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New Medicine for an Epidemic of Neglect

As a conference on tropical medicine gets underway in Germany Thursday, a look at pharmaceutical companies' long-criticized role in the field shows that entrenched attitudes just might be changing.

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Tropical diseases have been largely ignored in the West

Earlier this year, Swiss drug giant Novartis did what western pharmaceutical heavyweights have long been accused of failing to do: It invested heavily in the research and development of so-called neglected diseases in the third world with the official opening of an institute in Singapore dedicated to that purpose.

Called the Novartis Institute for Tropical Diseases, the $122 million (€149.4 million) project co-financed by Novartis and the Singapore government will focus on developing drugs to fight tuberculosis and dengue fever. The latter, which is estimated to affect around 50 million people in the developing world yearly and in extreme cases cause painful internal bleeding, was off the radar screens of drug research companies for years.

"The Singapore institute is a totally non-profit project," a spokeswoman for Novartis told DW-WORLD. "It's part of our commitment to the developing world, the new medicines will be distributed there free of cost."

Critics say the philanthropic move by the company which recorded profits of $5 billion last year is exceptional in a industry driven by profit and famed for its reluctance to invest in a market that holds no chance of turning one.

"It is a big step," Tobias Loppe, policy advisor of the "Access to Essential Medicines" campaign of the international organization Doctors Without Borders told DW-WORLD. "After all, these drug heavyweights make about 90 percent of their money in the US, Japan and western Europe. All of Africa accounts for just 1 percent -- there is no market there, no money to be made there and thus no motivation for the drug companies to research."

German companies involved too

Esther Babalola HIV/AIDS in Sagamu, Nigeria, Medikamente

Esther Babalola, 38-year-old mother of four, waits for a doctor at the HIV/AIDS clinic in Sagamu, southern Nigeria

Despite the lack of financial incentive, Novartis isn't the only pharmaceutical heavyweight to get involved in developing cures for diseases afflicting the Third World.

In addition to British companies like GlaxoSmithKline and AstraZeneca working to develop medicines against tuberculosis, malaria and visceral leishmaniasis also known as kala azar, a handful of German drug giants too have indicated a willingness to play a part.

Ralf Hömke, press spokesman for the German Association of Research-based Pharmaceutical Companies (FDA), an umbrella group that represents 42 German drug giants including Bayer, Boeringher Ingelheim, Aventis and Schering, said "tropical diseases may not have the same importance in the West as say cancer, where we have lots of research experience, but many German firms are regularly involved in producing medicines for the Third World."

Some have forged alliances with non-governmental organizations and private foundations. They include Franco-German firm Aventis, which in 2001 committed $25 million to supporting the World Health Organization's activities in the field of sleeping sickness, a deadly disease which affects as many as half a million people in sub-Saharan Africa, and donate new drugs. Bayer is working together with "Medicines for Malaria Venture," a WHO initiative jointly financed by the World Bank and private foundations, to develop by 2005 a faster and more effective medicine against malaria.

AIDS pressure and negative image

Weltaidstag in Südafrika Kind

AIDS orphan Sihle, stands in front of the Peace Ma Africa Children's Home, near Johannesburg, South Africa. Many of the home's children are AIDS orphans.

Experts believe that one of the reasons for the drug industry's turnabout on tropical disease research is the spread of AIDS, which is largely taking place in the developing world, and the immense public pressure coupled with lobbying by public health activists for companies to do something about it.

"AIDS and the role of drug companies has been a major subject in the public consciousness for a few years now," Bernard Pecoul of the Geneva-based Drugs for Neglected Diseases initiative told DW-WORLD. "While some firms reacted by offering their medicines free of cost to the Third World, others lowered their prices once it became clear that cheaper imitation medicines would swamp the market anyway."

Another reason, said Loppe of Doctors Without Borders, is the companies' realization that they need to change their negative image as profit-hungry sharks.

"A classic example is when the German company Hoechst withdrew the medicine Eflornithine from the market in 1995 which was used to treat sleeping sickness in Africa," Loppe said. "It then emerged that the substance, which could save lives in Africa, was being sold by Hoechst as a depilatory cream for women's upper lips in the US. There was a huge public outcry then."

More needs to be done

Despite the gradual change of stance on tropical diseases, experts argue that efforts by drug companies still represent a mere drop in the ocean.

"Ninety percent of research and development spending still goes towards just ten percent of the world's diseases," Pecoul said.

A 2003 report by the German Gmünder health insurance company found that most new medicines on the German market, 17 last year, "were not really needed for any kind of serious therapy." According to the Bielefeld-based BUKO alternative pharmaceutical campaign "billions are invested for new hair-growth and slimming cures or new aphrodisiacs."

"It's a total lopsided development -- of the around 1,400 new drugs approved between 1975 and 1999, only 16 were specifically developed for tropical diseases," Pecoul said. "The ways things stand now, there is a kind of standstill in research and development for the Third World."

The other major argument critics put forward is that of big money.

"It's no secret that the drug companies make immense profits," said Loppe. "So why not invest more, lower prices in the Third World and do away with insisting on patents?"

Tablettenproduktion

Pill production

Hömke, who represents researchers in the German drug industry, was clear why not. The German drug industry, which recorded a total turnover of €25.7 billion in 2003, is worried about getting a good return on its investments.

"We invest about $800 million in researching and developing a medicine before it even gets on the market," he said. "How would we ever recover that kind of money in the developing world?"

The arguments aren't new and the battle lines clearly entrenched. But there are encouraging signs that the drug industry's new-found philanthropy might not just be a passing trend: This week GlaxoSmithKline signed an agreement to allow a Kenyan firm to start manufacturing generic copies of its patented AIDS drugs.

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