The ‘OneWorld’ health model and the prospects for future development of therapeutics for infectious disease of the developing world

Jennifer M.

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The ‘OneWorld’ health model and the prospects for future development of therapeutics for infectious disease of the developing world

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Abstract

Despite the vast improvements in health care and prevention of infectious diseases in the developed world, six out of ten deaths in the developing world can still be directly attributed to infectious disease. Diarrheal diseases, lower respiratory infections, malaria, measles, TB, and HIV/AIDS kill literally millions of children each year. Morbidity and mortality due to infectious disease is a key driving force behind the underdevelopment of economies, particularly in the global South. There are compelling political, economic, social, and moral interests at stake surrounding the decision of private industry and public institutions to invest in the development of treatments for infectious diseases in the developing world. However, the medical research and development infrastructure as it stands fails to address the substantial medical challenges that subsequently place vulnerable communities at a disadvantage. Research and development for safe, efficacious antimicrobials for developing world diseases lacks for several reasons. Pharmaceutical companies considering their financial goals suggest they are unable to develop drugs for developing world diseases because individuals in the developing world will not be able to purchase the drug such that the company makes a significant profit. Without a guaranteed large market, the current model for pharmaceutical research and development fails.

Introduction.
Research and development for safe efficacious antimicrobials.
Recognition of market failure and the genesis of One World Health.
1. The visionary behind One World Health.
2. Four unique features of this model.
3. Two major roadblocks.
A report card at six years.
1. Studies on paromomycin.
2. Clinical trials, market approval and establishing a manufacturing partner.
Post-approval challenges and opportunities.
1. The challenge of distribution in rural and developing communities: How does Coke do it?
2. The challenge of local manufacture of pharmaceuticals: Lessons from Brazil's HIV/AIDS efforts.
One World Health's Innovation and the Implications for pharmaceutical pipelines and access to information.
Additional opportunities for innovation by One World Health.
1. Scientific networks.
2. Financial support.
Summary of recommendations.
Implications for health disparities.

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[...] I will comment on the strengths and weakness of the One World Health model and offer several suggestions that may strengthen the strategic capabilities of the organization and allow One World Health to continue on the path towards research and development of treatments for the world's most vulnerable, underserved populations. Recognition of market failure and the genesis of One World Health The visionary behind One World Health is Dr. Victoria Hale. While working for the FDA in the 1990s, approving proposals for clinical studies, Dr. [...]

[...] It took much longer than was expected for a modicum of comfort to be established between One World Health researchers and the local community. The process improved markedly when One World Health was able to recruit a strong, local project manager. One World Health is now in the process of establishing an office in India, staffed by Indians. As mentioned, it was noted by the Gates Foundation that the WHO reluctance to share important data from previous paromomycin trials increased the amount of time it took to get the trials established and running. [...]

[...] While One World Health could certain put additional resources into finding more foundation and philanthropic dollars, there is an opportunity for the organization to innovate in their funding model by asking an important question that may add dignity to the transaction between the vendor and the ‘customer', or patient: is it possible for One World Health to treat the poor who are in need of their product as active, engaged consumers? Is it possible to get the bottom of the pyramid to exchange some financial capital or collateral in exchange for the services provided by the hospital and One World Health? [...]

[...] However, suppose One World Health and a consortium of other non-profit were interested in securing a license for a medication that could be used to treat a net total of 3 million HIV/AIDS cases spread throughout 8 countries that the drug manufacturer does not consider core targets of their business model for that drug. Currently, the arguments predicate on the concept of sovereign nations, not a utilitarian concept of greatest good for the greatest number. This is not a current concern for One World Health but rather a potential downstream consequence of the growth of non-state actors invested in the well-being of the global community that is poorly demarcated by state boundaries. [...]

[...] Two smaller programs work with other NGOs in Kenya and Tanzania.[12] It may be possible for One World Health to learn from the model of Riders for Health but not utilize the services of the NGO directly. Instead, One World Health could build its own cadre of riders in India to execute the distribution of the drug. Such an arrangement would allow One World Health to retain a close link with the riders instead of contracting with a second organization that would be bringing their experience into an entirely new environment. [...]

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