The world needs an overhaul of medical research

The global health landscape is marked by fundamental contradictions. Scientific innovation is accelerating at an unprecedented pace, yet many of the world’s most urgent health needs remain unmet. New drugs, diagnostics, and therapies are constantly being developed, but they remain largely inaccessible to the countries and communities that need them most. This is a crisis of equity, leadership, and imagination, and addressing it demands nothing less than an overhaul of the dominant model of medical research.As matters stand, medical-research agendas and standards are largely dictated by funders in the Global North. Breakthroughs often depend on data from lower-income countries – which bear the brunt of the global disease burden – but credit for them is typically awarded to elite Western institutions.But researchers, clinicians, and institutions in the Global South possess deep firsthand knowledge of the diseases afflicting local populations. They know which diagnostics and treatments can work in low-resource settings, and how to navigate local health systems. When they lack the opportunity to bring their expertise and insight to bear in setting research priorities or guiding research and development strategies, outcomes suffer.Consider diagnostics, which is essential for disease management and surveillance. Global health experts often advocate expanding access to molecular diagnostics, which use in vitro techniques to analyse markers in the genome and proteome. But these approaches are costly and impractical in resource-limited settings, especially during disease outbreaks.Global medical research and development must be reoriented toward equity and impact. This means not just giving countries a seat at the table, but letting them lead the research that primarily affects them. One of the most powerful levers for such a transformation is the public-private partnership (PPP) model, including not-for-profit product-development partnerships (PDPs) to advance the delivery of health products for poverty-related and neglected diseases, such as malaria and tuberculosis.Over the past two decades, PDPs have played a crucial role in improving global health, by bringing together governments, philanthropies, industry, academia, and NGOs to tackle diseases for which there were no market incentives to develop solutions. Organisations like the Drugs for Neglected Diseases initiative, the Foundation for Innovative New Diagnostics, and the Medicines for Malaria Venture have proven that collaborative, public-interest-driven models can fill gaps left by the for-profit sector.But this model appears to have lost its way. Nowadays, PDPs often appear to be entwined with large multinational companies, disconnected from countries’ health priorities and focused on the needs and demands of the Global North, with many using development pipelines and regulatory approaches designed for North American or European markets.Meanwhile, ballooning overhead costs are being met with shrinking funding. It does not help that many PDPs remain headquartered in expensive Western cities like Geneva or London, with staffing that does not reflect the communities being served. To remain relevant, PDPs must be led by the countries they serve and headquartered in the Global South, with both cost structures and regulatory pathways being adapted to local realities.Fortunately, such models are already emerging. In Malaysia, the International Affordable Diagnostics and Therapeutics Alliance (IA-DATA), a locally driven initiative, recently began clinical trials on a repurposed antimalarial drug called artesunate for use against cervical pre-cancer and colorectal cancer, which represent a significant disease burden in developing countries. By combining existing medicines with regional clinical expertise, IA-DATA bypassed the need for expensive new chemical entities, thereby accelerating progress.IA-DATA and its platform for global collaboration, the South-South Diagnostic Alliance (SSDxA), are also seeking to democratise access to diagnostics – the often-neglected sibling of therapeutics – by decentralising research and development. Already, SSDxA (one of the authors is Director) is connecting scientists, manufacturers, and regulators from across Malaysia, Brazil, Sri Lanka, Thailand, and Vietnam.The SSDxA’s recent analysis of dengue diagnostics revealed that, while molecular assays can be useful, lateral flow tests are more accessible and affordable in affected regions. As developing-country researchers have often pointed out, these rapid tests, which were critical in managing the Covid-19 pandemic, offer a viable and scalable solution in low-resource settings.The role of regulators must not be underestimated. Malaysia’s National Pharmaceutical Regulatory Agency was among the first in the world to approve the use of ravidasvir, a hepatitis C drug developed through South-South co-operation. Instead of waiting for endorsement from Western regulatory authorities, Malaysia worked with partners from the Global South to approve this low-cost treatment. The drug has since been added into the World Health Organisation’s list of essential medicines.Many countries in the Global South, including Malaysia, Thailand, Brazil, Jordan, and South Africa, have what it takes to lead this transformation in medical research, including robust public-health systems, internationally accredited regulatory bodies, political will, and cost advantages. But they will need to introduce policy reforms that facilitate the registration and operation of organisations with a regional or global nonprofit mandate – not least so that they can attract sufficient foreign investment, including from the Global North.A global rebalancing of medical research does not mean excluding Western partners, which still have a vital role to play, directing not only resources, but also expertise toward locally driven R&D agendas. This vision aligns with the Yamoussoukro Consensus on South-South Co-operation, adopted by the G77 in 2008: While North-South co-operation remains essential, developing countries must set their own priorities for collaboration and evaluate progress on their own terms.Empowering countries to lead medical research is not charity; it is a strategic necessity. Beyond righting historical inequities, it would unlock the next frontier of equitable and effective healthcare for all. – Project Syndicate

• Sanjeev Krishna is Professor Emeritus of Molecular Parasitology and Medicine at City St George’s University of London and a visiting professor at the Universiti Malaya Affordable Diagnostics and Therapeutics.
• Jean-Michel Piedagnel is Director of the South-South Diagnostic Alliance (SSDxA).