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‘‘All
chains of drug development exist in India’’
 Dr
Bernard Fourie is the executive director of the Tuberculosis
R&D Coalition of Stakeholders in High-Burden Countries - an initiative
directed towards identifying existing R&D capability in high-burden
countries. The Coalition aims to build research and technology partnerships
between the coalition members and developed countries and facilitate
the establishment of active collaborations in tuberculosis research.
The coalition also aims to provide an operational base for and engage
in projects in need of a multi-centre approach and encourage capacity
building efforts as part of the R&D process. Dr Fourie was in India
last week to promote the Coalition’s objectives and goals to various
Indian stakeholders in TB research. Excerpts from the interview
with Ananth Iyer:
The
Tuberculosis R&D Coalition has identified India as a separate
focal point. What role could India play in helping the Coalition’s
objectives?
The
Tuberculosis R&D Coalition was formed to support the objectives
of the Global Alliance for Anti-TB Drug Development, and that is
to find a new therapy for tuberculosis treatment by 2010. Amongst
other things, this therapy must be affordable and accessible to
high-burden countries. In response to that, the Coalition felt that
there must be an opportunity for scientists from the high burden
countries to participate in this process. Instead of waiting for
the process of drug development to take place and playing a role
of an evaluator, the high-burden countries can offer their scientific
capabilities to fasten the process of drug development to meet the
target of 2010.
And
it is against this background that a number of colleagues from a
variety of countries, including India, agreed to form a steering
group and drive towards establishing a coalition of scientists from
high-burden countries. We have kept India as a separate region simply
because of the magnitude of the disease and the capability it offers.
India is unique when compared to other developing countries. There
is a great industry involvement here. There is also a lot of government
control in research, which is not the case in other developing nations.
Both of these unique scenarios must be turned into potential opportunities.
We must recognise the role of government research institutions and
the industry in TB R&D and organise their capabilities through
the formation of a virtual organisation.
 It
is already clear that there are a number of institutions and individuals
in India who are active in TB drug research. However, these activities
need to be structured under a common umbrella. Also, we need to
define what and where in the process of TB drug development lies
India’s expertise and contribution. And by doing so we then
create a capacity
for
India to become exchange partner to other regions of the coalition
whereby some of the developmental work could be shared.
Streamlining
research capabilities will also ensure equity in research funding
distributions. To give you an example, the meeting organised by
AstraZeneca early this year in Bangalore was fantastic and I congratulate
them. All the big funders were present in that meeting. However,
if you ask the funding agencies now where will you put the money,
they say either in individual researchers or in AstraZeneca. This
dilemma can be avoided if India forms a coalition of various stakeholders.
Q
It has been two years since the coalition model was first adopted
in Brazil. What has been the progress there?
The
scientists in Brazil organised a meeting two years back to expose
themselves to the Coalition and also to the big funding agencies
such as the Global Alliance. It was an impressive meeting, but,
at the end of the day, what they presented was a number of loose
strands. Each one of them was doing their own things. he funding
agencies were not impressed. Brazilians became extremely frustrated,
as the Global Alliance was not putting money into their ventures.
They were also frustrated because their own government was not ready
to invest in science.
Interestingly,
in May 2001, the scientists wrote a document to form a Brazilian
network. They chose a leader and developed a study proposal containing
variety of aspect such as drugs, vaccines, and diagnostics, among
other things. At the same time, they also proposed to offer the
Brazil government a commitment for doing research on nationally
important issues. They then approached the government and got substantial
funding. In September this year, they will hold their first annual
meet. This annual meet is attracting funders from all over the world.
I am sure that the CEO of Global Alliance is the first one to confirm
the participation. You see how the wheel has turned because now
there is a definition to the Brazilian effort. They are quite clear
on what they want to do and where they can contribute. A similar
model could be followed in India to ensure that the capability is
organised and showcased to attract investors.
Q
Do you think the Brazilian model will work in India?
It
is very much possible. All chains of drug development exist in India.
All you need to do is to fit the jigsaw puzzle by forming a virtual
organisation. We are planning to organise a meeting of very high
profile technical personnels in India in November. This meeting
will not be restricted to only drug development, but also for diagnostics
and vaccines. We expect to create all possible awareness on the
need to form a coalition in India through this meeting.
Q
Since TB research is predominant in government-controlled institutions,
there could be chances of duplicity. How do you tackle that?
One
thing we want to avoid is people feeling threatened by such a coalition.
If there is duplicity, it is possible that people may feel threatened.
The objective of the coalition is to identify individuals or institutions
who have workable ideas and, if they are interested, the Coalition
can link their information or capabilities directly to the Global
Alliance or other potential funders and really promote that development.
The Coalition can also facilitate that idea to the local industry.
But, nothing will be done to threaten people or force them to a
compromise. People should be encouraged to join the coalition only
if they see an opportunity for themselves. And our belief is that
opportunity will only come if there is sufficient funding.
The
way you do that is to become a part of the umbrella. India has collective
expertise in drug development. It is important to exploit this expertise
and move some logical projects through the pipeline and demonstrate
that we can handle an agent. Maybe, Global Alliance is sitting on
a compound they want to move through the pipeline, but are not able
to do so due to lack of collective systems. India can attract this
molecule.
Q
Will the Coalition also embark upon common research programmes among
the various regions?
Definitely.
The Coalition is planning to start with medicinal plant screening
project at high capacity to identify leads for developing TB drugs.
I am not saying that this programme will happen for sure, but a
proposal is being put forward to member researchers. The coalition
will also try to facilitate the process of attracting funds. And
it will not be a single funding body. We already have the interest
of WHO Tropical Disease Research wing. The WHO has approached the
Coalition to apply the available funds. This is recognition of the
fact that Coalition might have a capability that can be exploited.
This is a very recent development.
Q
Do you think the target of 2010 set by Global Alliance for a new
TB drug is realistic?
TB
unfortunately is a slow disease. Therefore, any investigation by
nature is longer compared to any other organism you study. So this
long drawn up time frame for the development of the drug is just
beyond reality, and therefore, you need to have partnerships to
shorten the period as much as you can. It is an ambitious target.
It can be made realistic provided: - We have compounds that have
undergone a little bit of work. So, Global Alliance is particularly
looking for compounds that are in late stage discovery.
-
Or, it must be a existing drug that could be optimised or its combination
with other medications are being investigated. That is another possibility
of reaching a new treatment with existing compounds. This is the
main target at the moment since we can minimise risks. We should
see 2010 as some sort of a target to get started, but even if it
is delayed by a couple of years it is okay. But what is not okay
is the target stretching to 2020. We have to put all our eggs into
our basket by taking up five or six compounds and develop simultaneously.
It is also possible that some companies are developing a drug and
we do not know of it at this stage. It is possible that a new drug
might hit the market before the target date.
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