After decades of simmering silently, tuberculosis (TB) began in the early 1990s to make a deadly comeback, triggered largely by the AIDS epidemic. Drugs, diagnostics and vaccines against the disease were outdated and inadequate. But most of TB's victims are poor and there was little incentive for companies to invest in new tools—at least, not until recently.

Public-private partnerships (PPPs) funded by governments and organizations such as the Rockefeller Foundation and the Bill & Melinda Gates Foundation are successfully negotiating deals with companies that have found promising drug leads. In the past, these leads would have been buried because their profit potential wouldn't have justified the enormous costs of bringing them through to trials.

TB's toll: Countries in sub-Saharan Africa and Asia have the highest prevalence of tuberculosis. Credit: Data courtesy of WHO

Some companies used to feel that the worst thing that could happen was to find a drug for a nonprofit disease. Mary Moran, Pharmaceutical R&D Policy Project

“Some companies used to feel that the worst thing that could happen was to find a drug for a nonprofit disease,” says Mary Moran, director of the Pharmaceutical R&D Policy Project at the George Institute for International Health in Sydney, Australia. But thanks to the new partnerships, Moran says, “the climate has been changing.”

In 2005, Moran released an analysis showing that PPPs are beating traditional drug development timelines for neglected diseases (PLoS Med. 2, e302; 2006).

The Global Alliance for TB Drug Development, the largest product development partnership in TB, is sponsoring clinical trials of two drugs, the Aeras Global TB Vaccine Foundation is looking for a better preventative vaccine and the Foundation for Innovative New Diagnostics is searching for cheaper, more reliable ways to detect TB and other diseases.

Credit: Associated Press

Partnerships are also forming between small biotech companies and academic organizations—such as the agreement between the US National Institutes of Health and the Maryland-based company Sequella (see page 266).

But the partnerships are too reliant on money from a few donors, such as the Gates Foundation, cautions Roy Widdus, a veteran of the Global Forum for Health Research who now consults from New York. Also, none of the partnerships has delivered a product to market as yet, and they been grappling with growing pains.

“They got created with an overoptimistic set of goals and when people got down to managing them they had to reassess the environment,” Widdus says. “But they're now functioning incredibly well.”