A new initiative based at the University of California, Davis, will tap the power of sharing to develop health solutions for the developing world.

But the Global Health Share Initiative is not about charity. It aims to combine university discoveries, philanthropy, social entrepreneurs, investors and private companies to create profitable, affordable health care products in a socially responsible and culturally relevant way, said Ray Rodriguez, a professor of molecular and cellular biology and director of the Center of Excellence for Nutritional Genomics at UC Davis, who is leading the initiative.

"It has been estimated that the potential market for food and health products in low-income and developing countries is worth as much as $4 trillion. This is a tremendous opportunity for anyone who has the courage, compassion and the creativity to get involved," Rodriguez said.

The initiative is already working on two projects in collaboration with doctors and scientists in Bangladesh and South Africa: a new, improved formulation of oral rehydration solution for treating diarrhea, and plant-based vaccines and antibodies for treating and preventing rabies.

The U.S. model of entrepreneurs backed by venture capitalists looking to invest a lot of money and get a big return does not work in the developing world, said Somen Nandi, managing director of the GHSI. Nandi said that the GHSI approach uses a “teach a man to fish” philosophy that will give researchers, philanthropic groups, local social entrepreneurs and private companies an opportunity to work together to make safe, effective, affordable and sustainable health products.

In the jargon of international development, this approach is called a “hybrid value chain,” which uses the assets and capabilities of businesses and organizations to address the needs of a low-income population. Hybrid value chains are neither purely philanthropic, nor entirely profit-driven, but combine elements of both.

The ultimate goal, said Rodriguez, is to turn developing and low-income countries from consumers of imported health products into exporters of these products.

"Why are companies like Google and Skype so successful? They use the power of the Internet and free downloads to attract customers and then charge minimal fees for services and products. It’s the concept of unit price times a billion instead of the 5 to10-fold on investment in three to five years model,” Nandi said.

Rodriguez, Nandi and the partners in the GHSI, which includes representatives from universities, government labs, non-government organizations, and private companies around the world, believe that there is a new approach that can improve health and turn a profit. It's an approach based on making small profits on big markets; low-cost manufacturing; and experts who are willing to invest not just money but time, expertise and intellectual property -- and wait a long time for a payout.

About 4 billion people, two-thirds of humanity, live on a dollar a day or less, with inadequate nutrition and little or no access to healthcare, Rodriguez said. Simply giving food or medicine to those in need is not sustainable and increasingly unpopular with philanthropic and humanitarian organizations, he said.

"But if you can make and sell things for reasonable profits within these countries, you can create both healthy communities and healthy economies, in other words, we can expand global economic citizenship, one healthy village at a time," Rodriguez said.

The biotech industry is notorious for its "valley of death" — the gap between making a promising discovery in the lab and bringing the product or technology to the market. In the U.S., bridging this gap can cost hundreds of millions of dollars in research and development costs and the clinical trials needed to achieve regulatory approvals. To recoup that money, venture investors are understandably keen to see big profits once a drug hits the market.

In many cases, that means promising products, particularly those suited for the needs of the developing world, get shelved even though research and early development have been done, because they are not expected to be lucrative in Western markets.

The GHSI plans to pick up some of these orphan products and take them to market.

"We can reduce the financial burden by taking products that are already prototyped and leveraging the collected assets of our members to take it the rest of the way," Nandi said. "We're not doing discovery research."

Oral rehydration solutions, a mixture of glucose and salts that can be mixed into water and used to quickly revive patients dehydrated by diarrhea, are one promising group of products.

The GHSI recently signed a memorandum of understanding with the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B) and the government of Bangladesh to go ahead with clinical trials for a new oral rehydration solution. Infectious diarrhea kills almost 2 million children a year.

“The ICDDR,B hospital can see up to 500 sick babies per day and five times that in the country’s two peak cholera seasons,” Rodriguez said.

At the ICDDR,B, doctors routinely add rice flour to the rehydration solution to boost its effectiveness. The GHSI will work with the Center’s doctors on a next-generation oral rehydration treatment that will also include two antibacterial compounds, lactoferrin and lysozyme, which are found naturally in human breast milk. The physicians are calling it the “Super ORS,” Rodriguez said.
In clinical trials in Peru, researchers from UC Davis and Peru found that the enhanced mix reduced the duration and severity of diarrhea in children compared to regular oral rehydration mix.

In addition to the super ORS, the GHSI also has an agreement with the Center for Disease Control in the Bangladesh’s Directorate for Health Services and the Institute for Allergy and Clinical Immunology to begin testing a plant-based vaccine and antibodies for preventing and treating rabies.

While Louis Pasteur made the first rabies vaccine over 125 years ago, it is still a serious health problem in Africa. South and South East Asia and Latin America. Experts estimate that about 55,000 people die annually as a result of rabies, usually contracted from dog bites, but many more cases probably go undiagnosed.

“Rabies is a disease of the poor because it is largely neglected by the developed world. This is inhumane,” said Professor Moazzem Hossain, former director of Disease Control for the government of Bangladesh and now director of the Bangladesh Anti-Rabies Alliance. Likewise, indiscriminately killing thousands of strays, including household pets, in an effort to curb rabies, is also inhumane.

“We need better solutions,” he said.

Rabies is 100 percent fatal if not treated but 100 percent survivable if treatment is given before symptoms develop. Treatment involves inoculation with both anti-rabies antibodies made from human or horse serum, as well as with an anti-rabies vaccine that primes the body’s immune system.

But these treatments are expensive, potentially risky and often in short supply. There is a clear need for an effective, safe, low-cost product, said Rachel Chikwamba, chief scientist at the Council for Scientific and Industrial Research in Pretoria, South Africa.

To meet that need, Chikwamba and CSIR, in collaboration with the GHSI, are setting up Greenpharm, a startup company that will make rabies antibodies in tobacco plants.

The plants are genetically engineered to produce a cocktail of antibodies to rabies, and the proteins will then be extracted and purified for use in humans. Data from tests so far show that the plant-based product is as effective or better than a product made from human or horse serum, and much cheaper to produce, Chikwamba said.

They also plan to make an anti-rabies vaccine, she said.

Working with Hossain, the GHSI is exploring sites in Bangladesh for a future rabies vaccine and antibody production facility that can produce the materials needed to begin human clinical studies.

The target price for the rabies vaccine is 10 to 30 cents or about one tenth of the current price per dose -- affordable for the poor but with a small profit built in to repay the investment.

"This is all proven technology, but it has not been implemented for financial or regulatory reasons," Rodriguez said. "There are so many potential health products like these just sitting on the shelf."

Through GHSI, Rodriguez is donating some of his own intellectual property on protein production in plants to the effort, which would make the antibodies and vaccine free for use in the developing world and for sale elsewhere.

Everybody wins with the power of sharing, Rodriguez believes. He said that he has been gratified to find that many of his colleagues feel the same way. And the depth and variety of UC Davis's international connections have also been a great help, he said.

"GHSI has taken off because people have tremendous respect for UC Davis and know what this institution can do when it sets its mind to meeting a challenge," he said.