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Gates, Clinton Address Global Health Summit

By Salvatore Salamone

Dec 2005 / Jan 2006 | Microsoft Chairman Bill Gates, former President Bill Clinton, and pharmaceutical company research leaders met last month to discuss ways for drug companies, governments, and public philanthropic groups to work together to develop and deliver drugs to fight infectious diseases such as tuberculosis (TB), malaria, and HIV/AIDS.

The talks took place on Nov. 1-3 in New York at the Time Global Health Summit, a Time magazine conference that brought together leaders in business, government, medicine, public policy, and the arts to address and develop solutions to the world’s heath crises.

A recurring point throughout the summit was how to make it economically more attractive for a drug manufacturer to invest in drug discovery research to develop drugs that fight infectious diseases — diseases that afflict a very large number of people who are poor and who live in the poorest countries.

For years, philanthropic groups have helped pay for medicines that simply were too expensive for people in poorer countries. Such efforts continue today. But there is a new philanthropic funding shift that could radically alter the way life science companies select the drugs they choose to develop.

This issue came up in a keynote panel that featured Clinton and Gates.

Both men are actively involved in philanthropic efforts to fight infectious diseases, including HIV/AIDS, TB, and malaria, among others.

For example, through his William J. Clinton Foundation, the former president is promoting a number of healthcare and wellness programs. One program, the foundation’s HIV/AIDS Initiative helps developing countries plan and implement large-scale integrated care, treatment, and prevention programs. Similarly, Gates is focusing on fighting HIV/AIDS, TB, malaria, and other diseases through the Bill & Melinda Gates Foundation.Increasingly, philanthropic organizations like these are helping offset the costs of developing new drugs.

“The fantastic thing over the last few years, and particularly even the last few months, is the creation of these public/private partnerships where you bring in the expertise and some of the resources of the drug, biotech, and pharma companies,” said Gates.

The idea with the partnerships is to bring in enough philanthropic and government funding so that pharmaceutical companies respond to the need for certain drugs without incurring a financial risk that could impact their work on other (potentially more profitable) drugs.

“The problem is that we spend about 10 percent of the world’s research money on diseases that affect 90 percent of the world’s people,” said Clinton. “That’s why there’s such a need for what [the Gates Foundation] does. He steps into the gap, oftentimes all by himself.”

Gates reiterated this point. “If you have [situations] where there’s no money to buy medicines, you need some special intervention to come in and provide resources,” said Gates.

He noted that companies such as GlaxoSmithKline, Merck, Johnson & Johnson, Bristol-Myers Squibb, and others have stepped forward to partner up in these new approaches. “It’s fantastic to see this happening. After all, it’s not an issue of the medicines we have to date. It’s an issue of the new medicines that need to be invented.”

To that point, just last week Gates’ foundation awarded “$107.6 million to the Malaria Vaccine Initiative to work with GlaxoSmithKline and African investigators to complete testing of a malaria vaccine candidate.” Also last week, the foundation awarded “$100 million to the Medicines for Malaria Venture to work with public and private sector partners to accelerate the development of several promising new drugs through the regulatory process.”

Industry Takes Note
The role and importance of such public/private partnerships was duly noted in a summit roundtable discussion that included Peter Corr, senior VP, science and technology, Pfizer; Paul Herrling, head of corporate research, Novartis; and Adel Mahmoud, chief medical advisor, vaccines and infections diseases, Merck.

“When I think about the problems we face in global health, about availability [of drugs], it’s what can we do across the industry and, particularly, in public/private partnerships,” said Corr. “[I] look at what can we do together to make new drugs available — that means what can we do to discover and develop new drugs. What incentives can we put in place?”

He noted there have been really great public/private partnerships such as the Medicines for Malaria Venture and the Global Alliance for TB Drug Development.

Novartis is taking a partnership approach with its Novartis Institute for Tropical Diseases (NITD), which is dedicated to finding new drugs for the treatment of tropical diseases including TB and dengue. “One of the ways the NITD works is by extensive partnerships with academia,” said Herrling. “For instance, we’re part of the Gates Grand Challenge to find new targets for TB, and we share everything we do there with our partners.” (In 2003, the Bill & Melinda Gates Foundation’s Grand Challenges in Global Health Initiative selected 43 projects and funded them at more than $436 million.)

Partnerships can also help in other areas. “”We can contribute by providing the scientific insights that will make [new drugs] available,” said Mahmoud. “We can make a difference if we put our scientific capabilities behind the problem, we will discover something. The challenge will be how to deliver vaccines.”

“We are struggling today to deliver measles vaccines that have been with us for 30 years,” said Mahmoud. He noted that this is an area where partnerships are already making some progress. For example, he points to the efforts of the Gates Foundation and the work of the Global Alliance for Vaccines and Immunization (GAVI).

For the last five years, the GAVI has focused on delivering hepatitis B vaccine and “today two-thirds of [newborns] — that means 90 million out of 130 million kids born every year in the world — are immunized against hepatitis B,” said Mahmoud.

Besides dedicating human resources to get vaccines into the field, there is also some hope that new technology will play a role. For instance, one of the core objects of the Grand Challenges “was where we asked scientists to come up with new ideas, including things like having a vaccination that doesn’t require refrigeration to still be effective,” said Gates. “We’ve got to make [administering of drugs] simpler, we’ve got to apply technology. We need [new approaches] to be able to get to the most rural areas.”

Incentives Are Key
While there have been some promising examples of public/private partnerships, there is a recognition by politicians and industry leaders that more needs to be done to get the pharmaceutical industry more involved in some research areas that may not make business sense to pursue.

“We can’t solve these problems without drawing in the pharmaceutical companies,” said Gates. “There’s an element of expertise that they have.”

But pharmaceutical companies will need incentives to spend money on drugs that will not return a profit.

“What I’d like to do is see us make a deal with [pharma] and say, ‘Look we want you to earn money, we want your stock prices to be high, we want you to be successful,’” said Clinton. “But we need to have these drugs available at affordable prices for these poor countries.”

In his last few years in office, Clinton “tried to get a 25 percent across-the-board tax credit, over and above all of the other tax preferences they had, for research in things like TB, malaria, and AIDS,” he said.

“We’ve got to make some deal with [pharmaceutical companies] that allows them to do what they do well and still gets this medicine to people in the [shortest] possible time at prices they can afford,” said Clinton.

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