Saket Vora

 First they ignore you,
then they laugh at you,
then they fight with you,
then you win.
~ Gandhi

A few years ago  my friend Naman talked me about how big pharmaceutical companies don’t develop drugs for neglected diseases, and proposed creating a university-based pharmaceutical company. I laughed. I couldn’t see how that made sense in the value-chain. Well today I attended a seminar by Dr. Victoria Hale, the co-founder of the Institute for OneWorldHealth — a “non-profit pharmaceutical company.” Dr. Hale is a pharmaceutical engineer, but was unsatisfied with her work at pharma companies and wondered what she could do about the diseases that affect those in the developing world. People have noticed what she’s done — she is a 2006 MacArthur Fellow, fellow of the Academies of Science, an Ashoka Fellow, awarded for Social and Economic Innovation by The Economist, and a Skoll Award for Social Entrepreneurship.

The neglected diseases because despite market sizes in the billions of customers, they don’t have much money to pay. 1.1 billion people live with < $1/day. 2.7 billion people live with < $2/day. It doesn’t seem to get better beyond that — roughly 4 billion people live with < $4/day. Dr. Hale asked whether one could take a pharmaceutical company and remove the ‘profit’ aspect of it — could it work? It’s not totally sustainable yet, but with strong support from the Gates Foundation the iOWH has gotten a one-dose-cure for visceral leishmaniasis for $12. The crazy part? Despite this drug (paromycin) being effective, it was discontinued from production back in 1989.

The Institute for OneWorldHealth  has focused on malaria, diarrhea, and leishmaniasis. A few notes I jotted down:

• The 10/90 gap: 10% of the global health R&D funding denoted to diseases which that result in 90% of illnesses.
• Most neglected tropical diseases (NTDs) are parasitic, something which the developed world lacks and thus the way to fight the problem is more challenging. Little bugs have various stages in their life cycle and such.
• People in the bottom billion want choice, and they want to pay for medicine, thus be committed to the drug and program.
• The effective malaria drug, artemisinin, is derived from a plant that grows in China and Thailand. The process of cultivating the plant and processing it results in a treatment that costs a LOT of money, several hundred dollars. Researchers at Berkeley took the plant’s relevant gene, put it some bacteria, and fermented it. This innovative process has dropped the price to a $30 treatment, and is likely lower now. This same process was then adapted to form the basis for Amyris, which is trying to make jet fuel out of bacteria. How cool is that?
• One idea for supplemental income is for iOWH to take on an overlooked illness that affects those in the Western world and use the revenues from that to fund other projects.
• There is the important question of “whose standards to follow” is still a heated debate. Should all drugs go through the FDA and EMEA regulatory process? This would unavoidably increases costs so you might only be able to do far less than if you use the regulatory process in these other countries.
• What’s neat is that while you can market these drugs to the poor in the developing world, another group of people who work in the developing world can also use them — soldiers. The DoD would be interested in malaria treatments! That dichomoty is fascinating — the soldier who is carrying $20,000 worth of equipment needing the same $10 treatment that a person making < $1/day needs also.

But ultimately, Dr. Hale pointed that really, the pathogen that medicine fights is just the symptom. The cause is global poverty, and we have to do something to fight the good fight against it.

There are people in the world so hungry that God
cannot appear to them but in the form of bread.
~ Gandhi