Crowdfunding drug development: the state of play in oncology and rare diseases

Quantitative revenue estimates and qualitative assessments of innovative fundraising sources for treating rare diseases in Colombia

Background: Like many developing countries, Colombia faces difficulties in financing health-care services as well as programs for health promotion and health education and there is evidence that its health-care system is underperforming. Objective: To provide evidence-based estimates of potential funding levels and assess the strengths, weaknesses, and viability of innovative funding mechanisms with a focus on treating rare diseases in Colombia. Methods: The strategy involved evidence-based projections of potential funding levels and a qualitative viability assessment using an expert panel. Results: Crowdfunding, corporate donation, and social impact bonds (SIBs) were deemed to be the most viable of numerous potential strategies. Expected funding levels over 10 years for rare diseases in Colombia from crowdfunding, corporate donations, and SIBs were roughly $7,200, $23,000, and $12,400, respectively. Conclusions: Based on the combination of projected funding potential along with expert consensus regarding viability and operability, crowdfunding, corporate donations, and SIBs, especially in combination, have the potential to substantially improve funding for vulnerable patient populations in Colombia.

An overview of Fintech applications to solve the puzzle of health care funding: state-of-the-art in medical crowdfunding

Crowdfunding is emerging as an alternative form of funding for medical purposes, with capital being raised directly from a broader and more diverse audience of investors. In this paper, we have systematically researched and reviewed the literature on medical crowdfunding to determine how crowdfunding connects with the health care industry. The health care industry has been struggling to develop sustainable research and business models for economic systems and investors alike, especially in pharmaceuticals. The research results have revealed a wealth of evidence concerning the way crowdfunding is applied in real life. Patients and caregivers utilize web platform-based campaigns all over the world to fund their medical expenses, generally on a spot basis, using donation-based or even reward-based schemes, regardless of the health care system archetype (public, private insurance-based or hybrid). Academics have also focused on funding campaigns and the predictors of success (which range from social behaviour and environment to the basic demographics of the campaigners and their diseases) and on social and regulatory concerns, including heightened social inequality and stigma. While equity crowdfunding is disrupting the way many ventures/businesses seek capital in the market, our research indicates that there are no relevant or consistent data on the practice of medical equity crowdfunding in health care, apart from a few anecdotal cases.

Crowdfunding for health research: a qualitative evidence synthesis and a pilot programme

Background

Many low-income and middle-income country (LMIC) researchers have disadvantages when applying for research grants. Crowdfunding may help LMIC researchers to fund their research. Crowdfunding organises large groups of people to make small contributions to support a research study. This manuscript synthesises global qualitative evidence and describes a Special Programme for Research and Training in Tropical Diseases (TDR) crowdfunding pilot for LMIC researchers.

Methods

Our global systematic review and qualitative evidence synthesis searched six databases for qualitative data. We used a thematic synthesis approach and assessed our findings using the GRADE-CERQual approach. Building on the review findings, we organised a crowdfunding pilot to support LMIC researchers and use crowdfunding. The pilot provided an opportunity to assess the feasibility of crowdfunding for infectious diseases of poverty research in resource-constrained settings.

Results

Nine studies were included in the qualitative evidence synthesis. We identified seven findings which we organised into three broad domains: public engagement strategies, correlates of crowdfunding success and risks and mitigation strategies. Our pilot data suggest that crowdfunding is feasible in diverse LMIC settings. Three researchers launched crowdfunding campaigns, met their goals and received substantial monetary (raising a total of US$26 546 across all three campaigns) and non-monetary contributions. Two researchers are still preparing for the campaign launch due to COVID-19-related difficulties.

Conclusion

Public engagement provides a foundation for effective crowdfunding for health research. Our evidence synthesis and pilot data provide practical strategies for LMIC researchers to engage the public and use crowdfunding. A practical guide was created to facilitate these activities across multiple settings.

