Pharmaceutical companies like to focus on developing two kinds of drugs: blockbuster drugs that lots of people use (like Lipitor), and more recently, extremely expensive niche drugs. Drugs targeted specifically for common afflictions that affect the developing world aren't as profitable and are often left out of the picture entirely.
Global health nonprofit Path is trying to change that with an ambitious drug development program that targets diseases like kala-azar (also known as black fever disease), malaria, HIV, and diarrheal diseases, such as cholera. The organization's head of drug development, Ponni Subbiah, is a neurologist and longtime executive at pharma giant Pfizer. She joined One World Health—now the drug development arm at Path—in 2011. I had the chance to catch up with Subbiah at this year's Social Capital Markets conference in San Francisco.
One of the big differences between working at a nonprofit and a place like Pfizer, says Subbiah, is the funding. "In a nonprofit, you don't have revenues coming in. At a big company, there are lots and lots of resources," she says. "At Pfizer, if you had a good strategic plan that made technical sense, regulatory-wise sense, and business sense, you got the funding. But in a smaller company and a nonprofit, it's critical that you understand the funding landscape."
At the moment, Path's big focus is on diarrheal diseases. Diarrhea is not part of what Subbiah calls the "big three"—HIV, tuberculosis, and malaria, all of which get a lot of attention. Working on an unsexy disease also isn't particularly conducive to funding. But make no mistake—diarrhea is an epidemic. There are almost 1.7 billion cases of diarrheal diseases each year around the world, and almost 760,000 children under the age of 5 die from diarrheal diseases annually.
Victims don't die from the diarrhea itself, but actually from the massive outpouring of fluids that happens as a result. Path is working on a new class of anti-diarrheal agents called active secretory agents that could turn off the fluid tap at the gut level.
Another challenge for Path is that it can't work in a vacuum. Even if it comes up with an effective drug, there are still structural issues, like poor sanitation, that need to be fixed as well. That's the big advantage of developing drugs within a larger global health organization, instead of a big drug company. "We're now coming together as a cross-divisional diarrheal disease strategy [at Path]," says Subbiah. Within Path, there are groups working on related issues such as better sanitation methods, access to clean water, and vaccines for rotavirus—one of the biggest diarrheal disease-related killers of children.
Path is currently running two Phase II trials to evaluate potential treatments to address dehydration associated with diarrhea in Bangladesh at the International Center for Diarrheal Disease Research. The organization is also working on earlier-stage drugs that can deal with cryptosporidium, a parasite prevalent in children that causes chronic diarrhea, stunting, and malnutrition, in addition to a number of other projects.
Subbiah says that Path doesn't see itself as a drug manufacturer. Instead, it's partnering with traditional pharmaceutical companies that have global health missions. Sanofi and Path, for example, have teamed up to produce a key ingredient in a malaria treatment called semisynthetic artemisinin that will hit the market in April of this year. Maybe those big pharma companies can help out in the global health sphere after all.