The pharmaceutical industry’s multifaceted role in neglected tropical disease control: from market failure to global health innovation

BACKGROUND: Neglected tropical diseases (NTDs) represent a profound market failure wherein pharmaceutical innovation systematically underserves populations with the greatest need. Despite affecting over 1.7 billion people globally, NTDs receive less than 2% of pharmaceutical research and development (R&D) investment. OBJECTIVE: This review synthesises evidence on the pharmaceutical industry's evolving role in NTD control, examining both traditional commercial models and innovative partnerships that have reshaped the global health landscape, with particular attention to implementation mechanisms and concrete operational pathways. METHODS: We conducted a comprehensive analysis of WHO reports, G-FINDER data, peer-reviewed literature, and industry commitments spanning 2000-2024, focusing on drug development pipelines, mass drug administration programmes, and financing mechanisms. RESULTS: Product Development Partnerships (PDPs) have delivered 183 approved products since 1999, though the majority represent reformulations or repurposed compounds rather than novel chemical entities (NCEs). Mass drug administration programmes have distributed over 17 billion treatments from pharmaceutical donations valued at approximately $30 billion (at wholesale prices), preventing millions of disability-adjusted life years. However, persistent innovation gaps remain: only 4 NCEs (0.5% of all new therapeutics 2000-2011) specifically targeted NTDs. Diagnostic development continues to lag due to commercial barriers and fragmented regulatory pathways. CONCLUSIONS: The pharmaceutical industry's contribution to NTD control has evolved from minimal engagement to strategic partnerships blending philanthropic drug donation, nonprofit-led R&D, and market-based incentives. While mechanisms including Priority Review Vouchers and Advance Market Commitments show potential, their effectiveness remains debated in the literature, particularly regarding access provisions and additionality. Future progress requires sustained push funding for PDPs, multi-year donor commitments, expansion of WHO prequalification for diagnostics, and strengthened South-South technology-transfer partnerships with concrete implementation frameworks.