Financial Times contrasts 'bottom up' and 'top down' approaches to developing country drugs

The Financial Times contrasts the model of drug development for developing countries being used by non-profit groups like the Meningitis Vaccine Project (MVP), which recently rolled out the MenAfriVac, to that of some pharmaceutical companies.

The article reports that pharmaceutical companies "are increasingly pushing a 'top down' model" known as Advance Market Commitment (AMC), "a process by which government donors pledge a pool of money upfront so that the companies are guaranteed a sufficient market to cover production or research costs" for drugs to be used in poor countries. "The first [AMC] example, a vaccine for pneumococcal disease, is set to launch next week with $1.5bn from donors. It provides a more modest but important incentive: the guarantee of a significant market, which allows companies to invest in manufacturing and infrastructure," Financial Times reports.

The article examines MVP's approach to create "a vaccine 'from the bottom up,' engineered to meet the needs of the poor'" and traces MenAfriVac's development - from securing research and development funding "upfront" and focusing on the "affordability for the poorest from the start" to producing a vaccine "tightly targeted on the African's concern - meningitis A - rather than one with a larger potential market" and the formation of "a network involving low-cost contractors."

Proponents of the strategy say "MenAfriVac is a model for vaccine development that could already have led to less costly versions of industry-developed products. Sceptics, however, say it remains at best an exception and at worst an unproven remedy even for meningitis A," Financial Times writes.

The article also includes comments from those on both sides of the argument about the applicability of MVP's model. Suresh Jadhav, quality assurance director at the Serum Institute, a company the newspaper writes "has invested $20m to produce MenAfriVac" and Bill Hausdorff, a vice-president at GSK, who oversees the company's pneumococcal vaccine, are quoted.

"If you can develop a product and have it up and running for $70m, it's a big question mark whether you need [big pharma's] $1bn," Jadhav said. Hausdorff notes the challenges that may arise in circumstances where the preliminary science is not so far along and the vaccine development is more complicated, such as vaccines that offer protection against multiple strains. The article also includes comments from Chris Elias, head of PATH, and Marc LaForce, head of MVP (Jack, 12/6).