Solutions for the developing world

At the same time that various government agencies and commercial interests throughout the Western world prepare for the latest strain of H5N1 influenza, tens of millions of people throughout the developing world are dealing daily with the repercussions of pandemics that already exist.

And whereas technological advances and societal stabilization should be resulting in increased life spans, improved well being, and expanding economies in most countries, many people are seeing significant reversals of fortune while they cope with widespread HIV infection and increasingly drug-resistant microbes that bring disorders ranging from enteric disease to malaria to tuberculosis.

To top it all off, the developing world is not only home to these historically destabilizing diseases, but it is also an incubator of emerging diseases that start locally and spread rapidly, such as HIV and SARS. To fight these conditions, international agencies like the World Health Organization and non-governmental organizations (NGOs) like the Drugs for Neglected Diseases Initiative and the Institute for OneWorld Health organize research into the development of drugs to treat people in endemic regions.

These groups—and several drug companies—have made significant progress toward this goal; however, even the most affordable or effective therapeutics are useless if clinicians can't get the right drugs to the right people. For this to occur, effective disease diagnosis is critical. But therein lay the problem, because the developing world is faced with a variety of challenges that are rare or unknown elsewhere.

Recently, I had the opportunity to speak with a number of NGOs and diagnostics companies to examine the reasons behind these challenges and possible solutions. Most issues revolved around the lack of a viable infrastructure in these countries, the lack of public awareness in the developed world, the need to develop cost-effective solutions for much smaller economies, and the technical challenges of developing point-of-case diagnostics.

But for the greatest part, it seems to me that there needs to be a significant change in the mind-set of government agencies, NGOs and corporations. Stop thinking of the developing world as a charity case, but rather as a new market providing vastly new opportunities.

Matt Steele, clinical and field research coordinator for the Program for Appropriate Technology in Health (PATH), suggests that rather than start with the developed world and move products to the developing world, companies need to turn that paradigm on its head. Steele in fact sees a variety of market opportunities that are opening up much faster in the developing world than in the West.

Someone who echoes these sentiments is Gary Hopgood, business development manager for Beckman Coulter International (see Hopgood Q&A). "Certain developing markets are certainly key areas for commercial growth for the future," he says. "Obvious examples are China and India with their huge populations that will demand ever-improving healthcare quality and delivery. This all requires a growing learning curve for any company so that the demands of these growing economies are understood and can be responded to.

"Furthermore, such economies are usually changing and adapting at rates far more rapid than Western economies," he continues. "This can often lead to a disconnect between a stable, slow-to-react, generally conservative Western commercial culture and a vibrant, changing, fast-paced developing economies. This shift in reactivity needs to be met lest those countries take the markets for themselves."

What seems to be working most effectively is a group approach, where agencies like PATH work with private corporations, combining the individual strengths of each group. NGOs and academic groups are often better suited to provide technological insight, while corporations are often best at dealing with financial and logistical issues such as economies-of-scale and distribution channels.

To that end, companies like Roche, Nanogen and Partec are dealing with a variety of agencies to push the developing world agenda. Beckman Coulter, for example, has engaged with the Clinton Foundation in the fight against HIV, licensing governmental technologies to enable cost-effective testing in markets where AIDS is of greatest concern.

But as Steele points out, these are very complex problems with very context-specific issues, so people cannot afford to take a monolithic approach. Awareness, cooperation and the breaking down of barriers are just going to be the first steps in a very long, but very important, process.