On November 1, 2014, the GHIT Fund facilitated a unique discussion at the Japanese Society of Tropical Medicine and Japanese Association for International Health joint conference in Tokyo. Entitled “Global Health Innovation through Partnership,” the symposium highlighted scientific breakthroughs that are now enabling us to address key global health R&D challenges, and the creative partnerships that have made these breakthroughs possible. A panel of distinguished speakers—chaired by Dr. Hiroyoshi Endo of the Department of International Affairs and Tropical Medicine at the School of Medicine, Tokyo Women's Medical University—called upon decades of distinctive, game-changing impact across sectors in the global health arena to articulate what makes those partnerships unique and how cross-sector collaboration offers a win-win to partners while producing cutting-edge innovation. Additionally, the panel addressed how Japan can contribute further to improving global health through innovative partnerships, as well as how to engage the strengths and unique role of the country’s academic community to help bring about and maximize global health impact.
Dr. Lorenzo Savioli, who recently retired from his role as the first Director of the WHO’s Department of NTD Control, provided a framework for the discussion by describing on the current need for global health innovation and the necessity of partnership in creating that innovation. Those needs stem from the unfortunate reality, he said, that “free-market mechanisms fail to function in the R&D of infectious disease products for developing countries.”
“Such market failure,” he added, “has enormous implications for innovation and the development of new tools, as well as for access and the pricing and continued production of existing tools.”
GHIT Executive Director and CEO Dr. BT Slingsby explained this market failure by noting that 43% of the global population is at risk of contracting of infectious diseases, particularly neglected tropical diseases, malaria and tuberculosis. He added that 14% of the global population is already infected with at least one of these diseases. “This would be an enormous market, if it were profitable. But it's not profitable,” Dr. Slingsby said. “In the period between 2000 and 2011,” he continued, “only 1% of all the drugs that were created, developed, and approved were for infectious diseases. This is our market failing us.” Dr. Slingsby went on to explain the lack of incentives for pharmaceutical companies to invest in R&D for truly new products, and the resulting decline over the past 20 years of true innovation: the creation of new chemical entities.
Rather than each sector working in silos, open innovation and cross-sector partnership has been changing the game for global health R&D. “In terms of trying to drive forward the development of new tools for infectious diseases, the only way to do that right now in is through partnership,” said Dr. Slingsby,
Dr. Takafumi Tsuboi, Director of Malaria Research for Ehime University’s Proteo-Science Center, offered a concrete case study of a “gold standard” global health innovation partnership on malaria vaccine research. Each partner brings something unique to the table, expanding impact and increasing efficiency. Ehime University and Cell Free Sciences Co, Ltd. have been focused on research discovery for the vaccine using malaria genome information, while PATH Malaria Vaccine Initiative (PATH MVI) handles preclinical and clinical development angles. He boiled it down to: “We represent the research and PATH MVI represents the development.”
In addition to combining strengths for greater impact and efficiency, partnerships can help fill critical gaps in the product development pathway, explained Dr. Michael Kurilla, Director of the Office of Biodefense Research Affairs and Associate Director of Biodefense Product Development at the U.S. National Institute of Allergy and Infectious Diseases. One critical gap, often referred to as the “valley of death”, is the point in the product development process where preliminary research is promising, but major investments of financial, time, and other resources are required to determine whether or not something actually “works”. Getting a potential product across that bridge is challenging, especially when the partner on the research side hails from a different sector than potential partners on the development side. In these cases, noted Dr. Kurilla, government provides a valuable bridge, helping the research side understand what the development partner would need to join forces, and then meet those needs so that a productive collaboration can move forward.
“The drug development process highly complex, and that complexity has contributed to the disconnect between what academics are doing and think is valuable versus what pharmaceutical companies see a need for or how they value things,” he added.
Dr. Kurilla noted that one of the major strengths of the academic community in terms of global health is driving innovation. Helping academia translate innovative ideas and identifying which ones have the most potential to become approved products and thus will be attractive to the private sector, he added, is where government can play a key role.
Turning to the role of Japan in global health R&D in the 21st century, Dr. Savioli began by applauding the country’s many past contributions to global health. He began with the successful elimination and eradication of many infectious and parasitic diseases domestically through public health programs that now serve as the global gold standard for diseases control, then recognized Japan’s catalytic role in the creation of the Global Fund and numerous global health research centers throughout Asia and Africa. He encouraged Japan to be “less humble” about its contributions. “There's a lot of innovative thinking that Japan has already done over the last 50 years,” he said. “This should be recognized and appreciated globally.”
The symposium concluded with a discussion about the roles for young researchers in global health. The spirit of the speakers’ advice and tone of the discussion is best encapsulated by a statement from Dr. Kurilla: “With new technology comes the ability to ask new questions, and to ask questions differently. The important thing for young scientists is not to try to replicate the success of the last generation. You have different questions to answer. You will have new ways to approach those questions. What you need to do is identify those new questions your generation must answer. That's where the innovation is going to come from. That's where the impact in global health is going to come from.
Reinforcing this vision, Dr. Tsuboi had a special message for Japanese researchers, whose challenges he has experienced first-hand. He acknowledged the enormous pressure on Japanese researchers to publish extensively and noted that Japanese scientific research papers represent some of the best in the world; the country ranks number two for the number of papers published in the top 100 scientific journals. “The flip side of that pressure, of building that expertise and those research skills” he noted, “is freedom—to explore, and to dream. Another advantage to such tremendous basic science skills is that Japanese researchers become very attractive partners in global health.”
“If your dream is to work on global health,” Dr. Tsuboi told the audience, “make that dream a priority. Build and clarify your specific expertise to make that dream happen. The international community is looking to partner with you.”