One step forward, one step sideways? Expanding research capacity for neglected diseases

Stimulating research will mean overcoming barriers such as patent thickets, poor coordination of research activities, exclusive licensing of new technologies by universities and the structural problems that inhibit conducting appropriate clinical trials in developing countries. In addition, it is necessary to ensure that the priorities for research reflect the needs of developing countries and not just donors. This article will explore each of these issues and then look at three emerging approaches to stimulating research -paying for innovation, priority review sales or vouchers and public-private partnerships, - and evaluate their strengths and weaknesses.All of the stakeholders agree that there is a pressing need for a major expansion in the level of R&D. Whatever that new model turns out to be, it will have to deal with the 5 barriers outlined in this paper. Finally, none of the three proposals considered here for expanding research is free from major limitations.Research and development (R&D) of new medicines is driven by the market where the market typically means large numbers of potential patients with chronic diseases who live in first world countries. These people either have the ability to purchase medicines on their own or, as is more often the case, the cost of medicines is covered publicly. Under these circumstances, companies are able to realize sustained substantial rates of return [1] and are willing to invest in the necessary R&D.There is general agreement that this model for R&D has failed when it comes to neglected diseases. This assessment comes not just from critics of pharmaceutical companies but from within the industry itself. Speaking to a reporter from the Financial Times, Daniel Vasella, the CEO of Novartis, said "We have no model which would (meet) the need for new drugs in a sustainable way ... You can't expect for-profit organization[s] to do this on a large scale. If you want to establish a system where companies systematically invest