Fred Ledley discusses the deep ties between public science funding and private drug development. He traces the origins of this relationship to World War II and highlights how the NIH continues to provide the foundational research behind nearly every new drug. But for diseases of poverty and underserved communities, the for-profit model often fails. Ledley explores the potential of nonprofit biotech organizations—like the TB Alliance—to fill this gap. He challenges assumptions about drug pricing, innovation incentives, and the sustainability of different business models. Ledley argues for policy reforms that recognize the value of nonprofits in global health, while still holding the private sector accountable and leveraging government power to align drug development with public good.
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