In 2023, Johnson & Johnson announced it had stopped research and development on therapeutics for many infectious diseases, including hepatitis and tuberculosis. Less visibly, AbbVie shuttered last year its pro bono technical R&D support on infectious diseases such as malaria and Chagas’ disease.
These are not isolated cases. An increasing number of large pharmaceutical companies from the Global North are leaving the field of R&D for infectious disease therapeutics to move to more lucrative areas, particularly cancer, obesity, diabetes, auto-immune, and rare (but highly profitable) diseases. This trend is not new — it has been consistent over the past two decades — but it is accelerating.
I’m the R&D director of a nonprofit research organization that was created 20 years ago in response to pharma’s insufficient investment in developing anti-infectives. Over the years, we have built a successful model of collaboration with public and private partners to develop new medicines for infectious diseases that are usually neglected by commercially driven R&D investments.
In our efforts to rewire the market-based research model, large pharma companies have been crucial partners: They have cooperated with us and shared their compound libraries and expertise. We build on the innovation they have created to reach populations otherwise underserved.
This is how we delivered a series of groundbreaking new treatments against sleeping sickness in partnership with Sanofi. Or how the nonprofit research organization Medicines for Malaria Venture and Novartis developed the first-ever malaria treatment for newborns.
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Even though we continue to work closely with committed pharma partners that remain in the infectious diseases space, I am concerned by the shrinking number of “innovation champions” with the capacity to engage with us in this vital work.
This is one of many industry evolutions having a significant impact on the partnerships upon which our alternative model is based. Large, innovative pharmaceutical companies increasingly externalize their R&D activities (including safety, pharmacokinetics, manufacturing, and control) to service providers, progressively losing the in-house expertise — in drug discovery and early drug development, for example — that nonprofit R&D organizations such as mine have relied on for years through in-kind donations.
They also prefer to in-license innovation from biotechs that have already developed technologies with the potential to become their next blockbuster. This trend isn’t new. For most infectious diseases, the innovation we need is thus less and less likely to come from large drugmakers. Biotechs face funding challenges and are often unable to partner with us and develop projects within our nonprofit innovation model, or unable to pursue such projects through the market authorization and commercialization phases.   Â
Another trend that, once again, is not new but is reaching a tipping point: Large pharma companies consistently focus their internal R&D efforts on new, costly therapeutic modalities and personalized approaches to medicines such as biologics, mRNA, and cell therapies. These have limited chances to become accessible in the near future for the diseases that disproportionately affect the world’s poorest. Recent gene-editing therapies for sickle cell disease, for example, have a price tag of more than $1 million on average, placing them almost entirely out of reach for patients in sub-Saharan Africa, which accounts for nearly 80% of global cases.
These trends will significantly reshape the collaborative, nonprofit model that R&D organizations like mine have adopted. We will be required to take on more expertise internally, which will make our R&D contributions more expensive for our funders, and will distance us further from private sector medical innovation. This is not what we wish.
Especially because the unmet innovation needs for infectious diseases are already immense. According to the World Health Organization, more than 1 billion people are affected by neglected tropical diseases every year. They need better medicines. They need medical innovation. Where will it come from?
What is already an innovation gap could become an innovation chasm.
Massive recent cuts to foreign aid and early-stage research have made this issue all the more pressing. Global discussions on access to life-saving medicines usually focus on technology transfer and local production. While this is important, we also need to talk about where these technologies and industrial know-how will come from in the first place.
The innovation model for neglected infectious diseases will evolve. New actors are already emerging. Academic champions in drug discovery and development are now excelling in areas previously reserved for large pharmaceutical companies.
A lot of medical innovations, particularly in the areas of vaccines and diagnostics, are already coming from many low- and middle-income countries, including Brazil, India, and China. Robust drug discovery research is being done in countries where neglected infectious diseases are endemic, including South Africa, Brazil, and Thailand. My organization is partnering with the Serum Institute of India to develop an innovative treatment for dengue.
But not all of these countries have the same level of research capacity, and it will take years for many to reach the focus and scale needed to tackle all of the neglected infectious diseases.
We don’t have that time.
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This is not just a market failure: Without action, it becomes a public policy failure. Public funding for innovation, both in LMICs and at the global level, is necessary, as are policies directed at different stages of the R&D process and different actors.
There are a number of other proposals to address the innovation gap. For example, one option is a “pay or play” model, based on an approach touted to address antimicrobial resistance: Drugmakers that do not invest in infectious disease innovation could financially support those that do through a private fund. European countries could also consider establishing a “pull” incentive system for neglected disease research similar to the “priority review voucher” offered by the Food and Drug Administration.
Nonprofit R&D organizations will continue to play a key role, but will have to evolve, extend their geographical footprint, and work with partners and emerging innovation actors including biotechs, academic research institutions, and public and private pharmaceutical actors from a geographically diverse set of countries.
No single ready-made solution exists. But it is crucial the discussion involves all stakeholders: governments, pharmaceutical companies, universities, funders, and affected communities. If we fail, the deep inequity in access to innovation for life-saving medicines is about to get much worse.
Laurent Fraisse is R&D director of the Drugs for Neglected Diseases initiative.