Expert insight

Thomas Cueni on The McKay Interview show – The value of innovation and bringing innovations to LMICs

12 November 2019
  • Thomas Cueni Director General

Last month I sat down with Michael McKay from the WRS to discuss the biopharmaceutical industry and its role, opportunities and challenges in this very complex world of health.

As I was telling him during our lengthy conversation, the biopharmaceutical industry is responsible for a lot of what has changed in our lives in the past 50 years. We can only be amazed by the fact that we are living longer than ever, deaths of children under five have fallen in every region of the world due to immunisation, and there are 4000 or more new drugs and vaccines under development for cancer alone.

Despite the immense progress to date, there are still many health issues that keep most of us in the biopharmaceutical industry up at night. We still need to find a cure for dementia and many types of cancer. And we want to live up to society’s expectation from us. However, it is always important to stress that innovation is meaningless if it does not reach the patients. While we continue to strive for more biopharmaceutical innovation, we need to consider the nuances related to affordability and sustainability to make sure that our products reach the patients that most need them.

We need to recognise that when we talk about R&D, we are dealing with high-risk investments. The case of dementia is an illustrative example of this. For the last 40 years, we have had billions of dollars go into Alzheimer’s research. Since 2001, 99.7% of clinical trials for Alzheimer’s disease have failed. If today, we were to find a drug to cure Alzheimer’s, how could we possibly account for those billions of dollars spent in R&D that led us to this hypothetical drug? Furthermore, it is worth noting that 80% of the medicines used globally nowadays are generics. These medicines could not possibly exist without a steady flow of innovative drugs developed through costly R&D, and whose prices went down because their patents expired.

An aspect that is often ignored in the pricing debates is that we tend to look at health spending in silos. We do not have a way of calculating savings when patients get cured from diseases that would be a long-term expense to the person or their healthcare systems for the rest of their lives. An example of this is the Hepatitis C/HCV case, which affects 180 million people globally. With our most innovative antiretrovirals, Hep C rose from a 6% to a 94-96% cure rate. The upfront expense originally seemed high in 2014 but it went down by 75% after three years, when other HepC cures made it to market. Nonetheless, the price is comparatively low compared to the costs of what it would cost the health system to treat somebody with the disease for 10 or 20 years. That is why we need to do a better of job of framing health spending as an investment, rather than as a cost.

We are deeply concerned about the serious challenges in bringing these innovations to patients in LMICs. The WHO describes a fair price as one that strikes a balance between incentivising research and having medicines that are affordable. 60% of patients around the world and most patients in LMICs do not have health insurance and pay for healthcare out of pocket. This places them at serious risks of impoverishment. The recently adopted Political Declaration on UHC highlights that to make real progress towards tackling access challenges, we need to tackle out of pocket payments, improve procurement processes, address regulatory frameworks and invest in capacity building for doctors, nurses, and community health workers, among many other things. As the biopharmaceutical industry, we need more concerted efforts in ensuring that the medicines are accessible in low-resource settings.

My closing remarks to Michael McKay were that UHC means that no one will be left behind. The challenges the biopharmaceutical industry faces in industrialised countries and LMICs are different and therefore require different approaches. In industrialised countries, we need to further highlight the tremendous impact of R&D and innovation in our everyday society. Building a better case for health spending calculations to be more holistic is a good start. In LMICs, we need to further facilitate domestic resource mobilisation and building capacity in county capacity to address the multi-dimensional access challenges they face. The bottom line is that while each country needs to find their own solution to achieve UHC, the universal aspect of the term implies that our biopharmaceutical industry needs to be more involved in the process. Unless we are willing to leave our comfort zone to engage in dialogue and seek new solutions, we will not make progress.

To listen to the full interview, click here.