Children are often last in the line of drug development and pandemics like Covid-19 only exacerbate the situation, says a paper published by Netherlands-based Access to Medicine Foundation.
When it comes to the “big three” epidemics of tuberculosis (TB), malaria and HIV, children in the lower- and middle-income countries are the most vulnerable. And despite focussed efforts to end these diseases by 2030, as outlined in the Sustainable Development Goals, it remains an uphill task, says the paper.
Medicines like hard pills and bitter syrups are difficult to swallow for children, making it difficult for them to stick to the treatment regimen. Additionally, when drug-resistance sets in, new medicines are needed to replace the ineffective ones. And these product gaps further hit the availability of medicines for children who are at the frontline of these diseases in less developed economies, according to the paper.
However, a pandemic like Covid-19 makes matters worse. “Governments are already struggling with the pandemic and economic losses, so it gets harder to make money available to other diseases,” Jayasree K Iyer, the Foundation’s Executive Director, told BusinessLine. “Pandemics like the coronavirus Covid-19 disrupt even basic services and supply of treatments for many diseases including HIV, malaria and TB, with a consequent impact on mortality and infection rates,” the paper pointed out.
“Children’s medicines need to be tailored for kids, be available in oral forms and not be bitter,” Iyer said, adding that there were a spate of regulations to close the gap in the development of paediatric medicines in the European Union and the United States. But research needs “more money on the table”, as there are regulatory and other costs, she said.
Calling for prioritisation, the paper points out, “If these three infectious diseases received a similar level of funding and prioritisation as the coronavirus Covid-19, successful vaccine development could have been likely years ago.”
Nudge companies
Clinical trials for paediatric medicines pose their own set of problems. And this results in delays, as medicines are first tried on adults for safety reasons. Companies too are looking for simpler regulatory processes and may be even financial incentives, she said, to nudge them to develop paediatric drugs.
Among other issues affecting the development of paediatric drugs is the increasing reliance on a few pharmaceutical companies, usually innovators to fight diseases. This increases the vulnerability of children as a group, the paper said. “This dependence can create downstream supply issues, delays and rising prices that can be particularly challenging for low- and middle-income countries with limited resources and diverse public health priorities.”
Suggesting methods to facilitate the development of paediatric drugs, the paper called for harmonisation of treatment guidelines to ensure “safe, effective, and high-quality treatments are developed and registered in the most resource-efficient manner.”
The paper, published on Tuesday, received financial support from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Foreign Affairs, UK AID, and the Bill and Melinda Gates Foundation, the Foundation said.