Interview with Dr Bernard Pécoul, Founder and Director of the Drugs for Neglected Diseases Initiative | August 2013
Why did you create DNDi in 2003?
During the 1980's, working in the field as a volunteer physician for Doctors without Borders (MSF), I often found myself in the unacceptable situation of being unable to properly care for patients suffering from infectious diseases, due to the lack of effective or appropriate treatments. For instance, in treating sleeping sickness, we had to use Arsobal, an arsenic derivative, which could kill up to one in every 20 patients it was meant to cure. We're talking about marginalized patients, poor and forgotten populations. The reality was easy to describe: in the absence of a market, pharmaceutical companies were no longer committing to the research and development of new therapeutic tools. Only a bit more than 1% of research investments were devoted to diseases that affected the most neglected people. In 2003, upon the initiative of MSF, several scientific institutions based in the countries of the Global South, along with Institut Pasteur and with support from the World Health Organization, DNDi was created with the goal of developing new treatments for neglected diseases.
Your organization is now ten years old. What are your greatest accomplishments?
According to our short-term strategy, DNDi and its partners have developed and made available six new treatments based on existing products in order to provide rapid therapeutic improvements. To take malaria as an example, we have developed ASMQ (a fixed-dose combination of artesunate and mefloquine) and ASAQ (a fixed-dose combination of artesunate andamodiaquine). More than 200 million courses of ASAQ treatment have been distributed since its registration in 2007. For sleeping sickness, NECT (a combination of nifurtimox and eflornithine) is currently used to treat 96% of patients in the advanced stage of the disease in the Democratic Republic of Congo (where 84% of cases are found). Further upstream in the research pipeline, we've built a portfolio of new molecules that should allow us to offer even more appropriate and accessible treatments in the longer term.
All of this is possible thanks to solid partnerships with public and private institutions based on a long-term vision.
DNDi has also contributed to clinical research capacity building in endemic countries by helping to create three platforms: the LEAP platform in East Africa for leishmaniasis, the Human African Trypanosomiasis (HAT) Platform in Central Africa, for sleeping sickness, and the Chagas Clinical Research Platform in Latin America for Chagas disease.
Could you explain, using a concrete example, how you manage to develop affordable treatments for neglected illnesses?
Let me revert to the example of ASAQ, which is a fixed-dose combination of artesunate and amodiaquine to treat malaria in a simplified dosage. In 2002, the WHO had recommended the use of artemisinine in combination with another component. DNDi, working with MSF, TDR, and academic and industrial partners developed a fixed-dose combination of already-known active ingredients, one of which was artesunate. The goal, simply put, was to combine two active ingredients in the same tablet so as to reduce the dosage to 1 or 2 tablets a day for 3 days, depending on the age of the patient, and thus simplify the treatment. ASAQ was developed in partnership with Sanofi and made available to patients in 2007 at the price of USD 1 for adults and USD 0.5 for children. Sanofi committed to producing ASAQ at cost, without a patent, to ensure the widest possible distribution by the public sector, NGOs, and international organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Since its launch, 200 million courses of treatment have been distributed and ASAQ is now available in 33 countries in Africa, as well as India and Colombia.
Does the development of new medicines always happen with a partner in the private sector?
DNDi works in partnerships with both public and private institutions. Thus, collaboration with a private-sector partner such as a pharmaceutical company could be part of any stage of the development of a drug: in the phase of discovering new molecules, by providing easier access to a company's libraries of molecules, or at the clinical development phase, by producing the batches used during clinical trials, and of course, at the time of the drug's production and distribution.
This type of partnership doesn't seem obvious at first glance. How do you convince the pharmaceutical companies to work with you?
The environment of medical research has evolved over the past few years. The pharmaceutical industry is currently looking for new business models in order to reach new markets. In addition, new models such as public-private partnerships are responding to a need, where typical market mechanisms are not functioning, and where the protection of intellectual property is not an important driver of medical and scientific innovation. Also, pharmaceutical companies need to improve their image, both with the general public and among their own staff. Once the leadership of a company gives the green light, the question isn't how to convince the researchers, but rather which skills and expertise can be to utilized in defining realistic projects... projects that will really be able to change the course of a disease and improve the effective treatment of patients.
Where do you stand on the question of patents?
In developing new drugs, DNDi strives, to the greatest possible extent, to make sure that drugs are produced as public goods, which is to say non-patented. This is a basic condition to ensure that the populations concerned can obtain fair access to them.
Are you collaborating with WIPO on these issues?
DNDi is a collaborator on the WIPO Re:Search project, which was launched in 2011. WIPO Re:Search gives access to a library of pharmaceutical compounds, technologies and especially know-how, as well as already accessible R&D data, for neglected tropical diseases, tuberculosis, and malaria. WIPO Re:Search facilitates new partnerships to support organizations conducting research on treatments for neglected tropical diseases, and accelerates innovation on behalf of patients waiting for appropriate treatments.
A lot of your work takes place in a network of organizations, and you have partners on every continent. What role does your Geneva office play?
To be closer to the projects and their beneficiaries, DNDi maintains a presence on all continents, with offices in Brazil, in Kenya, in the Democratic Republic of Congo, in India, in Malaysia, in Japan, in North America, and here in Geneva. Our Geneva office functions as the headquarters of the organization, where we define our strategic guidelines and coordinate their implementation. Aside from our 107 employees, half of which work at headquarters, and half of which are based in regional offices, DNDi has a very broad network of partners working with us on projects. All in all, more than 630 people – of which 300 in Africa – are currently involved in DNDi's work. This network is what makes a product development partnership (PDP), like DNDi, effective.
Has the process of research and development for neglected illnesses changed since the creation of DNDi? What are the greatest issues for the sector today?
In the past 10 years, the landscape has changed. Substantial progress is noticeable, notably by the new treatments being developed, but great effort is still required to respond to patients' needs. In terms of the environment, one can sense a new level of energy stemming from a diversification of actors involved, with the presence of private and public institutions from endemic countries, governments, pharmaceutical companies, biotechnology companies, public-private partnerships, and new investments and financing mechanisms.
Despite this evolution, and despite a new landscape that allows for more synergies and progress in the area of R&D for neglected diseases, large investments are still necessary from both governments and from the private sector in order to guarantee that these efforts are sustained and intensified.
Public authorities need to bring in policy changes to enable the development of new tools that are essential to health, and to allow all affected populations to have access to these treatments. The enactment of innovative policies, especially in matters of intellectual property, to encourage R&D, as well as technology transfer and research capacity building in endemic countries are important in this process.
What is your relationship with the other players in International Geneva?
Inherent in its model, DNDi works with many partners, a good number of which are based in Geneva. The WHO, as the world authority in matters of public health, is a very important interlocutor in our fight against neglected diseases. DNDi also maintains a close partnership with other public-private partnerships such as Medicines for Malaria Venture (MMV) or FIND, but also with the Geneva University Hospitals, the permanent missions, and other foreign state representatives. Finally, DNDi has been a recipient of financial assistance from the Republic and Canton of Geneva since it was founded in 2003.