Swiss non-profit drugmakers team up as funding shrinks

A technician in Guinea runs a blood test for sleeping sickness, or human African trypanosomiasis, a neglected disease transmitted by the tsetse fly. Sleeping sickness can lead to death if left untreated. It is one of the diseases the Drugs for Neglected Diseases initiative focuses on. Keystone

Waning commitments to global health causes and big pharma’s financial imperatives are threatening the development of innovative drugs to help patients left on the sidelines of medicine.

Key takeaways

• Three Geneva-based non-profit drug developers are pooling resources for R&D, advocacy and communications.
• Pharma R&D spending on neglected diseases fell from $824 million in 2018 to $623 million in 2024.
• Experts are warning the world is becoming “a more selfish place.”

A malaria therapy for newborns, an antiviral medicine against chronic hepatitis C, and an antibiotic to treat gonorrhea are among new drugs developed by three Geneva-based non-profit organisations that will be launched in various low- and middle-income countries in the coming months.

And these are just the treatments approved in the last eight months. Over the past two decades, the Medicines for Malaria Venture (MMV), the Drugs for Neglected Diseases initiative (DNDi) and the Global Antibiotic Research and Development Partnership (GARDP) have delivered dozens of solutions to millions of low-income patients neglected by profit-driven pharmaceutical companies.

DNDi’s hepatitis C drug, for example, was initially sold for less than $300 (CHF240) in Malaysia, whereas a patented drug targeting the same disease cost $11,000. This was only made possible by a non-profit model that’s based on collaboration with pharma.

But a decline in partnerships and in commitments from major donors to international organisations like the World Health Organization (WHO) have plunged successful non-profit drug development models into uncertainty. Pharma research and development (R&D) for neglected diseases peaked at $824 million in 2018, but shrank by nearly a quarter to $623 million in 2024, according to the G-Finder data portal of research and policy organisation Impact Global Health.

Faced with waning interest from pharma, the three NGOs announced in June they were forming an alliance that will pool their resources in R&D, advocacy, and communications to accelerate the development of treatments for neglected patients.

“Our model works: we develop drugs that address urgent public health needs and that wouldn’t otherwise exist, but what we clearly see across donors is that the world has become a more selfish place,” said Peter Beyer, deputy executive director of GARDP.

As the industry and governments in high-income nations become less engaged with developing drugs for patients in poorer countries, these NGOs are looking for ways to continue delivering solutions.

How it all started

The Medicines for Malaria Venture (MMV) was set up in 1999 to develop new drugs targeting the illness. It was followed in 2003 by the Drugs for Neglected Diseases initiative (DNDi), which focuses on “diseases of poverty” that can proliferate in areas with lack of access to clean water and basic sanitation, like dengue, Chagas disease, and leishmaniasis. Its spin off, the Global Antibiotic Research and Development Partnership (GARDP), was set up in 2016 to address the collapsing field of antibiotic research.

All three NGOs are based in Geneva because of the global health ecosystem that has developed in the city around the headquarters of the WHO.

Despite the nature of their work, none of these organisations has a lab. Instead, they are product development partnerships (PDPs), meaning they have access to big pharma expertise, including compound libraries (a collection of molecules that could treat pathogens) and manufacturing capabilities. Because the NGOs confine themselves to neglected or abandoned areas of research, pharmaceutical companies agree to collaborate.

When in 2005 DNDi started working on sleeping sickness, a parasitic disease prevalent in sub-Saharan Africa that’s caused by tstetse fly bites, it searched through Sanofi’s library in partnership with the Swiss Tropical and Public Health Institute. DNDi researchers unearthed Fexinidazole, a molecule first discovered in 1978 by a company that later merged with Sanofi, and conducted successful clinical trials. Sanofi then secured approval for the drug in endemic countries, manufactured it, and donated it from 2018 onwards to the WHO, which assured distribution.

The drug development timeline is roughly the same as big pharma (eight to ten years to bring a drug to market), although PDPs usually work with compounds that already exist. These molecules have simply not been researched further by manufacturers because of their poor financial prospects.

