How to build a supportive public health economy
- In 2011, the pharmaceutical industry spent between $162-265bn on research.
- But the industry tends to under-invest in certain areas, such as maternal and neonatal health.
- Neoplasms carry the same medical weight as neonatal disorders but were the subject of 1,600 clinical trials in 2015, compared with 11 projects for neonatal health.
- The reasons for this lack of support include regulations, limited knowledge, and financial profitability.
- One solution is to encourage more public-private partnerships, as was the case for neglected tropical diseases in the 2000s.
It’s an understatement to say that healthcare requires major investment: indeed, the pharmaceutical industry spends a huge amount every year preparing the solutions of tomorrow. And yet, despite such huge sums, some sectors still suffer from under-investment. While this phenomenon of under-investment may be predictable – certain diseases are becoming increasingly rare – it is more surprising when it affects areas such as maternal and neonatal health, which are the subject of far fewer projects and clinical trials. The reason is not, of course, a lack of relevance or interest in these subjects: the research conducted by Professor Simcha Jong highlights the role played by regulations, the relative lack of knowledge and expectations of limited financial returns in this phenomenon. This research also indicates that public-private partnerships are capable of providing a solution to the under-investment in maternal and newborn health research, just as they were useful in accelerating research into tropical diseases 20 years ago.
Thierry Rayna, Tech4Change Chair
Economics can become a key factor in public health: this is the hypothesis that has been the focus of our work over the last few years. On the one hand, drugs account for a major proportion of healthcare expenditure. On the other, certain innovations, such as treatment for hepatitis C, antiretrovirals and cancer immunotherapies, have the intrinsic power to massively reduce the impact of these diseases on our societies. In 2011, the pharmaceutical industry spent between $162–265bn on research1. Encouraging biopharmaceutical companies to invest in research and development (R&D) in medical fields with high mortality and morbidity could therefore reduce the burden of these diseases. Our research suggests that public-private partnerships are an effective tool. Why public-private partnerships? Because, left to its own devices, industry tends to under-invest in certain disease areas such as maternal and neonatal health.
High demands, low investments
Previous work has mapped medical needs and their importance in terms of global health2. We have linked this data to the R&D efforts of pharmaceutical companies for each disease group, the latter parameter being calculated based on the number of clinical trials. More than 62,000 projects were analysed, including nearly 11,000 in active (pre)clinical development as of summer 2015, covering 1,202 different diseases. In some cases, there is a clear match between the impact of the disease and its funding. For example, the biopharmaceutical industry allocates R&D resources to projects targeting different types of cancer on the basis of the global impact that these different diseases represent. In other cases, there is an imbalance between the scale of the health need and the R&D coverage: this is the case, for example, with maternal and neonatal health problems.
However, if we use the number of years lost due to disease as an indicator on a global scale (DALY, for disability-adjusted life years), we see that neoplasms, tumours made up of cells that proliferate excessively, have a similar weight to neonatal disorders. But the commitment to clinical research that they generate is in no way comparable. In the summer of 2015, there were 1,600 clinical trials for neonatal tumours, whereas for the same period there were only 11 active industrial R&D projects for neonatal disorders. These childhood pathologies are therefore victims of under-investment in R&D. In a perfect market, the industry’s R&D efforts would be more evenly distributed between these two categories of disease.
Of course, there are structural reasons why biopharmaceutical companies make such little commitment to R&D in neonatal and maternal diseases. These include the particularly protective regulatory framework for these populations, as well as the difficulties in building up a body of detailed biological knowledge about these critical periods of life. We also need to consider the profitability imposed by the industrial system: a treatment for cancer may be sold at a much higher price than its equivalent for maternal diseases, because the former affects populations that are on average wealthier than the latter. Can we correct this imbalance in incentives? The example of neglected tropical diseases shows that it can.
Encouraging public-private sector partnerships
This group of diseases was identified as a health priority by the UN in the early 2000s. This decision led to measures to encourage the creation of public-private partnerships such as the Medicines for Malaria Venture and DNDi, as well as investment by public donors in research into these diseases, and generally to a much more attractive and less risky environment, for example by committing the international authorities to purchasing a certain quantity of anti-malarial treatments at a pre-defined price. This programme has been deployed through a wide variety of mechanisms that help to reduce R&D risks for these diseases from the point of view of industry.
The industry tends to under-invest in certain disease areas such as maternal and neonatal health.
This model, devised for neglected tropical diseases, has proved its worth. Between 1975 and 1999 of the nearly 1,400 compounds approved by the health authorities, 13 concerned neglected and tropical diseases. Since then, there are 54 drugs on the market and 188 therapies in development.
Could this model be applied to other public health issues? Europe already has a strong R&D policy, as demonstrated by the Horizon 2020 and Horizon Europe programmes. But when it comes to health, the priorities generally focus on European health issues. And, as the pandemic has vividly illustrated, health issues cannot be covered by a regional approach. It is therefore in our collective interest to put in place ambitious public funding policies for all the neglected fields of medicine. Only then can we hope to encourage the development of new treatments for maternal pathologies and neonatal disorders.