Last year was another extraordinary year for medical innovation. The World Health Organization recommended a second vaccine for the prevention of malaria in children and a second vaccine for Dengue fever. The first ever CRISPR treatment was approved to treat sickle-cell disease and β-thalassaemia and we had another Alzheimer’s medicine approval by the US Food and Drug Administration.

These breakthroughs provide hope to patients, families, and caregivers all over the world. However, we know that these ground-breaking advances in healthcare are only meaningful when they can reach the people who need them. To be successful, we need to be as innovative in our approaches to patient access as we are in the scientific discovery and development of medicines and vaccines themselves.

The health, economic, and societal value of medicines and vaccines

Investing in medicines and vaccines can provide significant health, economic, and societal value. In the European Union alone, prescription drugs added an estimated 2 million healthy years to patients’ lives between 2007 and 2017. Furthermore, for just a subset of medicines, the pharmaceutical industry contributes €27 billion in productivity gains for EU economies, and approximately €13 billion in healthcare cost savings due to averted complications. Vaccination is recognized as one of the most cost-effective ways of saving lives, promoting good health and well-being, and promoting economic recovery. The return on investment in innovation is significant for health systems and economies.

Yet the burden of disease, particularly from non-communicable diseases (NCDs), is growing. Between 2020 and 2050, cancer is projected to cost the world economy $25 trillion. The global cost of Alzheimer’s and related dementias will cumulatively reach between $11.3 trillion and $27.3 trillion by 2050, with low- and middle-income countries (LMICs) set to shoulder 65% of that economic burden. These examples alone demonstrate the value of investing in new treatments that tackle some of our most significant global health challenges.

Partnering to improve access

The upcoming Fair Pricing Forum, hosted by the WHO, will focus on the role that affordability and pricing can play in determing access to health products. This is an important discussion to have, not only to better understand the evidence, but also to identify ways governments, payers, and industry can work together to find tailored and pragmatic solutions to the barriers that prevent patients from benefiting from new treatments.

The pharmaceutical industry perspective is clear. When determining the price of any medicine or vaccine we must recognize the value they bring and take into account a country’s economic circumstances, so that it reaches the people who need it, and provides an incentive for R&D investment into the next generation of medicines and vaccines.

Pharmaceutical companies are working in partnership across healthcare systems and governments to ensure patients can access new treatments. Tools such as tiered and differential pricing have been shown to be effective and sustainable in improving access to medicines in low- and middle-income countries (LMICs). While the specifics vary among companies and products, tiered pricing is now a standard approach across much of the industry, in which prices are aligned to take into account a country’s relative wealth.

For example, tiered pricing was used extensively by companies during the pandemic to ensure that COVID-19 vaccines were affordable. Gavi, COVAX, and other procurers for low- and lower-middle-income countries benefitted from reduced prices.

• Pfizer’s Accord for a Healthier World is another example, which commits to make the company’s full portfolio of about 500 products available on a not-for-profit basis in 45 LMICs.
• GSK has a long standing commitment to tiered pricing for their vaccine portfolio. For their malaria vaccine, GSK has committed to a price that covers the cost of manufacturing the vaccine, together with a small return of around 5% that will be reinvested in research and development for global health medicines and vaccines.
• Sanofi’s Global Health Unit is improving access to affordable quality products through its not-for-profit Impact brand, that provides 30 Sanofi medicines, many considered essential by WHO, in 40 countries with the highest unmet medical needs.
• Global equitable access was a priority for MSD’s COVID-19 therapy development and the company is using tiered pricing, granting voluntary licenses to generic manufacturers and the Medicines Patent Pool (MPP), and the coordination of advance purchase and supply agreements and allocation processes to ensure timely, affordable availablity globally.
• To ensure equitable access to innovative medicines, Novartis deploys a combination of approaches, and in 2019, the company created a dedicated sub-Saharan Africa unit. Focus is now directed toward impact, as calculated by the number of patients reached with innovative medicines across 46 countries, as opposed to the maximization of profit.

Other integrated approaches such as value-based healthcare (VBHC) where value reflects the outcomes for all stakeholders, especially patients, affordability-based patient assistance programs, and managed entry agreements are also increasingly supporting health systems to allocate resources effectively and efficiently to address diverse access barriers.

Strengthening healthcare systems

However, the price of an individual medicine or vaccine is only one factor, and it alone does not determine whether patients are able to access the treatment they need. There are many challenges that impede the journey of a medicine or vaccine from a developer to a patient. These challenges can be linked to regulatory pathways, reimbursement and procurement processes, funding and financing of healthcare systems, and the ability of healthcare systems and infrastructure to deliver products and services to the people who need them.

If we are going to tackle barriers to access and support patients to receive innovative treatments, we must strengthen the funding and capacity of healthcare systems so they have the facilities and skills to diagnose, treat, and support patients. Progress toward the provision of Universal Health Coverage (UHC) alongside increasing investment into health systems needs to be accelerated to achieve the SDG targets.

It is too often the case that even inexpensive treatments for many major diseases are unavailable to the patients and populations who need them. Many of the WHO ‘Best Buy’ NCD medicines that could save lives in low- and lower-middle-income countries are off-patent and cost less than $1, but are still not accessible to millions of people who would benefit from them.

This is why industry, health systems, and healthcare organizations should work together to improve access to care by supporting greater investment in healthcare – including prevention – and building the capacity and capability for the delivery of high quality care, including innovative treatments.

Pharmaceutical companies understand this, and many are working closely with healthcare systems and stakeholders around the world to improve access. For example, since 2017, Access Accelerated, a collective initiative of leading biopharmaceutical companies in partnership with the World Bank and other civil society partners, has resulted in the mobilization of billions of dollars  to improve the prevention, treatment, and care of people living with NCDs in LMICs. Access Accelerated and the World Bank will soon launch a renewed partnership to support countries to catalyze increased financing for NCDs.

Several companies are working in partnership with City Cancer Challenge Foundation (C/Can) and the Access to Oncology Medicines (ATOM) Coalition led by Union of International Cancer Control (UICC) to build healthcare system infrastructure and capacity to provide innovative medicines in sustainable ways.

The health and economic benefits of these treatments can be unlocked by ensuring better access to the latest medical innovations. To focus purely on affordability misses many of the main barriers. Unless we strengthen the healthcare systems that people rely on, progress toward sustainable, equitable access will remain elusive.

Author

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  James Anderson Executive Director, Global Health j.anderson@ifpma.org