Exploring new uses for existing drugs: innovative mechanisms to fund independent clinical research

BACKGROUND

Finding new therapeutic uses for existing medicines could lead to safe, affordable and timely new treatment options for patients with high medical needs. However, due to a lack of economic incentives, pharmaceutical developers are rarely interested to invest in research with approved medicines, especially when they are out of basic patent or regulatory protection. Consequently, potential new uses for these medicines are mainly studied in independent clinical trials initiated and led by researchers from academia, research institutes, or collaborative groups. Yet, additional financial support is needed to conduct expensive phase III clinical trials to confirm the results from exploratory research.

METHODS

In this study, scientific and grey literature was searched to identify and evaluate new mechanisms for funding clinical trials with repurposed medicines. Semi-structured interviews were conducted with 16 European stakeholders with expertise in clinical research, funding mechanisms and/or drug repurposing between November 2018 and February 2019 to consider the future perspectives of applying new funding mechanisms.

RESULTS

Traditional grant funding awarded by government and philanthropic organisations or companies is well known and widely implemented in all research fields. In contrast, only little research has focused on the application potential of newer mechanisms to fund independent clinical research, such as social impact bonds, crowdfunding or public-private partnerships. Interviewees stated that there is a substantial need for additional financial support in health research, especially in areas where there is limited commercial interest. However, the implementation of new funding mechanisms is facing several practical and financial challenges, such as a lack of expertise and guidelines, high transaction costs and difficulties to measure health outcomes. Furthermore, interviewees highlighted the need for increased collaboration and centralisation at a European and international level to make clinical research more efficient and reduce the need for additional funding.

CONCLUSIONS

New funding mechanisms to support clinical research may become more important in the future but the unresolved issues identified in the current study warrant further exploration.

Predicting Fundraising Performance in Medical Crowdfunding Campaigns Using Machine Learning

The coronavirus disease (COVID-19) pandemic has flooded public health organizations around the world, highlighting the significance and responsibility of medical crowdfunding in filling a series of gaps and shortcomings in the publicly funded health system and providing a new fundraising solution for people that addresses health-related needs. However, the fact remains that medical fundraising from crowdfunding sources is relatively low and only a few studies have been conducted regarding this issue. Therefore, the performance predictions and multi-model comparisons of medical crowdfunding have important guiding significance to improve the fundraising rate and promote the sustainable development of medical crowdfunding. Based on the data of 11,771 medical crowdfunding campaigns from a leading donation-based platform called Weibo Philanthropy, machine-learning algorithms were applied. The results demonstrate the potential of ensemble-based machine-learning algorithms in the prediction of medical crowdfunding project fundraising amounts and leave some insights that can be taken into consideration by new researchers and help to produce new management practices.

Participant-funded clinical trials on rare diseases

The development of medicines for certain rare diseases can be cut short by lack of funding. In certain cases the patients themselves, or their relatives, occasionally fund the clinical trial in which they will be treated with the investigational medicine. There are three models of self-funded clinical research: two of them, 'pay to try' and 'pay to participate', have already been put into practice. The third, the 'plutocratic' proposal, which has been recently put forward is still a theoretical model. In this work the scientific, social and ethical benefits and risks of the two clinical research models, 'pay to participate and the 'plutocratic' proposal, are reviewed. Patient-funded clinical trials are frequently performed through crowdfunding. The most controversial aspects of this funding modality are also addressed in this article from several perspectives. Finally, a future scenario that would allow the launching of self-funded clinical trials in Spain by the 'plutocratic' proposal is proposed.

Understanding the Dimensions of Medical Crowdfunding: A Visual Analytics Approach

Background

Medical crowdfunding has emerged as a growing field for fundraising opportunities. Some environmental trends have driven the emergence of campaigns to raise funds for medical care. These trends include lack of medical insurance, economic backlash following the 2008 financial collapse, and shortcomings of health care regulations.

Objective

Research regarding crowdfunding campaign use, reasons, and effects on the provision of medical care and individual relationships in health systems is limited. This study aimed to explore the nature and dimensions of the phenomenon of medical crowdfunding using a visual analytics approach and data crawled from the GoFundMe crowdfunding platform in 2019. We aimed to explore and identify the factors that contribute to a successful campaign.

