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DNDi at ten: past success, future challenges

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Since it was created in 2003, there is little doubt that the Drugs for Neglected Diseases initiative (DNDi) has been one of the most successful Product Development Partnerships (PDPs), with 6 new treatments delivered for 4 diseases in less than ten years.

While these have been developed from existing or repurposed drugs, the achievement is tangible in that many of these treatments (like NECT, ASAQ fixed dose combination and SSG&PM) are being rolled out and scaled up in endemic countries where they are needed the most.

DNDi’s website hints on what they believe are reasons for success, with buzz words like ‘collaborative’ and ‘needs driven’. But there is much more than this.

First, DNDi was created with a sense of need and urgency born from the feeling that something must be done to change things for the better, quickly. This is a direct inheritance from MSF. This sense of urgency has been critical in facilitating DNDi to set up a pragmatic and sensible strategy of developing both short- and long-term projects in its respective portfolios- not sacrificing the needs of now for the theoretical magic bullet of the future. This has allowed DNDi to deliver quickly, and hence be seen as a success in its own right.

Another key factor is real, meaningful engagement with stakeholders in endemic countries. This goes beyond its founding partners- to partners in the South that have been a critical part in implementing DNDi projects. DNDi has shown belief in these partners by providing significant investment in field-level capacity building- and has been rewarded by its partners delivering the successes. DNDi’s success ultimately belongs to these partners- and the fact that DNDi has made this recognition clear has also been critical to maintaining successful collaborations. Facilitating all of this are DNDi’s regional offices based in or near endemic countries. This model has been critical for its ability to build and maintain relationships and manage projects in a diverse range of settings.

DNDi also has a key asset that is often not so clearly understood- its staff; or rather the varied mix and background of its staff. This includes people with a background in pharma, academia, government and humanitarian NGOs. This gives DNDi a unique skill mix that is technical, strategic and dare I say, it, passionate. It also has created a healthy tension and space to grow ideas.

There are other important factors that are important to mention: DNDi has striven to ensure a balanced funding portfolio- ensuring no dominant funding entity. At Board level, it has tried to ensure that it keeps the space and independence it needs to maintain its approach and style of working. It has striven to create a good network of experts to support its work- including in its scientific advisory committee.

Nonetheless, the next 10 years presents real challenges to DNDi. The jury is still out on the success of the PDP model, and this may impact on DNDi’s ability to raise public funds. DNDi’s current portfolio now demands success in its long-term projects - the low-hanging fruits have been plucked and we are now waiting for new chemical entities (NCEs) to game change the way we manage diseases like sleeping sickness, Chagas and leishmaniasis. In its efforts to ‘professionalise’ and grow its team to deliver NCEs, there is a danger in taking a too technocratic approach that may compromise the culture of the organisation. This is all against a backdrop of donor fatigue in an economic downturn.

DNDi needs to continue to deliver, but there are a few things that can be taken into consideration.

The organisation at headquarters level needs to ensure it stays lean- and relying on its regional offices and network of partners should be an important part of the process. Strong advocacy on patients’ needs has to be maintained to ensure it can effectively communicate the urgency and need for continued funding.

Also, considering new mini portfolios, especially on ‘low-hanging fruit’ to optimise existing treatments, will be important. Organisations should always continue what they are good at- and there is a clear need and gap in the area of R&D on optimising and improving treatments through developing novel co-administrations or fixed-dose combinations, or developing repurposed drugs, for example. This may require ‘boldly going’ beyond its current comfort zones of the kinetoplastid diseases. It will be interesting for instance to observe if DNDi sees itself having a role in producing optimised treatments and combinations based on current active pipelines for diseases where there still remain gaps- its paediatric HIV portfolio is such an example, but this could include viral Hepatitis or tuberculosis .

DNDi should ensure it keeps or retains part of the culture that has made it unusual and successful. This includes maintaining an interesting and balanced range of backgrounds and skills in its staff. It will also mean that it should ensure it does not get too corporate or ‘co-opted’ into the Global Health Actor environment. By doing so, it would lose it uniqueness. This means not being too afraid to speak out and taking bold (but not reckless) positions and decisions.

If DNDi continues to be pragmatic and deliver, I am sure it will continue to be successful in building partnerships, including in the for-profit sector, and will be able to successfully respond to patients’ needs in the future. I wish DNDi the best for the next ten years.

DNDi marks its 10th anniversary this year with an online campaign, ‘Connect to Fight Neglect’. For one year, ‘Connect to Fight Neglect’ will highlight the voices of all actors in neglected disease R&D, from patients and advocates, to the health workforce and public health experts, to private companies and governments.