Barriers to innovation in human rabies prophylaxis and treatment: A causal analysis of insights from key opinion leaders and literature.

L.H.M. van de Burgwal, A.M.G. Neevel, C.A.C.M. Pittens, A.D.M.E. Osterhaus, C.E. Rupprecht, H.J.H.M. Claassen

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    Rabies is an essentially 100% fatal, zoonotic disease, caused by Lyssaviruses. Currently, the disease is vaccine-preventable with pre- and post-exposure prophylaxis (PrEP and PEP). Still, rabies virus is estimated to cause up to 60,000 human deaths annually, of which the vast majority occurs in rural Asia and Africa, due to the inaccessibility of prophylaxis and non-existence of treatment. Despite these unmet clinical needs, rabies control mainly focuses on the sylvatic reservoir and drug innovation receives relatively little attention compared to other neglected tropical diseases (NTDs). As such, the lag of innovation in human rabies prophylaxis and treatment cannot be explained by limited return on investment alone. Strategies countering rabies-specific innovation barriers are important for the acceleration of innovation in human rabies prophylaxis and treatment. Barriers throughout society, science, business development and market domains were identified through literature review and 23 semi-structured interviews with key opinion leaders worldwide. A subsequent root cause analysis revealed causal relations between innovation barriers and a limited set of root causes. Finally, prioritization by experts indicated their relative importance. Root causes, which are fundamental to barriers, were aggregated into four types: market and commercial, stakeholder collaboration, public health and awareness, and disease trajectory. These were found in all domains of the innovation process and thus are relevant for all stakeholders. This study identifies barriers that were not previously described in this specific context, for example the competition for funding between medical and veterinary approaches. The results stress the existence of barriers beyond the limited return on investment and thereby explain why innovation in human rabies medication is lagging behind NTDs with a lower burden of disease. A re-orientation on the full spectrum of barriers that hinder innovation in rabies prophylaxis and treatment is necessary to meet unmet societal and medical needs.

    Original languageEnglish
    Pages (from-to)599-611
    Number of pages13
    JournalZoonoses and Public Health
    Volume64
    Issue number8
    DOIs
    Publication statusPublished - 1 Dec 2017

    Funding

    The authors gratefully acknowledge the contribution of all participants of the interviews as well as the members of the ASKLEPIOS consortium ([email protected]) for participating in the focus group discussion. The authors would like to thank Bahar Ramezanpour, PhD, Tommy Riemens, MSc, Pim Kamphuis, MSc, regarding data collection and Esther Pronker, PhD, for her contributions regarding data analysis. The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement No.602825-2 (Project ASKLEPIOS). The authors gratefully acknowledge the contribution of all participants of the interviews as well as the members of the ASKLEPIOS consortium ([email protected]) for participating in the focus group discussion. The authors would like to thank Bahar Ramezanpour, PhD, Tommy Riemens, MSc, Pim Kamphuis, MSc, regarding data collection and Esther Pronker, PhD, for her contributions regarding data analysis. The research leading to these results has received funding from the European Community's Seventh Framework Programme under grant agreement No.602825-2 (Project ASKLEPIOS).

    FundersFunder number
    Seventh Framework ProgrammeNo.602825-2

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