Methods

This data-driven study used a visual analytics approach. It focused on descriptive analytics to obtain a panoramic insight into medical projects funded through the GoFundMe crowdfunding platform.

Results

This study highlighted the relevance of positioning the campaign for fundraising. In terms of motivating donors, it appears that people are typically more generous in contributing to campaigns for children rather than those for adults. The results emphasized the differing dynamics that a picture posted in the campaign brings to the potential for medical crowdfunding. In terms of donor’s motivation, the results show that a picture depicting the pediatric patient by himself or herself is the most effective. In addition, a picture depicting the current medical condition of the patient as severe is more effective than one depicting relative normalcy in the condition. This study also drew attention to the optimum length of the title. Finally, an interesting trend in the trajectory of donations is that the average amount of a donation decreases with an increase in the number of donors. This indicates that the first donors tend to be the most generous.

Conclusions

This study examines the relationship between social media, the characteristics of a campaign, and the potential for fundraising. Its analysis of medical crowdfunding campaigns across the states offers a window into the status of the country’s health care affordability. This study shows the nurturing role that social media can play in the domain of medical crowdfunding. In addition, it discusses the drivers of a successful fundraising campaign with respect to the GoFundMe platform.

Working the crowd for forensic research: A review of contributor motivation and recruitment strategies used in crowdsourcing and crowdfunding for scientific research

Crowdsourcing and crowdfunding have been successfully used in a range of scientific disciplines and present opportunities for forensic researchers to draw on the power of large numbers of people to contribute to research projects through participation or by providing an alternative source of funding. This review aimed to examine whether contributors to crowd science and crowdfunding for scientific research are motivated to participate or provide financial support by the same factors, and to examine recruitment strategies in an attempt to identify a potential crowd for forensic researchers to approach. There was found to be limited research into crowdfunding for scientific research that addressed the motivations of contributors or recruitment strategies used, and no conclusions could be made. There is a need to overcome low response rates and high attrition over the lifetime of a crowd science project or crowdfunding appeal. It is necessary to target a large number of people who are interested in the subject studied and who want to make a difference in some way and contribute to science. True crime podcast audiences are proposed as they present large numbers of listeners who are interested in forensic science, criminal investigation or law enforcement. These audiences have been targeted for successful fundraising efforts and invitations to participate in crowd activities previously. They should be considered by forensic researchers who are looking to venture into crowdsourcing or crowdfunding for research projects.

Success factors of crowdfunding campaigns in medical research: perceptions and reality

Crowdfunding in medical research is becoming more popular owing to increasing competition for the shrinking amount of government funding. To inform researchers applying for this complementary source of research funding, we investigate the determinants of successful crowdfunding campaigns in medical research. We find that establishing and maintaining professional contacts through social media is of major importance for successful crowdfunding campaigns; an additional tweet or retweet significantly increases the success of crowdfunding campaigns. In contrast to the stated preferences of prospective donors, we document that crowdfunding campaigns can achieve their fundraising goal regardless of the disease characteristics. Scientists could therefore request funding for any kind of project, including therapies for rare diseases and diseases with lower mortality rates.

Ethical implications of medical crowdfunding: the case of Charlie Gard

Patients are increasingly turning to medical crowdfunding as a way to cover their healthcare costs. In the case of Charlie Gard, an infant born with encephalomyopathic mitochondrial DNA depletion syndrome, crowdfunding was used to finance experimental nucleoside therapy. Although this treatment was not provided in the end, we will argue that the success of the Gard family's crowdfunding campaign reveals a number of potential ethical concerns. First, this case shows that crowdfunding can change the way in which communal healthcare resources are allocated. Second, within the UK's National Health Service, healthcare is ostensibly not a market resource; thus, permitting crowdfunding introduces market norms that could commodify healthcare. Third, pressures inherent to receiving funds from external parties may threaten the ability of patients-cum-recipients to voluntarily consent to treatment. We conclude that while crowdfunding itself is not unethical, its use can have unforeseen consequences that may influence conceptions of healthcare and how it is delivered.

