Global Healthcare on the Ground: Merck and AstraZeneca Tackle Cervical Cancer and Tuberculosis

Last month, Pharmaceutical Technology launched this series to cover the ways in which pharmaceutical companies, nonprofit and nongovernmental organizations, charities, and others are working to increase access to needed drugs in the developing world. Here, we highlight the efforts of two of the world's largest pharmaceutical companies, Merck and AstraZeneca, in this area.

Merck

From its home base in Whitehouse Station, New Jersey, Merck is working with the government of Bhutan and the Australian Cervical Cancer Foundation to implement a national cervical cancer vaccination program for girls aged 12 to 18. Bhutan, which borders India and Tibet, will be the first developing nation to have such a program in place.

The six-year program, which began in 2010, is intended to reduce cervical cancer in the country. Currently, cervical cancer affects more women in Bhutan than any other cancer—about 200 women are diagnosed each year, and one-half of them die. Merck's Gardasil (human papillomavirus [HPV] quadrivalent [Types 6, 11, 16, and 18] vaccine, recombinant) vaccine will be administered. As part of the program, Bhutan's Ministry of Health will also provide educational materials regarding HPV to girls who receive the vaccine at local schools and through routine vaccination services in basic health units.

The Bhutan program is part of a larger Merck effort to improve access to cervical cancer vaccines in the developing world Through the company's Gardasil Access Program, Merck is donating at least 3 million doses of its HPV vaccine to low-income countries, including: Bolivia, Cambodia, Cameroon, Georgia, Ghana, Haiti, India, Kenya, Lesotho, Moldova, Nepal, Nicaragua, Papua New Guinea, Tanzania, Uganda, and Uzbekistan.

More recently, the company launched a joint venture with United Kingdom's Wellcome Trust, a global charity based in London, to create the MSD Wellcome Trust Hilleman Laboratories, which will use a nonprofit operating model to develop and deliver vaccines to low-income countries. While an initial portfolio of projects will be selected after a technical assessment and consultation with the international community, an example of the kind of program being considered is developing vaccines that do not require refrigeration, according to the company. The laboratory, to be based in India, will help to advance projects to proof of concept and help to ensure that production can be scaled up.

Overall, Merck believes it has an important role to play in helping to improve access to medicines, vaccines, and quality healthcare worldwide, says Brenda Colatrella, executive director of Merck's Office of Corporate Responsibility. "Barriers to quality care and medical treatment such as lack of trained healthcare professionals, weak infrastructure, and civil strife in many parts of the world make even basic healthcare delivery difficult at best," she said. "[Although] substantial progress is being made to address these challenges and future technological advances portend even greater opportunities for the world's population and growing economies,... more progress and more partnerships are needed to ensure everyone worldwide has access to the same level of quality medicines, vaccines, and healthcare."

AstraZeneca

With headquarters in London, this pharmaceutical company is the only one in the world with a research program dedicated specifically to finding a new, improved treatment for tuberculosis. The disease affects 2 billion people globally, according to the 2009 TB fact sheet from the World Health Organization (WHO), and 5% of those infected have a multidrug resistant form of the disease, which means that standard first-line drugs do not work. In fact, last month, the US Food and Drug Administration announced nearly $3 million in grants for TB research, including research on the resistant forms of the disease, as part of its Critical Path Initiative.

In 2003, AstraZeneca opened a purpose-built TB research center in Bangalore, India, focused on multidrug resistant strains. Today, more than 80 scientists work there in collaboration with AstraZeneca's infection research center in Boston. And in May 2010, AstraZeneca joined forces with the Global Alliance for TB Drug Development to accelerate the discovery, development and clinical use of drugs to treat TB, including drug-resistant strains of the disease.

Under the agreement, the TB Alliance and AstraZeneca will contribute promising TB drug-discovery projects into a joint portfolio that will be codeveloped. Potentially successful compounds will be tested in combination with other therapies as part of the program, which is being called Critical Path to TB Drug Regimens.

The European drug manufacturer also has programs focused on finding treatments for malaria, including collaboration with the Medicines for Malaria Venture (MMV), a nonprofit Switzerland-based public–private partnership established in 1999 to reduce the burden of malaria in disease-endemic countries. The MMV project involves the use of AstraZeneca's compound library to search for novel drug candidates to treat malaria. And last year, AstraZeneca agreed to provide at least 3 million doses of its H1N1 attenuated intranasal vaccine to WHO for distribution.

Looking ahead, AstraZeneca believes industry needs to work together with other groups to keep up momentum for finding new treatments for diseases that largely affect developing and neglected populations. "The challenge for pharmaceutical companies is to balance downward pressures on the price of medicines with the cost of the continued innovation that is required to address the unmet medical needs and bring benefit for patients and society," says AstraZeneca R&D's Aileen Allsop, vice-president of science policy. "Just as there is no single source to the issues related to improving health outcomes, there is no single solution. We need to foster a collaborative, multistakeholder approach to ensure strong partnerships between pharmaceutical companies, other industries, governments and NGOs."