Amrita Palriwala

Will Prizes Help Fight TB and Other Neglected Diseases?

A recent article in The New Yorker, “A Deadly Misdiagnosis“, paints a bleak picture of TB in India. Tuberculosis takes a substantial toll on vulnerable people in India and elsewhere, in turn sapping economic productivity and growth throughout the developing world. It claims almost two million lives every year and progress in controlling the disease has been slow, especially where HIV prevalence is high. In India alone, a thousand people die of the disease every day.

As the story vividly illustrates, one major obstacle to improving this situation is that tuberculosis is diagnosed in the same way as it has been for almost a century, in public and private clinics as well as hospitals in most resource-poor countries. Current TB tests are inaccurate, resulting in huge number of misdiagnoses every year; slow to deliver results, therefore delaying the start of appropriate treatment; and inaccessible to those living in remote areas. What’s needed is a cheap, accurate, fast, point-of-care (POC) test, one that could be used in clinics within easy reach of most patients.

Why aren’t better diagnostic tests available? Part of the problem is technological: creating a test that has all the right characteristics, including affordability, isn’t easy. But, as with other needed drugs, vaccines, and diagnostics for so-called neglected diseases, the crux of the matter is lack of incentive to drive investment by the pharmaceutical and the biotechnology industries. Typically, private companies have been reluctant to invest in neglected disease products because the markets for these products are either too small or uncertain, and therefore not sufficiently profitable. As it turns, out, the market for TB diagnostics might not be so small after all – one WHO report estimated that as many as 80-100 million POC tests might eventually be used every year. But this prospect hasn’t proven enough to persuade most diagnostic firms that the returns are worth the risks. What could change their behavior and speed development of urgently needed new tests?

Several advocates have proposed the use of prizes as a new way to spur medical innovation for neglected diseases, including for the development of TB diagnostics. Prizes have stimulated breakthroughs in areas as diverse as mathematics, agriculture, space flight and fuel-efficient cars. Lately, prizes are enjoying a resurgence as governments, policymakers, and the private sector experiment with more and bigger prizes in various contexts. But there has been little experience so far with prizes as an incentive for pharmaceutical R&D and questions remain about the feasibility of this approach in the global health context.

To address some of these questions, the Center for Global Health R&D Policy Assessment last Thursday launched its draft report “Prizes for Global Health Technologies,” the first in a series of assessments of policy proposals for accelerating global health R&D. This report analyzes the strengths and weaknesses of prizes for global health and provides a detailed case study of recent prize proposals for point-of-care TB diagnostics.

This consultation draft of the prizes assessment is available for public comment on the Center’s website. We invite you to post comments to our website in response to our draft and to share your own assessment of prizes for promoting development. Commenting will remain open through Friday.