon existing R&D capacity in the less-developed world.