After Charles Kenny agreed with me that public-health aid should be run through governments rather than non-governmental organizations acting largely independently, I had a simple question for him. If I want to give money to a public-health charity, what’s the best way of making sure that my money is being spent in alignment with the local government’s priorities?
Kenny couldn’t think of anything, at least nothing in the realm of public-facing charities. (If you’re a billionaire, of course, the opportunity space opens up a lot.) So let me make my own suggestion: DNDI, the Drugs for Neglected Diseases Initiative.
DNDI is not a government; Rachel Cohen, the executive director of DNDI for North America, calls it “a nonprofit R&D organization”. But compared to most non-profits, it has very strong ties to governments in the countries it works in, as well as to the World Health Organization.
For instance, if you look at DNDI’s board of directors, you’ll find representatives from the Kenyan and Indian medical research institutes, as well as from the Malaysian ministry of health. And DNDI’s most ambitious new project, which is designed to bring access to antibiotics to the whole world, has been structured as a joint venture with the WHO.
The basic idea behind DNDI is leverage – that dream of much philanthropy. DNDI researches neglected diseases, and tries to find cures which are suited to often-harsh field conditions where technologies like refrigeration, which many western researchers tend to take for granted, can be hard to find. But it doesn’t act like most single-disease charities, raising funds “for a cure” and acting largely unilaterally. It doesn’t have its own laboratories, it doesn’t have its own manufacturing sites, it doesn’t even employ most of the people doing research on its behalf. “We’re the conductor of a virtual orchestra” is the way that Cohen puts it – and the orchestra includes everybody from pharmaceutical companies to academic researchers to health ministries to development agencies to other nonprofit organizations. (There’s an especially close relationship with Doctors Without Borders, which seeded DNDI with the money it got from winning the 1999 Nobel Peace Prize.)
For a great example of how this works, look at fexinidazole, a new treatment for one of the deadliest diseases in sub-Saharan Africa, sleeping sickness. The standard treatment was historically to literally inject the patient with arsenic. And yes, that’s as terrible as it sounds: many people die immediately, and if you don’t die you will certainly suffer excruciating pain. More recently, the arsenic treatment has been replaced by a newer protocol involving eflornithine, a drug originally developed to prevent facial hair in women. But that involves intravenous infusions four times a day for two weeks, which is simply not practicable for many of the millions of people at risk of the disease, most of whom live very poor lives in the Democratic Republic of Congo.
Finally, however, it looks like a much easier and cheaper treatment is going to be available, in the form of fexinidazole – a drug which can be put into pill form. Just take a course of pills for 10 days, and there’s a very high chance that you’ll be cured. Regulatory approval should be coming in a matter of months, and DNDI isn’t stopping there: an even newer treatment, called oxaborole, is already undergoing real-world testing. Meanwhile, fexinidazole is also being tested to treat Chagas disease, which can have devastating effects mainly in South America. The Colombian health ministry is closely involved in the Chagas program, in a way that’s easily replicable in the rest of the continent.
Fexinidazole will be owned as a treatment for sleeping sickness by the pharmaceutical giant Sanofi, which has worked closely with DNDI for years. The partnership has managed to develop drugs at astonishingly low cost, and DNDI has extended that model to many other companies, including Astra Zeneca, Celgene, AbbVie, and Merck. Local governments are often involved from the very beginning of the process: patients are now being enrolled in a trial at the Mycetoma Research Centre in Sudan, for instance, where the drug fosravuconazole is being used to treat the neglected disease of mycetoma.
And DNDI isn’t just about drug development: it has already screened more than half a million individuals in the DRC for sleeping sickness, and globally it has distributed an astonishing 430 million ASAQ treatments for malaria. Pretty impressive for a small Geneva-based organization with just 178 employees.
DNDI is not one of those charities many people have heard of: it tends to get its donations in very large chunks from large non-profits (the Gates Foundation has given €103.7m since 2003) and governments (led by the UK, which has given €83.5m). Public support has also come from Australia, Brazil, the Netherlands, the EU, Germany, France, Japan, Norway, Switzerland, Italy, Colombia, and the USA. But, as ever, more is better. If you give money to DNDI, you will be helping to save lives all over the world, and buying into a proven and extremely efficient model. Most importantly, you will be swimming with the current, rather than against it: your money will be effectively leveraged across many different sectors, including local governments in the affected regions.
Let other medical charities strike their own course in a quixotic attempt to zag where governments zig. This is one area where it’s best to just trust the global experts in the field, and let your money work in concert with dozens of well-funded institutions and governments around the world.