Teamwork Makes the Dream Work: How Collaborative Efforts Have Made Malaria Eradication a Possibility Again
Mosquitoes have long claimed title as the world’s most dangerous animal[1], and for good reason. Malaria, one of the many infectious diseases spread through the bites of mosquitoes, has caused an estimated half of all human deaths since the Stone Age.[2] Today, nearly half of the world’s population is at risk of contracting malaria[3], with an overwhelming majority of this risk concentrated in a handful of sub-Saharan countries.[4] Children under the age of five continue to be the most vulnerable, accounting for 61% (266,000) of all malaria deaths worldwide in 2017.[5]
Current strategies for malaria prevention include indoor residual spraying and long-lasting insecticidal nets.[6] While these have been effective methods of prevention, more than 30 countries have reported resistance to the insecticide on which these tools rely.[7] Despite this increasingly desperate need for a vaccine, one massive hurdle has stalled developments in malaria vaccination for decades: money.[8] The cost of commercial drug research and development has exploded in recent years.[9] An oft-cited study by The Tufts Center for the Study of Drug Development claims the average cost of developing a new drug between 1995 and 2007 was $2.6 billion.[10] Patent protection plays a vital role in recovering this substantial investment that drug research and development requires. Patents allow pharmaceutical manufacturers to recoup as much of their investment as possible during the patent term before competitors can create and market a generic version at a fraction of the cost.[11]
While successful blockbuster drugs can generate more than a billion dollars a year during their patent term[12], the cost of developing drugs for diseases exclusive to developing countries is often prohibitive. Because patients in need of medication for these “Type III diseases” generally cannot afford the high prices pharmaceutical companies charge to offset their substantial investments[13], market exclusivity resulting from a patent does not incentivize pharmaceutical companies to invest in those drugs. “To put it bluntly: inventing drugs for poor people just isn’t profitable.”[14]
To combat this enigma, those interested in creating a malaria vaccine abandoned the traditional drug discovery model and opted for a more open-source approach.[15] Foundations such as the Medicines for Malaria Venture (MMV) have created partnerships with pharmaceutical companies and relied on contributions from government and philanthropic entities, such as the Bill & Melinda Gates Foundation[16], to “de-risk” a collaborate endeavor and separate the R&D expenses from the drug price.[17] Further, MMV has distributed hundreds of “Malaria Boxes,” free of charge, to nearly 200 academic research groups in 30 countries.[18] The only condition for receiving one of these boxes, which contained 400 diverse compounds known to have antimalarial activity[19], was to publish all findings in the public domain.[20]
Patent protection for promising antimalarial products from MMV collaborations is sought in “large economies” to control the quality of manufacture and protect against an incidental application of the compound.[21] However, patent protection does not extend to malaria-endemic countries.[22] This strategic approach to intellectual property allows foundations such as MMV to attract industry partners and guard against the misuse of innovation while ensuring those in need receive affordable medication.[23]
On September 13, 2019, Kenya joined Ghana and Malawi as the third country to launch a pilot program for the malaria vaccine known at RTS,S.[24] RTS,S was developed through a collaboration between the non-profit organization PATH Malaria Vaccine Initiative (MVI)[25] and pharmaceutical giant GlaskoSmithKline (GSK) and is the first and only vaccine to significantly reduce malaria in children.[26] While these pilot programs are an exciting step toward the eradication of malaria, it raises questions about the outlook for other Type III diseases. The recent progress in malaria vaccination resulted from unprecedented cooperation in drug research and a tremendous amount of public and philanthropic funding. Many lesser known but similarly deadly Type III diseases[27] might not receive the level of attention, and therefore might not receive the level of funding, that seems to be required for significant progress. While open-source drug discovery may help to alleviate some of the hurdles in developing drugs for poverty-associated diseases, funding will likely continue to be the biggest barrier in neglected-disease research.[28]
Footnotes
