| Popis: |
Summary A key step in the control of neglected tropical diseases (NTDs) is the development of novel preventive and therapeutic products that are appropriate for use in the areas most affected by the diseases. Safe and effective medical products against these diseases either do not exist, or they are inappropriate for use in remote, tropical and resource-poor areas. Now that the level of investments in research and development (R&D) seems to have reached a plateau, there is a clear need for maximizing the societal return on investments. This thesis aims to contribute to reducing the burden of NTDs by investigating how the societal impact of innovation in the field of NTDs can be enhanced. The research builds upon the Societal Impact Value Cycle (SIVC), a theoretical model rooted in knowledge valorisation, systems of innovation, and the linear model of innovation. A combination of qualitative and quantitative methods is used throughout this thesis and a case study approach is applied in three studies to gain in-depth understanding of the mechanisms that increase or impede the societal impact of innovation effort. Rabies is selected as a case for NTDs. Chapter 4 provides an overview of the most substantive impediments to innovation in human rabies prophylaxis and treatment. It shows that there are important barriers beyond the limited return on investment that sort their effect across all domains of the SIVC. The set of barriers is specific to the context of the disease and medical products under study, while some barriers are applicable to other NTDs or zoonotic diseases. Chapter 5 investigates to what extent unmet needs in the society domain are used as guidance for research in the field of NTDs. The results of this study show that experts consider the animal host most important for rabies control, while top research priorities reflect the invariable need for improved preventive and therapeutic products for human use. Chapter 6 investigates the extent to which the unmet needs of society are effectively articulated into demands and translated into research efforts, by providing insight in the amount of innovation efforts per Disability Adjusted Life Year (DALY) of the disease. The study reveals a large difference in the extent to which the individual NTDs are neglected. Chapter 7 provides an overview of the innovation landscape of rabies and an analysis of its relevance to high risk, low income settings. To this end, a quantitative measure for patent quality is developed. The results reveal quantitative and qualitative changes and discrepancies in patents and clinical trials over time, that point to limited potential of the product pipeline to decrease the burden of disease. Chapter 8 aims to understand the mechanisms through which research funding is allocated and how these influence the potential societal impact of the research projects that are awarded funding. The results show that although societal impact is funding organizations’ main rationale to fund R&D in the field of NTDs, it is not the most decisive funding criterion. The thesis demonstrates a gap between unmet medical needs and R&D efforts, that is created by market failure, a lack of stakeholder collaboration and context-specific challenges. It is the complex interplay between these stimulating and hampering factors, both within and between the value chains, that lead to competition within the field of NTDs and steer innovation efforts away from the most pressing needs. The distribution of resources should be carefully reconsidered in order to enhance societal impact of innovation and reduce the burden of NTDs. |
