The global burden of disease, especially the part attributable to infectious diseases, disproportionately affects populations in developing countries. Inadequate access to pharmaceuticals plays a role in perpetuating this disparity. Drugs and vaccines may not be accessible because of weak distribution infrastructures or because development of the desired products has been neglected. This situation can be tackled with push interventions to lower the costs and risks of product development for industry, with pull interventions providing economic and market incentives, and with the creation of infrastructures allowing products to be put into use. If appropriately motivated, pharmaceutical companies can bring to partnerships expertise in product development, production process development, manufacturing, marketing, and distribution-all of which are lacking in the public sector. A large variety of public-private partnerships, combining the skills and resources of a wide range of collaborators, have arisen for product development, disease control through product donation and distribution, or the general strengthening or coordination of health services. Administratively, such partnerships may either involve affiliation with international organizations, i.e. they are essentially public-sector programmes with private-sector participation, or they may be legally independent not-for-profit bodies. These partnerships should be regarded as social experiments; they show promise but are not a panacea. New ventures should be built on need, appropriateness, and lessons on good practice learnt from experience. Suggestions are made for public, private, and joint activities that could help to improve the access of poor populations to the pharmaceuticals and health services they need.

The development and marketing of medicines needed specifically to combat diseases of the developing world are commercially unattractive because the populations concerned are among the poorest on earth. Partnerships which bring together pharmaceutical companies, academics, not-for-profit organizations, philanthropists, governmental and inter-governmental agencies are an increasingly popular solution. These partnerships result in a complementarity of skills and resources that can accelerate the development and delivery of new medicines to those in need. Over the last 10 years or so, these public-private partnerships (PPPs) have grown significantly in number and diversity. However, they tend to cluster into two main groups: those dealing with product development (PD PPPs), and those concerned with improving the access of new medicines to target populations (Access PPPs). The Initiative on Public-Private Partnerships for Health was set up four years ago to monitor the performance of these new partnerships. After a series of studies of Access PPPs, it concluded that they provide significant benefits with very few side effects, particularly in the case of tropical diseases.

The growth of a range of Gram-positive bacteria was inhibited by organochlorine insecticides while that of Gram-negative organisms was unaffected. Growing cultures of Bacillus subtilis (ATCC 9372) treated with 20 p.p.m. technical chlordane ceased to grow and showed a decline in viable count and respiration rate, both being eliminated after about 3 h. A delayed release of incorporated ~-[U-l*C]leucine and L-malate dehydrogenase occurred concomitant with a fall of It is suggested that these phenomena are a result of disruption of membraneassociated metabolism, including electron transport and cell wall biosynthesis, which leads to cell lysis. No effect on these parameters occurred with growing cultures of Escherichia coli (ATCC 8739). The chlordane sensitivity of succinate oxidation by sphaeroplasts of E. coli indicates that the intact cell wall prevents penetration of pesticide to sensitive sites within the walls of Gram-negative bacteria.

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