Kenya Conference: Financial Incentives Needed For Tailored Neglected Disease Research

NAIROBI – Governments in Kenya and other developing nations must be willing to provide financial incentives if they expect companies to carry out research and development of drugs specifically tailored to those countries’ needs, a conference in Nairobi was told last week.

The conference, organised by the Geneva-based research group IQsensato, brought panellists together to discuss the World Health Organization’s Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property. The strategy, adopted in 2008, is meant to promote new ways of getting the right drugs to developing countries, which tend to grapple with diseases such as malaria, sleeping sickness, dengue fever and tuberculosis found far less often in the developed world.

Conference participants agreed that national governments, drug companies and non-governmental organisations have a long way to go to make the global strategy relevant to places such as Kenya and the rest of Africa, where poor people still cannot get the crucial medicines they need to fight off tropical diseases such as malaria.

They painted a bleak picture of the problems facing Kenya. Not least of them is the fact that because people in Kenya are so poor and cannot afford drugs now on the market, drug companies have little interest in conducting the costly research or delivery campaigns needed to solve the problems.

“The real health needs of countries like Kenya are unlikely to be taken into account because there is no market,” said Sisule Musungu, president of IQsensato. “Access to final products is treated as an exception rather than the rule.”

“If you have the biggest disease in the world and there is no market, there is no development,” he said.

The global strategy is aimed at fighting the so-called “10/90 gap,” which refers to the fact that developing countries account for 90 percent of the world’s 14 million annual deaths due to infectious diseases, but account for only 10 percent of the global pharmaceutical sales.

That’s a particular problem in Kenya, which is 13th amongst the world’s 22 high-burden tuberculosis countries, according to the US Agency for International Development. In late February, Kenya announced its first polio case in 20 years, and it is also grappling with the widespread presence of malaria along its Indian Ocean Coast and in the west, along the shores of Lake Victoria.

To fight that problem, Kenyan panellists said the government must play a more active role in drug research and delivery – by offering financial incentives for development of the drugs needed specifically in Kenya and countries like it.

The difficulty with that idea is making sure that the money does not dry up. In a country such as Kenya, which has many immediate problems – such as corruption, food shortages, and outbreaks of bloody ethnic violence – it may be hard to persuade companies that the financing won’t disappear.

There is also already little money to fund medicine research, and few researchers well-trained enough to do the work.

“There are no examples of incentives. If we had incentives that worked we wouldn’t need a global strategy,” said Dr Monique Wasunna, acting chief executive at the Kenya Medical Research Institute. “You need a framework that attracts financing in a sustainable way.”

Others at the conference suggested that the biggest problem was not necessarily inadequate research, but the actual fact of getting drugs to the poorest people. Roads are shoddy or nonexistent in rural areas, and the national electrical grid often does not extend much further than the biggest towns.

Graham Reid, a doctor with the International Development Research Center, told the audience that in his experience, even the best acting drugs see their efficacy reduced drastically because people don’t get them. Even drugs that have an efficacy rate of 98 percent will see their effectiveness reduced drastically if drugs are hard to find, or education on adherence is poor.

That, according to Reid, is why researchers in Kenya must focus less on specific diseases than on the larger problem of getting drugs to the people who need them.

“Research priorities should not be by disease. Many of these services can be delivered in an integrated way,” Reid said. “It’s the delivery of the drugs to the patient that is largely the problem.”

For many participants at the conference, the context of the global strategy was impossible to ignore. The WHO is proceeding slowly, and in places like Kenya, the challenges – local problems, counterfeiting, poor infrastructure – make implementation rather daunting. According to Mboi Misati, a senior patent examiner at the Kenya Industrial Property Institute, the World Health Organization recently rejected Kenyan efforts to establish a working group that would have studied ways of implementing the strategy.

Regina Mbindyo, representing the WHO, acknowledged that implementation had been slow at best, but said governments must invest more money to make sure the strategy is carried out.

On top of that, many researchers may try to take what little government money there is, even if they end up producing little by way of an effective result.

“The global strategy must not be perceived as just another resolution of the WHA [World Health Assembly] where most resolutions have gathered dusk on the desks,” said Patrick Mubangizi, a coordinator with Health Action International.

For his part, Kwam Owino, an economist at the Institute of Economic Affairs, argued that research and development cannot be funded by a one-time expenditure.

“You require medium term and long term stable finances for results and effectiveness to occur,” he said. “We have to move to a model where we pay for outcomes and not effort.”