San Francisco Chronicle - Thursday, December 5, 2002
Tom Abate, Chronicle Staff Writer

"I am embarrassed about being so crass," said AlphaVax's Peter Young. But as the head of a 40-person startup with only 18 months of cash, he has to be worried about making money.

The problem, of course, is that there is little or no money in developing medicines for the world's poor. Recognizing this, about 400 people, including U.S. and U.N. health officials, biotech executives, doctors from the developing world and leaders from the Bill and Melinda Gates and Rockefeller foundations gathered Wednesday to ponder that issue.

Una Ryan, chief executive of the Massachusetts biotech firm Avant Immunotherapeutics, said this odd assembly is focused on making it financially feasible to create new medicines for diseases of the poor, including malaria, tuberculosis and AIDS.

"You have to remember we are an industry," Ryan said.

The hope at this conference, co-sponsored by the Biotechnology Industry Organization, is that a new business arrangement called a public-private partnership might succeed where the market system hasn't. Such partnerships take many forms -- 80 variations can be found at www.ippph.org -- but the Institute for OneWorld Health, a San Francisco nonprofit drug development firm, is a good example.

OneWorld is the brainchild of 41-year-old biotech scientist Victoria Hale, who recently won a $4.7 million Gates grant to do the final clinical trials on an experimental drug to treat black fever, a disease that infects 500,000 people and claims 60,000 lives a year.

The drug was discovered by a pharmaceutical company that decided there was no money in it, shelved the project and gave its preliminary studies to an international health agency. The experimental drug was off patent when Hale found the file. Now she's using that data and the Gates grant to take the drug to India, Nepal and other countries where it is needed.

"This saved us years of work," Hale said, adding that by donating hand-me- down drugs to nonprofits like hers, pharmaceutical companies can get tax write-offs.

Other partnerships are more complicated. Some nonprofits are licensing early-stage patents from for-profit companies under terms like this: The nonprofit uses foundation grants to test the drug, with the understanding that it can sell or give away the medicine in the developing world. But the for- profit firm retains the right to sell the drug in Europe and North America if the nonprofit's efforts bear fruit.

Forum participants discussed how to avoid the appearance or the reality that such deals might become a backdoor way to run shoddy studies, using the poor as guinea pigs for medicines that might eventually benefit the affluent.

"Ten years ago, we had a problem with ethics, but we've come a long way," said Dr. Fred Binka, who runs a network of clinical trial sites that stretch from his native Ghana to other African and Asian nations. "There cannot be one form of science for the rich and another for the poor, or it is not science."

Economist Hannah Kettler, with the Institute for Global Health in San Francisco, said the world community must also find ways to buy drugs for the poor -- by getting rich nations to create buying pools, for instance -- because no matter how cheap medicines are, the hardest-hit nations can't afford them.

Elias Zerhouni, whose position as the director of the National Institutes of Health gives him the richest biomedical research budget in the world, sought to charm both the health officials and the business leaders in the crowd.

Reminding the former that he was born in Algeria and the latter that he has started two medical technology companies, he promised to use his post "to elevate the debate" over the growing health inequities between the rich and poor.

Laurie Garrett, Pulitzer Prize-winning author on global health, challenged the biotech firms to head off what she called "the feminizing" of AIDS in Africa, where "women have no right of refusal for sexual advances," and HIV- positive men, believing sex with a virgin will cure them, are infecting young girls.

E-mail Tom Abate at tabate@sfchronicle.com

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