The price of progress: Funding and financing Alzheimer's disease drug development

INTRODUCTION

Advancing research and treatment for Alzheimer's disease (AD) and the search for effective treatments depend on a complex financial ecosystem involving federal, state, industry, advocacy, venture capital, and philanthropy funding approaches.

METHODS

We conducted an expert review of the literature pertaining to funding and financing of translational research and drug development for AD.

RESULTS

The federal government is the largest public funder of research in AD. The National Institute on Aging, National Institute of Mental Health, National Institute of General Medical Sciences, and National Center for Advancing Translational Science all fund aspects of research in AD drug development. Non-National Institutes of Health federal funding comes from the National Science Foundation, Veterans Administration, Food and Drug Administration, and the Center for Medicare and Medicaid Services. Academic Medical Centers host much of the federally funded basic science research and are increasingly involved in drug development. Funding of the "Valley of Death" involves philanthropy and federal funding through small business programs and private equity from seed capital, angel investors, and venture capital companies. Advocacy groups fund both basic science and clinical trials. The Alzheimer Association is the advocacy organization with the largest research support portfolio relevant to AD drug development. Pharmaceutical companies are the largest supporters of biomedical research worldwide; companies are most interested in late stage de-risked drugs. Drugs progressing into phase II and III are candidates for pharmaceutical industry support through licensing, mergers and acquisitions, and co-development collaborations.

DISCUSSION

Together, the funding and financing entities involved in supporting AD drug development comprise a complex, interactive, dynamic financial ecosystem. Funding source interaction is largely unstructured and available funding is insufficient to meet all demands for new therapies. Novel approaches to funding such as mega-funds have been proposed and more integration of component parts would assist in accelerating drug development.

Crowdfunding our health: Economic risks and benefits

Crowdfunding is an expanding form of alternative financing that is gaining traction in the health sector. This article presents a typology for crowdfunded health projects and a review of the main economic benefits and risks of crowdfunding in the health market. We use evidence from a literature review, complimented by expert interviews, to extend the fundamental principles and established theories of crowdfunding to a health market context. Crowdfunded health projects can be classified into four types according to the venture's purpose and funding method. These are projects covering health expenses, fundraising health initiatives, supporting health research, or financing commercial health innovation. Crowdfunding could economically benefit the health sector by expanding market participation, drawing money and awareness to neglected health issues, improving access to funding, and fostering project accountability and social engagement. However, the economic risks of health-related crowdfunding include inefficient priority setting, heightened financial risk, inconsistent regulatory policies, intellectual property rights concerns, and fraud. Theorized crowdfunding behaviours such as signalling and herding can be observed in the market for health-related crowdfunding. Broader threats of market failure stemming from adverse selection and moral hazard also apply. Many of the discussed economic benefits and risks of crowdfunding health campaigns are shared more broadly with those of crowdfunding projects in other sectors. Where crowdfunding health care appears to diverge from theory is the negative externality inefficient priority setting may have towards achieving broader public health goals. Therefore, the market for crowdfunding health care must be economically stable, as well as designed to optimally and equitably improve public health.

An open source pharma roadmap

In an Essay, Matthew Todd and colleagues discuss an open source approach to drug development.

What will the crowd fund? Preferences of prospective donors for drug development fundraising campaigns

Biomedical researchers are increasingly turning to project-based online fundraising (i.e., crowdfunding) as a complementary source of research funding. To help inform the fundraising strategies adopted by researchers who take this approach, we conducted an online survey of prospective donors in North America. Respondents indicated not only an overwhelming preference for donating to projects conducted by nonprofit research organizations, but also an openness to donating to companies that have a 'for-benefit' corporate structure. They also showed a strong preference for projects that have alternate sources of funding, that have the potential to yield a curative therapy, and that focus on common and pediatric diseases.

Development of cell therapy medicinal products by academic institutes

In the rapidly evolving fields of cellular immunotherapy, gene therapy and regenerative medicine, a wide range of promising cell therapy medicinal products are in clinical development. Most products originate from academic research and are explored in early exploratory clinical trials. However, the success rate toward approval for regular patient care is disappointingly low. In this paper, we define strengths and hurdles applying to the development of cell therapy medicinal products in academic institutes, and analyze why only a few promising cell therapies have reached late-stage clinical development. Subsequently, we provide recommendations to stakeholders involved in development of cell therapies to exploit their potential clinical benefit.

