The Raffles Dialogue on Human Wellbeing and Security – Authors' reply
Authors: Tikki Pang
Journal: The Lancet Global Health (2016)

We thank Boris Cvet for his comments on our Article1Pang T Chong YS Fong H et al.Yes we can! The Raffles Dialogue on Human Wellbeing and Security.Lancet Glob Health. 2015; 3: e496-e500Summary Full Text Full Text PDF Scopus (4) Google Scholar and agree with him that discovering new uses for old drugs offers great promise with regard to making treatments for neglected tropical diseases in low-income and middle-income countries more cost-effective and accessible. This is an important and neglected area.2Pedrique B Strub-Wourgaft N Some C et al.The drug and vaccine landscape for neglected diseases (2000–11): a systematic assessment.Lancet Glob Health. 2013; 1: e371-e379Summary Full Text Full Text PDF Scopus (174) Google Scholar While we agree with Cvek that an imbalance exists in the role of governments and markets in investing in drug discovery and development, we propose that this is only one dimension of the problem. Broadly speaking, and with the large investments involved, we believe that most governments will neither have the resources, nor the political will, to invest in the clinical development of such drugs, and are therefore unlikely to make the necessary commitments. Instead, we suggest that governments can help facilitate the achievement of the desired right balance between the roles of government and markets through alternative but complementary and synergistic strategies. We propose four such strategies. First, governments can support the development of publicly accessible collections of existing drugs.3Chong CR Sullivan DJ New uses for old drugs.Nature. 2007; 448: 645-646Crossref PubMed Scopus (764) Google Scholar Despite the promise that finding new uses for existing drugs is a proven shortcut to improve access, comprehensive collections of the nearly 10 000 drugs known to medicine does not exist.3Chong CR Sullivan DJ New uses for old drugs.Nature. 2007; 448: 645-646Crossref PubMed Scopus (764) Google Scholar Government support for development of collections such as the Johns Hopkins Clinical Compound Library3Chong CR Sullivan DJ New uses for old drugs.Nature. 2007; 448: 645-646Crossref PubMed Scopus (764) Google Scholar would go a long way to facilitating the rediscovery process. As suggested by Cvek, such a strategy will facilitate government-backed efforts to, as he put it, “systematically monitor positive side-effects of existing drugs”. Second, governments can play an important part in providing incentives for industry to invest in discovering new uses for old drugs. For example, it could consider the extension of patent protection for old drugs that have found new uses, for example, as embodied in the Hatch-Waxman Act in the USA.4Pensabene LB Gregory D Hatch Waxman Act: overview.Practical Law Company. 2013; (accessed Nov 7, 2015).http://www.fitzpatrickcella.com/DB6EDC/assets/files/News/Hatch-Waxman%20Act%20Overview%20lpensabene_dgregory.pdfGoogle Scholar Third, it can provide more funding to support research aimed at better understanding of the modes of action of drugs, a fundamental requisite in discovering new uses for old drugs.5Shaughnessy A Old drugs, new tricks.BMJ. 2011; 342: 360-361Crossref Scopus (40) Google Scholar Such support should emphasise the application of newer in silico approaches and the harnessing of computer power in the fields of computational drug discovery, biomedical informatics, and so-called big data analytics.5Shaughnessy A Old drugs, new tricks.BMJ. 2011; 342: 360-361Crossref Scopus (40) Google Scholar In a related vein, governments can also facilitate and support the development of interdisciplinary collaboration networks of key stakeholders in academia and industry. Taken together, these strategies will go a long way in repurposing and repositioning older drugs to help in health improvement globally. We declare no competing interests. The Raffles Dialogue on Human Wellbeing and SecurityIn The Lancet Global Health (August, 2015),1 Tikki Pang and colleagues emphasise that “we must find the right balance between the roles of government and markets so that all those in need can access affordable medicine and health care“.1 Probably the biggest imbalance between role of government and market is in drug discovery and development. There is almost no way to finance large clinical trials of old, unpatentable drugs repurposed for treatment of deadly diseases. It has been the case for phase 3 clinical trials of paromomycin, an old antibiotic for visceral leishmaniasis, which were funded by the Bill & Melinda Gates Foundation, the WHO, and other institutions, but not by governments. Full-Text PDF Open Access