DNDi‘s work does not end with drug registration or WHO recommendation. DNDi takes on the responsibility of ensuring that the new therapies it develops become useful treatments.
Since its creation, DNDi has delivered eight treatments across a range of diseases and supported their registration and introduction. From this experience, we have learnt that the transition from registration to access is one of the most challenging aspects of our mission. DNDi‘s access strategy relies on partnerships with health ministries, national control programmes, industrial partners, NGO allies, and others to reach neglected patients and communities, and achieve maximum public health impact.
Treatments distribution scenarios vary depending on the disease, drugs, relevant countries, and degree of innovation: DNDi taps into existing distribution networks or works with partners to create new channels (e.g. public or not-for-profit).
Chagas: Innovative partnerships to spur access Chagas
DNDi has long sought to mobilize energies and funds in a bid to address the unacceptable situation for Chagas disease, where less than 1% of infected individuals are diagnosed and even fewer receive treatment.
These efforts received a considerable boost in August 2017, when pharmaceutical company Insud, with DNDi’s support, received a priority review voucher as a result of registering benznidazole for the treatment of Chagas disease with the US FDA. As part of the collaboration agreement between Insud and DNDi, half of the revenues from the sale of the PRV will be dedicated to increasing access to diagnosis, treatment and prevention throughout the Americas.
A Regional Access Framework for Chagas Disease has been developed by DNDi and Insud’s corporate social responsibility partner Fundación Mundo Sano, to be implemented in collaboration with members of the Chagas Coalition. Countries can look to efforts made by the Colombian Ministry of Health, which, with DNDi technical support, launched a pilot project to boost diagnosis and treatment. Initial results show a more than tenfold increase in the number of patients screened and a radical reduction in the wait for a confirmed diagnosis. A second project in Guatemala seeks to replicate this success and demonstrate the feasibility of diagnosis and treatment at the primary care level.
Fexinidazole: Using the regulatory process to pave the way for access Sleeping sickness
In December 2017, a few months after the conclusion of largescale DNDi clinical trials, our industrial partner Sanofi submitted the registration dossier for fexinidazole as the first all-oral treatment for sleeping sickness. In a promising move for access, a submission was made to the European Medicines Agency under what is known as Article 58.
If fexinidazole is registered in late 2018, regulatory approval will only be the first step. Translation into national policy and treatment guidelines will be needed as well as community awareness efforts and treatment knowledge for health providers.
Hepatitis C: A public health approach for access Hepatitis C
Although there are now several effective and safe treatment options for hepatitis C, access to affordable medicines is impossible for millions of people. Middle-income countries are the most affected. DNDi aims to bring a solution to this situation through multiple partnerships with widely different stakeholders who all share the common aim of increasing access to hepatitis C treatment.
DNDi has partnered with Pharco, an Egyptian pharmaceutical company, in the development of ravidasvir, a new chemical entity with potential effectiveness against all genotypes of the disease. In 2016, DNDi began working with the Malaysian Ministry of Health to introduce a public health approach within the framework of the country’s National Strategic Plan on viral hepatitis. Clinical trials were launched in six Malaysian hospitals with the Ministry as co-sponsor of the trial. A similar partnership followed in Thailand.
Promising results suggest that the ravidasvir/sofosbuvir combination is comparable to the very best hepatitis C therapies available, with one radical difference: its price. Thanks to partnerships in Malaysia (Pharmaniaga) and Argentina (Insud/Elea), DNDi has secured a target price of USD 300 to 500 per treatment course, a fraction of the price of what is available today in countries where patent barriers block generic options, and which are excluded from pharmaceutical company discount schemes.
However, to use this drug combination, countries would also need access to affordable sofosbuvir. In September 2017, Malaysia issued a “government use” licence to source generic sofosbuvir, a move which has allowed it to accelerate access to affordable hepatitis C treatment in its public hospitals.
Last updated: August 2018