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Letter from Chairman and Executive Director

                    Marcel Tanner
Marcel Tanner
Chairman of the Board

    Bernard Pecoul
Executive Director

When DNDi was created ten years ago...

...there was a dearth of research and development (R&D) for neglected diseases. Treatments either did not exist, or did but were toxic, expensive, hard to come by, or difficult to administer: in short, ill-adapted to patients’ needs. Pharmaceutical companies did not invest due to the lack of a lucrative market to recoup investments in R&D and scarce attention was paid to these patients. For HIV, R&D may have been active, but patient access to treatments was in a poor state, and little to nothing was being done for tuberculosis, malaria, and neglected tropical diseases (NTDs).

A decade later, despite the progress that we read about almost every day, still only 3.8% of newly approved drugs target the neglected diseases that account for 10.5% of the global disease burden.(1) Much of the progress in drug R&D over the past decade came about through drug reformulations and repurposing of existing drugs against these illnesses. As recently documented, only 1% of all health R&D investments in 2010 was for neglected diseases.(2) The neglect is still there, despite a decade of efforts and initial successes. To respond to a systemic crisis, we need more!

To help address the neglected disease gaps, new initiatives, including product development partnerships, have flourished and offer innovative ways to develop safe, effective, adapted, and affordable drugs, vaccines, and diagnostics for neglected patients. DNDi was part of this movement, providing an alter- native option in order to boost innovation and deliver effective treatments as quickly as possible to those in urgent need. Despite their relative ‘youth’, these initiatives have delivered new health tools and have begun to explore new thinking and practices such as open innovation models, echoed by several international initiatives including drug discovery consortia and intellectual property and patent-sharing mechanisms.

Indeed, most major pharmaceutical companies are now committed to neglected diseases R&D. Many provide access to compound libraries, data, and knowledge, whilst others limit their efforts to drug donations. Furthermore, emerging economies, and notably neglected disease-endemic countries, have begun to engage. These are all encouraging developments.

‘Elimination’ has become a real goal for some neglected diseases
Today we hear more and more about ‘elimination’, which was inconceivable a decade ago, and is illustrative of the progress made since. The WHO NTD Roadmap, for example, which defined very specific, time-bound targets for the prevention, control, elimination, or eradication of the 17 WHO-defined NTDs by 2020, is a clear sign that an end could be in sight for certain neglected diseases.

However, to ensure that the term ‘elimination’ is not just rhetoric, ongoing commitments will have to be sustained in order to radically change the course of these diseases. The WHO NTD Resolution, adopted at the 2013 World Health Assembly, is a major step forward by the international community, and emphasizes the paramount importance of strong leadership at country level, particularly in disease-endemic countries, for sustainability and success.

Even if today the major actors in neglected disease R&D are still based in high-income countries, numerous innovative initiatives over the past decade have proven the importance and efficiency of building, in endemic countries, the research capacities, manufacturing capabilities, and implementation systems required to sustain a long-term response to the problems inherent in neglected disease R&D.

In addition, the commitment of the private sector, as illustrated by the January 2012 ‘London Declaration on Neglected Tropical Diseases’, emphasized the private-sector support of the WHO NTD Roadmap and its objectives. The neglected disease landscape has benefited from the massive commitment of the Bill & Melinda Gates Foundation, having contributed over a billion dollars to global health, including R&D. Some governments, like those of the UK, The Netherlands, Spain, Germany, France, and Switzerland, also took important steps to increase their efforts, despite the financial crises that have hampered their economies. However, the financial stability of many high- income countries continues to deteriorate and the threat of funding cuts continues to loom.

A need for additional funding mechanisms
Moving into the next decade, additional resources are needed, particularly with a growing R&D drug pipeline with new chemical entities entering the more expensive phase of clinical development. There are very encouraging commitments from emerging economies, for example with Brazil’s recent announcement to support neglected disease R&D. Additional funding has also come from new funding mechanisms such as UNITAID. The challenge today and for the coming years, however, will be to ensure that new funding sources are sustainable and include R&D, such as the Financial Transaction Taxes (FTTs).

For DNDi, even though the six treatments we have delivered are substantial improvements for treatment of patients in the field, they are mainly incremental improvements of existing drugs, and have shortcomings, especially as ‘tools for elimi- nation’ in the long term. As such, DNDi will not have done its job until drugs that are oral rather than infusions or injections, are safe, efficacious, and cheap, and which will likely be used in drug combinations, are developed and delivered to neglected patients.

If we look at what the past decade has to tell us, as DNDi we clearly need to further assess and learn lessons from the challenges we have faced and extract the best practices from our successes. The role of DNDi’s regional offices in endemic regions, along with our founding partners, will certainly need to be strengthened to seize new scientific opportunities as well as to better respond to unmet medical needs. We also need stronger and more synergistic partnerships, and greater agility of the organization to explore innovative pathways to deliver adapted and cost-effective health tools.

The past decade has brought a lot of hope, but there is still a long road ahead in the fight against neglected diseases and the current momentum cannot stop after a few achievements. One thing we have definitely learned is that we need to revisit how we collaborate in order to progress from individual, one- shot, isolated, or fragmented achievements, and genuinely think out of the box about sustainable collaboration.

Connect to fight neglect
‘Connect to Fight Neglect’ is the motto for our 10-year anni- versary website, and it is our hope that all of the actors now engaged in neglected disease R&D will reflect with us on what form of engagement that motto implies.

After a decade of innovation for neglected patients, we have learned that if we are to truly ‘bring these diseases to their knees’, we have to ‘keep prodding, keep pushing, and keep searching’ as Dr Margaret Chan recently put it. Indeed, we have to dare to take risks and invest, break down barriers, and move bravely towards our goals for the future.

    signature Pecoul                           signature Tanner
Dr. Bernard Pécoul                  Dr. Marcel Tanner
Executive Director                   Chairman


(1) Medical innovations for neglected patients, DNDi-MSF, December 2012.   
(2) Rottingen J-A et al. (May 2013). Mapping of available health research and development data: What’s there, what’s missing, and what role is there for a global observatory? Lancet. doi:10.1016/S0140-6736(13)61046-6.

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