A Guide to Scientific Crowdfunding

Crowdfunding represents an attractive new option for funding research projects, especially for students and early-career scientists or in the absence of governmental aid in some countries. The number of successful science-related crowdfunding campaigns is growing, which demonstrates the public’s willingness to support and participate in scientific projects. Putting together a crowdfunding campaign is not trivial, however, so here is a guide to help you make yours a success.

A new way of funding research has recently emerged, potentially democratizing the way science is done. This article provides a guide to increasing the odds of financing your research through crowdfunding.

The long tail and rare disease research: the impact of next-generation sequencing for rare Mendelian disorders

There are an estimated 6000-8000 rare Mendelian diseases that collectively affect 30 million individuals in the United States. The low incidence and prevalence of these diseases present significant challenges to improving diagnostics and treatments. Next-generation sequencing (NGS) technologies have revolutionized research of rare diseases. This article will first comment on the effectiveness of NGS through the lens of long-tailed economics. We then provide an overview of recent developments and challenges of NGS-based research on rare diseases. As the quality of NGS studies improve and the cost of sequencing decreases, NGS will continue to make a significant impact on the study of rare diseases moving forward.

Cardiovascular drug development: is it dead or just hibernating?

Despite the global burden of cardiovascular disease, investment in cardiovascular drug development has stagnated over the past 2 decades, with relative underinvestment compared with other therapeutic areas. The reasons for this trend are multifactorial, but of primary concern is the high cost of conducting cardiovascular outcome trials in the current regulatory environment that demands a direct assessment of risks and benefits, using clinically-evident cardiovascular endpoints. To work toward consensus on improving the environment for cardiovascular drug development, stakeholders from academia, industry, regulatory bodies, and government agencies convened for a think tank meeting in July 2014 in Washington, DC. This paper summarizes the proceedings of the meeting and aims to delineate the current adverse trends in cardiovascular drug development, understand the key issues that underlie these trends within the context of a recognized need for a rigorous regulatory review process, and provide potential solutions to the problems identified.

Preeclampsia - will orphan drug status facilitate innovative biological therapies?

It is generally accepted that the development of novel therapies to treat pregnancy-related disorders, such as preeclampsia, is hampered by the paucity of research funding. Hence, it is with great interest to become aware of at least three novel therapeutic approaches for the treatment of this disorder: exploiting either the anticoagulant activity of antithrombin, the free radical scavenging activity of alpha-1-microglobulin, or the regenerative capacity of placenta-derived mesenchymal stem cells. As these projects are being carried out by small biotech enterprises, the question arises of how they are able to fund such undertakings. A novel strategy adopted by two of these companies is that they successfully petitioned US and EU agencies in order that preeclampsia is accepted in the register of rare or orphan diseases. This provides a number of benefits including market exclusivity, assistance with clinical trials, and dedicated funding schemes. Other strategies to supplement meager research funds, especially to test novel approaches, could be crowdfunding, a venture that relies on intimate interaction with advocacy groups. In other words, preeclampsia meets Facebook. Perhaps similar strategies can be adopted to examine novel therapies targeting either the imbalance in pro- or anti-angiogenic growth factors, complement activation, reduced levels of placenta protein 13, or excessive neutrophil activation evident in preeclampsia.

Crowdsourcing in pharma: a strategic framework

Conceptually, all organizations can be described as coordinated actors working together to deliver a product(s), or provide a service(s). For organizations to remain competitive, it is important to have processes that look outward for external 'innovations' that could improve how work is done, and what is delivered. We present a comprehensive review of a variety of processes that pharmaceutical companies have used to engage external actors ('the crowd') to provide innovation in the service of delivering novel therapeutic agents. This culminates in a framework that provides a consolidated view of crowdsourcing processes, which in turn enables a strategic application of a crowdsourcing methodology based on problem type.