Drugs for neglected diseases: a failure of the market and a public health failure?

Infectious diseases cause the suffering of hundreds of millions of people, especially in tropical and subtropical areas. Effective, affordable and eas y-to-use medicines to fight these diseases are nearly absent. Although scie nce and technology are sufficiently advanced to provide the necessary medic ines, very few new drugs are being developed. However, drug discovery is no t the major bottleneck. Today's R&D-based pharmaceutical industry is reluct ant to invest in the development of drugs to treat the major diseases of th e poor, because return on investment cannot be guaranteed. With national an d international politics supporting a free market-based world order, financ ial opportunities rather than global health needs guide the direction of ne w drug development. Can we accept that the dearth of effective drugs for di seases that mainly affect the poor is simply the sad but inevitable consequ ence of a global market economy? Or is it a massive public health failure, and a failure to direct economic development for the benefit of society? An urgent reorientation of priorities in drug development and health policy i s needed. The pharmaceutical industry must contribute to this effort, but n ational and international policies need to direct the global economy to add ress the true health needs of society. This requires political will, a stro ng commitment to prioritize health considerations over economic interests, and the enforcement of regulations and other mechanisms to stimulate essent ial drug development. New and creative strategies involving both the public and the private sector are needed to ensure that affordable medicines for today's neglected diseases are developed. Priority action areas include adv ocating an essential medicines R&D agenda, capacity-building in and technol ogy transfer to developing countries, elaborating an adapted legal and regu latory framework, prioritizing funding for essential drug development and s ecuring availability, accessibility, distribution and rational use of these drugs.