Finding better ways to treat disease in developing countries

The London offices of GlaxoSmithKline. Glaxo will buy the dermatology business Stiefel Laboratories, based in Florida.

Allan Pamba is the director of engagement and access initiatives in GlaxoSmithKline's Developing Countries Market Access Unit.

Before he went to work for one of the world's biggest pharmaceutical companies, he wondered whether drugmakers were part of the problem in fighting diseases in developing nations of Africa, Asia and South America.

When he first started working for GSK, he had the same question that non-pharma company employees and stockholders often wonder:

"I struggled and I wondered, 'why don't we just give this stuff away?' " Pamba said by phone from South Africa on Wednesday. "Yes, there is a place for pure philanthropy and a certain amount of money in our company goes to that. But through the years, in conversations with health policy officials in countries, I learned that they have refused donations when they are not sure it's going to last. They would say, 'If you give this to me free today, do I have to buy it from someone else or at a higher price when your company has a bad year? They prefer a cost-share approach."

Kate Elder, a Philadelphia native and vaccines policy advisor for Doctors Without Borders, also known by its French name Médecins Sans Frontières (MSF), said in a recent interview that MSF has turned down donations because it needs a sustainable model regarding availability and price, preferably a low price.

Pamba spoke on the day that that World Health Organization and the London Declaration on Neglected Tropical Diseases issued reports on efforts to reduce the pain and death associated with diseases that don't always get much attention in the West.

GSK is based in London, but has several facilities in the Philadelphia region.

A link to Thursday's Inquirer story is here.

The WHO group of neglected diseases includes these 17:

Dengue, Rabies, Trachoma, Buruli ulcer, Endemic treponematoses (includes yaws), Leprosy, Chagas disease, human African trypanosomiasis, Leishmaniases, taenaisis/cysticercosis, dracunculiasis (guinea-worm disease), echinococcosis/hydatidosis, foodborne trematodiases, lymphatic filariasis, onchocerciasis (river blindness), schistosomiasis (bilharzia), soil-transmitted helminthiases.

Pamba worked at a clinic in Kenya in the early years after HIV/AIDs was recognized and had become a big problem.

"At the time, there was still a lot of stigma with HIV, so no one thought anyone would come to the clinic we opened," Pamba said. "But we had 30 patients on Day 1."

Pamba became frustrated that he was seeing patients from teenager years through the elderly and did not antiretroviral drugs to help treat the HIV.

"It was quite gloomy," Pamba said. "People would say, 'How much time do I have?' "

That frustration led him to eventually join GSK.

"When I joined GSK, I said I would like to be an advocate for patients who often don't have a voice at the table with big companies in London or New York or Philadelphia," Pamba said. "When I arrived, I was pleasantly surprised to find a significant population of colleagues with similar attitudes, if not the experience I had in the field. I saw the company had a new CEO, who really got it. Andrew Witty had worked in Africa, so he understood."

Pamba said that some drugs are deemed market failures because there is not enough profit to be made in the West, where governments allow private companies to charge more, or in developing nations where there is even less money. But Pamba said problems sometimes can be solved by looking at them from a different angle or by providing information.

He referred to an arrangement GSK has with cell phone maker Vodafone, which is another British company. When women give birth at a clinic, they leave behind their phone number so they are sent text messages reminding them to get vaccines for their children.

"There are half a billion handsets in Africa," Pamba said of the spread of cell phone use. "Some people don't have enough food, but they have a cell phone."

The inhaler is a simple, cheap and relatively common gadget for treating asthma in the West. But in parts of the developing world, patients avoided them because it was perceived as a sign of imminent death. Once that perception set in, doctors did not want to prescribe them. Awareness of the reality that inhalers help prolong life was required.

Pamba said that GSK spends 20 percent of its emerging market resources on helping host nations with health-care infrastructure, either directly or with non-governmental partners.

"If we don't help the government," Pamba said, "our medicines might sit on a shelf."