Pharma’s great exit

Traditionally, pharmaceutical companies have engaged in these partnerships for reputational and corporate social responsibility (CSR) reasons – large companies in the European Union and Switzerland must provide CSR reports. Participation gives companies a higher score on the Access to Medicine Index, a benchmark tracking how the top 20 pharma giants improve access to medicines, vaccines and diagnostics in low- and middle-income countries. For many institutional investors, a high ranking is a key performance indicator.

The problem is that the index gives companies a PR boost but also allows them to game the system. That’s because it does not give engagement in innovation and R&D enough weight, according to Laurent Fraisse, R&D director at DNDi. Companies can gain CSR points by donating existing drugs instead of doing the initial, but expensive, research and laboratory work to discover new ones. “Giving products or providing access to them is great, but thinking about future needs and planning for them is better and should be more valued,” Fraisse said. “Innovating without pharma is possible, but we’d rather do it with them.”

Because pharma giants focus on delivery rather than discovery, non-profit organisations involved in PDPs are increasingly pushed to rely on academic laboratories and expensive service providers for early-stage R&D. But universities’ capabilities are far smaller than those of multinational corporations and it costs non-profits significantly more to build their own alternatives to industry expertise.

This has become an increasingly serious problem over the past decade, with several of the big pharma companies announcing they would abandon R&D for infectious diseases – including malaria and anti-microbial resistance – because of poor commercial returns. The exodus has decimated partnerships. While DNDi boasted 15 pharmaceutical partners in 2015, it now only has five. Similarly, GARDP’s gonorrhea treatment orignated at AstraZeneca but was transfered to its spin off Entasis when the unit housing the original compound closed down.

Astra Zeneca did not respond to a Swissinfo request for comment.

Not all companies are pulling out. Swiss pharma giant Novartis developed Coartem Baby, the world’s first malaria treatment for newborns and young infants in collaboration with MMV. The drug was prequalified by the WHO last April.

“It’s really great that some partners like Novartis are bucking the trend and staying invested in infectious diseases, but there has been a general reduction,” said Emma Hannay, MMV’s chief strategy officer.

“You lose the resources but also the expertise that comes from those partnerships. A lot of the world’s expertise in diseases of poverty sit within pharmaceutical companies, and we’re at risk of losing a lot of those assets,” she added.

Declining aid

Although access to pharma expertise is an invaluable resource, the three PDPs also rely on philanthropic foundations like the Wellcome Trust, and the development funds of countries like Switzerland, France, Germany, Japan and the United Kingdom. But the economic impact of the Covid-19 pandemic, rapidly shifting geopolitical landscapes and a growing trend of withdrawing from global cooperation (led by the US, which left the WHO in 2026 on the order of President Donald Trump), is pressuring other countries to also cut international aid.

While donors are still engaging and supportive of the work of PDPs, the amount of money they provide is shrinking. “There’s just less funding available for the same number of organisations,” said Beyer of GARDP.

And even when there is funding, scrutiny has intensified. “It’s not good enough today to say, ‘We are going to help some neglected population in a specific part of the world’,” said Beyer. “Parliamentarians ask for more – they want to know how their money will benefit their own population.”

While GARDP and DNDi have already been collaborating since 2016, the funding squeeze and pharma’s growing exodus have driven them to set up a formal three-way alliance with MMV. GARDP and DNDi already share processes used to control the physical and chemical characteristics of drugs along with their quality and consistency in manufacturing – that know-how traditionally sat with industry partners. DNDi and MMV have also launched a joint regulatory platform that will pool expertise and resources to streamline product registration and accelerate patient access.

Despite these headwinds, the immediate future of these PDPs is secure. Because their operations are backed by multi-year grants from sovereign donors and philanthropic foundations, their financing is locked in for the next five years.

“We are not afraid of going under or failing to survive,” said Beyer. “We are cost effective and we are producing real outputs. But it doesn’t mean that we can’t become more effective, and we are also very open to collaborate with other organisations.”

Edited Virginie Mangin/Nerys Avery/gw