Chagas disease is caused by a parasite transmitted through the bite of an insect. It is endemic to Latin America and most commonly afflicts the poor living in rural villages. Due to the high prevalence of infected individuals, blood transfusion is now the second leading cause of transmission in places like Brazil. Estimates vary, but there are probably 10 million people who are carriers of this disease, and approximately 30 percent of infected individuals will develop heart failure (cardiomyopathy) and die prematurely as a result of their infection.

BIO Ventures for Global Health is committed to bringing the tools of biotechnology and the expertise of the biotech industry—which have created dramatic improvements in the treatment of chronic diseases such as autoimmunity, heart disease, HIV, and cancer—to bear on the problem of neglected diseases such as Chagas disease. So an important question is: how can the global health community marshal the resources necessary for serious, innovative drug and diagnostics research and development (R&D) to address this health scourge? One mechanism is to create appropriately sized incentives to make it feasible for companies to invest in global health; the quid pro quo for this financial support is that companies must agree to principles allowing the poorest populations of the world to access these novel medicines at low or no profit. But incentives don’t have to be the sole solution.

In listening to the speakers at last week’s UCLA symposium “Chagas Disease in the Americas: Improving Access and Tools for Patient Diagnosis and Treatment,” I was struck by similarities between Chagas disease and a viral infection common in the U.S., hepatitis C virus (HCV). It turns out that there are about 3 million Americans who are infected with HCV, comparable to the 3 million people infected with Chagas in Brazil and Mexico combined. Like Chagas, HCV is a silent infection that causes long term damage to a major organ only after several decades. HCV is a leading cause of liver failure and liver cancer worldwide, while Chagas causes heart failure. Like the treatments for Chagas, the currently licensed therapy for HCV is difficult to tolerate (it’s described as feeling like having the flu for 48 weeks!) and, in the case of patients with genotype I virus (the major type in the U.S.), only about 50% effective.

Yet the parallels between Chagas and HCV only go so far. Less than $1 million was spent in 2008 on developing new medicines to treat Chagas. This is a paltry sum when one considers that it costs $300 to $800 million to develop a novel drug! But it reflects the reality that patients who have Chagas are among the poorest in the Western Hemisphere and have little voice politically or economically. While Chagas is an orphan, there is a monumental effort by pharmaceutical and biotech companies to develop novel therapies for HCV: one recent assessment noted that there are more than 40 novel drugs being tested at various stages of clinical trials! These therapies promise to transform this potentially deadly viral infection into one that can be cured with pharmaceutical intervention.

So why this dichotomy between Chagas and HCV? The main difference is that drug development companies can identify a robust market for HCV therapy. The market is currently well over $2 billion in the U.S. and Europe, and it stands to grow substantially upon approval of the next generation of drugs. In contrast, medicines for Chagas are sold at essentially no profit and the market is not an inducement to innovation. But one under-recognized fact regarding Chagas is that about 300,000 people in the U.S. are actively infected with perhaps another 60,000 infected individuals in Europe. These are mostly Latino immigrants who are now living outside their native countries. It stands to reason that these individuals, in the absence of a safe and effective therapy, will become a significant economic and medical burden if their disease goes untreated and they develop heart disease at some point in the future. So there may actually be a compelling financial–as well as humanitarian–reason to engage in drug discovery to create safer and more effective treatments to cure Chagas disease. While the market opportunity alone may not be sufficient to induce significant R&D investment, BVGH hopes that a combination of incentives and the recognition of a real commercial opportunity in the U.S. and Europe may lead more companies to take steps to invest in Chagas disease drug discovery.

David Cook is the Vice President of Business Development at BIO Ventures for Global Health.