Jill Wechsler

Funding to bolster healthcare systems in developing countries and to improve treatments for infectious diseases has increased in the last decade. US support in this area has grown exponentially, beginning with AIDS, and is now helping to combat malaria, tuberculosis (TB), and many neglected tropical diseases.

Pharmaceutical companies have responded by supporting public–private partnerships that strive to develop new vaccines and medicines and improve healthcare delivery systems in developing countries. The international financial crisis has squeezed resources for these efforts, however. US initiatives have suffered from delays in appointing a permanent director of the Agency for International Development as well as looming cuts in foreign aid. Although the list of promising drug and vaccine candidates for neglected diseases is growing, competition among donor agencies and multiple public–private partnerships threatens success in bringing new therapies through the costly development and registration process.

The slowdown in the growth of pharmaceutical sales in the industrial world is a prime factor encouraging manufacturers to expand their presence in emerging markets and developing nations. In announcing quarterly earnings in July, GlaxoSmithKline (GSK, London) CEO Andrew Witty highlighted the company's reduced reliance on "white pill, western market" sales and rising investment in younger, growing markets.

Similarly, Pfizer (New York) has established an emerging-markets business unit to build sales in Brazil, China, India, Mexico, Russia, and Turkey. sanofi aventis (Paris) has made a series of acquisitions in recent months to expand its drug and vaccine portfolio in emerging markets. Other pharmaceutical companies are taking similar tacks.

While newly industrialized nations offer sales potential, manufacturers also are tackling neglected tropical diseases. Merck (Whitehouse Station, NJ) announced in June that it would provide proprietary information about drug candidates to the Drugs for Neglected Diseases Initiative to develop treatments for Chagas and leishmaniasis, among other diseases. Roche (Basel) is working with the Institute for OneWorld Health to develop new treatments for diarrheal disease from leads uncovered in Roche's cystic-fibrosis research.