The successful collaboration between the health ministries of Malaysia and Thailand, industry partners in Egypt and Malaysia, and the Drugs for Neglected Diseases initiative (DNDi) to bring a new hepatitis C antiviral drug — ravidasvir — to market in 2022 was an important milestone. For years, a 12-week course of treatment using sofosbuvir cost between US$70,000 and US$80,000, putting it out of reach for many in the global south. However, ravidasvir — a safe and effective alternative when combined with sofosbuvir — costs far less, averaging less than US$500 per course.
This type of South-South cooperation could serve as a model for developing countries with endemic disease, highlighting how collective action can help them address health challenges and promote medical innovation. As this year’s ASEAN chair, Malaysia plans to advance the agenda of collaborative, need-driven research, and foster the development of therapeutics and diagnostics in the global south.
Ravidasvir’s success depended on several factors.
First, DNDi worked with an Egyptian drug manufacturer to develop the molecule, which was originally produced in the US, but overlooked by large pharmaceutical companies.
Second, once it became clear that this research and development initiative would produce an independent, affordable treatment for hepatitis C, the Malaysian Ministry of Health (where I am director-general of health), together with DNDi leadership in Southeast Asia designed an aggressive access strategy based on market competition, driving down the prices of three treatment options. Throughout the process, global south partners were in the driver’s seat.
This sense of ownership prompted a flurry of activity in Malaysia, ultimately lowering the barriers between siloed government departments and dispelling conventional thinking. For example, Malaysia’s regulatory authority was the first to register the combination of ravidasvir and sofosbuvir without approval by a stringent regulatory authority. Pharmaniaga, a Malaysian generic-drugs manufacturer, supported these efforts by taking on the challenge of preparing a registration dossier for a new chemical entity.
The Malaysian health ministry has continued to advance this treatment option. In February, the ministry unveiled results from a clinical trial showing that a shorter regimen (eight as opposed to 12 weeks) of sofobusvir-ravidasvir treatment was not inferior in non-cirrhotic hepatitis C patients. This represents a big win for those living with the disease in the global south, as it lowers the therapeutic cost even further and improves patient compliance.
While making treatment affordable and accessible is an important step toward eliminating hepatitis C, the same needs to be done for diagnostic tools. Traditional lab-based testing is expensive and logistically challenging for mass screening programs across Southeast Asia. However, instead of waiting for high-income countries to develop solutions, the global south should take the lead in innovating point-of-care diagnostics that are inexpensive and scalable.
The COVID-19 pandemic highlighted the fragility of global medical supply chains and the limits of solidarity among countries in the face of a public health crisis. The global north’s reluctance to share vaccines, tests, personal protective equipment and therapeutics fueled an “every country for itself” mentality. As a result, a credibility crisis has consumed the global health system, now exacerbated by a widening funding gap, largely owing to the US’ recent withdrawal from the WHO. The need for new models has never been clearer.
Recognizing the need for greater regional resilience, Southeast Asian countries have shown an increasing willingness to support clinical trials and boost local manufacturing of medical devices and pharmaceuticals. Malaysia has played a central role in these efforts.
In July last year, the Malaysian government hosted a workshop with the UK’s Academy of Medical Sciences to explore strategies for improving diagnostic and therapeutic access in the region. Workshop attendees recommended establishing a product-development partnership to foster collaboration among governments, academia and industry.
Clinical Research Malaysia, a research management organization under the health ministry that has focused on building clinical-trial capacity across the country — including for first-in-human phase 1 studies — is to host CRM Trial Connect next month. Focused on accelerating clinical trials in Asia, the conference is to bring together more than 1,000 academics, clinical researchers, industry leaders and policymakers from across the region.
As the current chair of ASEAN, Malaysia is also well-positioned to engage in dialogue with regional and international partners on how to address the global south’s health challenges.
The ASEAN-Gulf Cooperation Council-China Summit scheduled next month would provide a venue for exploring ways to strengthen South-South collaboration, particularly regarding knowledge and technology transfers and access to medical innovation.
The development of ravidasvir offers insights into how regional collaboration and targeted investment could lead to affordable medical innovations, adding to a growing playbook of strategies for improving access to therapeutics and diagnostics in the global south. If these countries agree to act collectively, they can likely repeat this success for a wide range of neglected and non-communicable diseases — and take ownership of a process long dominated by the global north.
Muhammad Radzi Abu Hassan is Malaysia’s director-general of health.
Copyright: Project Syndicate
The Executive Yuan recently revised a page of its Web site on ethnic groups in Taiwan, replacing the term “Han” (漢族) with “the rest of the population.” The page, which was updated on March 24, describes the composition of Taiwan’s registered households as indigenous (2.5 percent), foreign origin (1.2 percent) and the rest of the population (96.2 percent). The change was picked up by a social media user and amplified by local media, sparking heated discussion over the weekend. The pan-blue and pro-China camp called it a politically motivated desinicization attempt to obscure the Han Chinese ethnicity of most Taiwanese.
On Wednesday last week, the Rossiyskaya Gazeta published an article by Chinese President Xi Jinping (習近平) asserting the People’s Republic of China’s (PRC) territorial claim over Taiwan effective 1945, predicated upon instruments such as the 1943 Cairo Declaration and the 1945 Potsdam Proclamation. The article further contended that this de jure and de facto status was subsequently reaffirmed by UN General Assembly Resolution 2758 of 1971. The Ministry of Foreign Affairs promptly issued a statement categorically repudiating these assertions. In addition to the reasons put forward by the ministry, I believe that China’s assertions are open to questions in international
The Legislative Yuan passed an amendment on Friday last week to add four national holidays and make Workers’ Day a national holiday for all sectors — a move referred to as “four plus one.” The Chinese Nationalist Party (KMT) and the Taiwan People’s Party (TPP), who used their combined legislative majority to push the bill through its third reading, claim the holidays were chosen based on their inherent significance and social relevance. However, in passing the amendment, they have stuck to the traditional mindset of taking a holiday just for the sake of it, failing to make good use of
As strategic tensions escalate across the vast Indo-Pacific region, Taiwan has emerged as more than a potential flashpoint. It is the fulcrum upon which the credibility of the evolving American-led strategy of integrated deterrence now rests. How the US and regional powers like Japan respond to Taiwan’s defense, and how credible the deterrent against Chinese aggression proves to be, will profoundly shape the Indo-Pacific security architecture for years to come. A successful defense of Taiwan through strengthened deterrence in the Indo-Pacific would enhance the credibility of the US-led alliance system and underpin America’s global preeminence, while a failure of integrated deterrence would
RSS