There are hardly any new medicines in the pipeline for diseases such as tuberculosis, malaria, sleeping sickness and leishmaniasis - illnesses that are taking a massive and growing toll in deaths and suffering among the poorest people in the world, according to a new report.
The drug giants are focusing almost exclusively on the afflictions of the affluent north, according to Médecins sans Frontières, which convened a working group of distinguished academics to find some answers to the disastrous shortage of medicines for killer tropical diseases.
Their report, to be published tomorrow, points out that in stark contrast, there are eight new drugs on the way for impotence and seven for obesity.
The working group on drugs for neglected diseases wrote to the world's top 20 pharmaceutical companies to find out what medicines they were developing for poor countries. None of the 11 that responded, including Pfizer, Johnson & Johnson and Novartis, had brought a drug to market in the last five years for malaria, tuberculosis, sleeping sickness, Chagas's disease, leishmaniasis or other neglected diseases.
The prospects for the future look grim. Even with malaria and tuberculosis, where there are effective drugs, a constant stream of new ones is badly needed because of growing resistance to the drugs we have. But the companies revealed they were spending less than 1% of their research and development budgets on neglected diseases.
Harvey Bale, director general of the International Federation of Pharmaceutical Manufacturers' Associations, which represents companies from more than 60 countries, said the study "distorts reality".
"More research is of course needed, but there are effective treatments for the diseases they mention. The problem is that these drugs aren't getting to the people that need them." he said.
Yet millions are dying. Sleeping sickness threatens more than 60m people in sub-Saharan Africa. Until recently only one drug could help once the disease reached the brain - melarsoprol, the last remaining derivative of arsenic, which killed a substantial number of those treated.
In 1990, eflornithine was licensed for one form of sleeping sickness. But in 1999, production stopped because it was unprofitable. Production resumed when a new use for the drug was discovered - in hair-removing cream. The pharmaceutical company Aventis has now handed the licence to the World Health Organisation which is looking for a new source of production.
Nick White of Oxford University's centre for tropical medicine at Mahidol University in Thailand, who is on the working group, says there is no commercial incentive to develop the drugs.
"It may be even more serious. There may be a positive disincentive for a pharmaceutical company to become involved in the development of any of these drugs for poor countries," he said.
If one of their scientists was to come up with a compound for sleeping sickness, for example, not only would it be unprofitable, but the drug might well be fairly toxic, although less toxic than arsenic.
"So you are going to make a drug that you can't sell because nobody can afford to buy it and you will be sued for the entire development costs the first time an American tourist dies," said Prof White. "The best thing to do is kill it before anybody finds out about it."
Research by Dyann Wirth, professor of immunology and infectious diseases at the Harvard School of Public Health, found an enormous amount of investigation had taken place into neglected diseases within academic departments, but almost no attempt had been made by pharmaceutical companies to use their discoveries to develop new medicines.
"They sit in the literature," she said. "For the most part they are in the public domain. I have collated 80 to 90 references of discoveries that have the sense that something could be developed from them."
The group's report, Fatal Imbalance: the crisis in research and development for drugs for neglected diseases, says the public sector is also looking for returns on its money - grants to university departments tend to go to projects that will have commercial success. Public-private partnerships are being forged, but have not yet proved they can deliver.
The report suggests radical alternatives, such as obliging drug companies - which reap the benefits of state-funded academic discoveries - to invest in neglected diseases, encouraging pharmaceutical development in developing countries and setting up a not-for-profit body to promote research and development.
Deadly stalkers of the poor
• Malaria Parasitic disease kills 3,000 children a day under five and can affect development of those who survive. Up to 500m cases of malaria every year (the figure is for cases because individuals often have recurring bouts. Ninety per cent of cases are in sub-Saharan Africa. Drugs have worked well but resistance is rising. Drug combinations are being developed under the World Health Organisation. The public-private Medicines for Malaria venture looks promising
• Tuberculosis Kills 2m a year and is leading cause of death in people who are HIV positive. Spread through the air by water droplets but not all those infected develop the lung disease. South-east Asia has most cases, but there is a steep rise in eastern Europe. Drug treatment is effective but complicated. Resistance has developed
• Leishmaniasis Parasitic disease transmitted by infected female phlebotomine sandfly which appears in 88 countries on five continents. It has four different forms with devastating consequences, including disfigurement and death. Up to 500,000 cases a year but imprecise data on deaths - in 1999 the WHO recorded 57,000. There are few drugs to treat the disease and some are highly toxic
• Sleeping sickness and Chagas's disease Human forms of the parasitic disease trypanosomiasis. Sleeping sickness threatens more than 60m people in sub-Saharan Africa. Chagas's affects about a quarter of the population of Latin America. These conditions are fatal without treatment
