2 research outputs found
Investing in late-stage clinical trials and manufacturing of product candidates for five major infectious diseases: a modelling study of the benefits and costs of investment in three middle-income countries
BACKGROUND : Investing in late-stage clinical trials, trial sites, and production capacity for new health products could improve access to vaccines, therapeutics, and infectious disease diagnostics in middle-income countries. This study assesses the case for such investment in three of these countries: India, Kenya, and South Africa. METHODS: We applied investment case modelling and assessed how many cases, deaths, and disability-adjusted life years (DALYs) could be averted from the development and manufacturing of new technologies (therapeutics and vaccines) in these countries from 2021 to 2036, for five diseases鈥擧IV, tuberculosis, malaria, pneumonia, and diarrhoeal diseases. We also estimated the economic benefits that might accrue from making these investments and we developed benefit鈥揷ost ratios for each of the three middle-income countries. Our modelling applies two investment case perspectives: a societal perspective with all costs and benefits measured at the societal level, and a country perspective to estimate how much health and economic benefit accrues to each middle-income country for every dollar invested in clinical trials and manufacturing by the middle-income country government. For each perspective, we modelled two scenarios: one that considers only domestic health and economic benefits; and one that includes regional health and economic benefits. In the regional scenarios, we assumed that new products developed and manufactured in India would benefit eight countries in south Asia, whereas new products developed and manufactured in Kenya would benefit all 21 countries in the Common Market for Eastern and Southern Africa (COMESA). We also assumed that all 16 countries in the Southern African Development Community (SADC) would benefit from products developed and manufactured in South Africa. FINDINGS : From 2021 to 2036, product development and manufacturing in Kenya could avert 4路44 million deaths and 206路27 million DALYs in the COMESA region. In South Africa, it could prevent 5路19 million deaths and 253路83 million DALYs in the SADC region. In India, it could avert 9路76 million deaths and 374路42 million DALYs in south Asia. Economic returns would be especially high if new tools were produced for regional markets rather than for domestic markets only. Under a societal perspective, regional returns outweigh investments by a factor of 20路51 in Kenya, 33路27 in South Africa, and 66路56 in India. Under a country perspective, the regional benefit鈥揷ost ratios amount to 60路71 in India, 8路78 in Kenya, and 11路88 in South Africa. INTERPRETATION : Our study supports the creation of regional hubs for clinical trials and product manufacturing compared with narrow national efforts.The Bill & Melinda Gates Foundation.https://www.thelancet.com/journals/langlo/homehttps://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groupsam2023Graduate School of Technology Management (GSTM