The need for preventive drugs and vaccines in global cancer

Unless healthy people are known to have a very high

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Unless healthy people are known to have a very high risk for a disease, they ¡ / or their insurance companies ¡ / are unlikely to pay hundreds of dollars per month to prevent that disease. Another problem is patent protection. Even for cancer treatment drugs, a large fraction of the standard 20-year patent exclusivity period is com- monly used up by the clinical trials aimed at drug approval, a period when the drug is not being sold in the marketplace. For chemoprevention agents, that problem is magnified, since trials demonstrat- ing preventive benefit typically take much longer than therapeutic trials. The lack of biotechnology and information technology in less developed countries is also of concern. Genomics research involves large-scale creation and utilization of databases through a high level of automation, and therefore requires high capital investment. As such, it has been carried out primarily in developed countries, in both public and private sectors. In developed countries, although much of the genomics research was initially undertaken in the public sector, private company spending on genomics has recently over- taken and is now substantially higher than govern- ment and not-for-profit spending. The private sector does not invest in research aimed at diag- nosis, therapeutics or prevention for diseases that Preventive drugs and vaccines in cancer control H Vainio 87
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are predominant in developing countries because the populations that are afflicted and most likely need them do not have the purchasing power. In order to ensure high returns on their investments, companies tend to focus their research and devel- opment efforts on products aimed at diseases and health problems that are most prevalent among populations of the developed countries. In 1997, for example, it was estimated that low- and medium- income countries accounted for only 20% of the global pharmaceutical market, even through they made up over 80% of the world’s population (Widdus, 2001). Drug development is failing to address the major health needs of developing countries. The lack of market incentives for the global pharmaceutical industry to pursue geno- mics-based research and development towards dis- eases of the world’s poor countries means that, unless mechanisms can be fostered to facilitate greater investment from public and private institu- tions in both developed and developing countries, the potential of genomics to combat these diseases will not be realized and existing inequalities in health will be exacerbated. This has led to wide- spread consideration of supplementary action at the international level, both in terms of `push’ mechanisms, involving financial contributions to- wards `Research and Development’ into diseases prevalent among the poor in developing countries, such as malaria, and so-called `pull’ mechanisms, aimed at ensuring the existence of an attractive level of demand in the event that successful drugs or vaccines are generated. An example of internation- ally sponsored public-private partnership
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