Veuillez trouver ci-dessous un article publié cette semaine en anglais dans
le Lancet par Pierre Chirac (Medecins Sans Frontières) et Els Torreele (
Drugs for Neglected Diseases Initiative). L'article, particuliérement
pertinent en vue de l' Assemblée Mondiale de la Santé et des discussions
sur un cadre mondial pour les activités de recherche développement
essentielles en santé, porte sur le nombre de medicaments destinés aux
maladies négligées.
Veronique TERRASSE
Veronique.TERRASSE@geneva.msf.org
Cadre Mondial pour les activités de recherche développement
essentielles en santé
Global framework on essential health R&D
Pierre Chirac, Medecins Sans Frontieres, and Els Torreele, Drugs for
Neglected Diseases Initiative
One of the critical issues to be discussed at the next World Health
Assembly (Geneva, May 22-26) will be a resolution about a global
framework on essential health research and development. Over past
years, the crisis in research and development in the worldwide
pharmaceutical industry, and in particular the absence of research
and development for new medicines targeting diseases that mainly
affect people in developing countries (neglected diseases), has
become a global concern.
This worrying situation is clearly shown by the number of drugs
targeting neglected tropical diseases. From 1975 to 1999, only 13
drugs from 1393 new chemical entities (NCE) marketed were indicated
for a neglected disease. The 13 drugs included four for malaria and
nine for the most neglected diseases. Three more drugs could be added
if tuberculosis is included in the analysis.
We have updated these figures to 2004. From 2000 to 2004, an
additional 163 NCEs have been marketed in the world, adding up to a
total of 1556 NCEs for the 30 years from 1975 to 2004. During these 5
years, four NCEs targeting neglected diseases have been
commercialised. Artemotil is a derivative from artemisinine
discovered in the Chinese traditional medicine Artemisia annua.
Artemotil is available as injection for severe malaria. Artesunate is
another derivative from artemisinine. Artesunate should be used only
in combination (artemisinin-based combination therapy) to treat
malaria. Different co-blisters containing artesunate with a partner
drug (existing antimalarials such as sulfadoxine/pyrimethamine,
amodiaquine, mefloquine) are available on the market. Furthermore,
several co-formulations containing artesunate and the partner drug in
the same tablet are being developed. Lumefantrine is marketed as a
co-formulation with artemether, also a derivative from artemisinine.
Miltefosine is the first oral dug against leishmaniasis. The
combination of chlorproguanil with dapsone (Lapdap) has also been
launched during the past years. It is not a NCE, but there has been
research on this drug.
In total, over the past 30 years, the number of drugs targeting
neglected diseases is ten if we consider the most neglected diseases,
18 if we add malaria, and 21 if we add tuberculosis. These totals
still represent only around 1% of all NCEs (1556) launched during
this period - a situation that is essentially unchanged from 5 years
ago.
The emergence of product-development partnerships for neglected
diseases has been encouraging: with sufficient funding the current
pipelines for neglected diseases could potentially deliver eight to
nine drugs within the next 5 years. Although such a step forward
would be good, it is not enough to change the overall situation.
Product-development partnerships in drug research and development for
neglected diseases still mainly depend on philanthropic funding,
which reached US$212 million by April, 2005, or 78.5% of the total
funding of these initiatives, much of it from the Bill & Melinda
Gates Foundation. Public funding was calculated at a low 16%,
although the British Government in March, 2006, announced substantial
additional funding worth £17 million (or about $30 million). With
promising drug compounds moving into more expensive clinical trials,
there remains a funding gap of several hundred million dollars for
existing initiatives alone.
There is definitely a proactive role for WHO to play here, because
only a long-term commitment by governments to fund and otherwise
support research and development in neglected diseases in the public
interest would substantially change the situation of neglected
diseases and neglected patients.
The report of the WHO's Commission on Intellectual Property Rights,
Innovation, and Public Health, released April 3, 2005, is urging WHO
to "develop a Global Plan of Action to secure enhanced and
sustainable funding for developing and making accessible products to
address diseases that disproportionately affect developing
countries". The World Health Assembly's discussion in May on a global
framework on research and development in essential health will be a
timely opportunity for governments to take action to ensure
needs-driven research and development addressing rich and poor
patients' needs. Member states should warmly welcome the resolution
on research and development and start building a new framework on
research and development for essential health.