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 gutting of Voice of America (VOA) and Radio Free Asia (RFA) by US President Donald Trump’s administration poses a serious threat to the global voice of freedom, particularly for those living under authoritarian regimes such as China. The US — hailed as the model of liberal democracy — has the moral responsibility to uphold the values it champions. In undermining these institutions, the US risks diminishing its “soft power,” a pivotal pillar of its global influence. VOA Tibetan and RFA Tibetan played an enormous role in promoting the strong image of the US in and outside Tibet. On VOA Tibetan,
There is much evidence that the Chinese Communist Party (CCP) is sending soldiers from the People’s Liberation Army (PLA) to support Russia’s invasion of Ukraine — and is learning lessons for a future war against Taiwan. Until now, the CCP has claimed that they have not sent PLA personnel to support Russian aggression. On 18 April, Ukrainian President Volodymyr Zelinskiy announced that the CCP is supplying war supplies such as gunpowder, artillery, and weapons subcomponents to Russia. When Zelinskiy announced on 9 April that the Ukrainian Army had captured two Chinese nationals fighting with Russians on the front line with details
On a quiet lane in Taipei’s central Daan District (大安), an otherwise unremarkable high-rise is marked by a police guard and a tawdry A4 printout from the Ministry of Foreign Affairs indicating an “embassy area.” Keen observers would see the emblem of the Holy See, one of Taiwan’s 12 so-called “diplomatic allies.” Unlike Taipei’s other embassies and quasi-consulates, no national flag flies there, nor is there a plaque indicating what country’s embassy this is. Visitors hoping to sign a condolence book for the late Pope Francis would instead have to visit the Italian Trade Office, adjacent to Taipei 101. The death of
By now, most of Taiwan has heard Taipei Mayor Chiang Wan-an’s (蔣萬安) threats to initiate a vote of no confidence against the Cabinet. His rationale is that the Democratic Progressive Party (DPP)-led government’s investigation into alleged signature forgery in the Chinese Nationalist Party’s (KMT) recall campaign constitutes “political persecution.” I sincerely hope he goes through with it. The opposition currently holds a majority in the Legislative Yuan, so the initiation of a no-confidence motion and its passage should be entirely within reach. If Chiang truly believes that the government is overreaching, abusing its power and targeting political opponents — then
RSS