A young woman with a rare disease, treated every month in Oakland with a drug developed in California’s Bay Area, has been told by ICE that she has 33 days to leave the country. And Without that treatment she will die.
Meanwhile a new TB drug is approved in the USA and makes activists unhappy. What these two news stories tell us about the state of drug research and development in the 21st century.
We are going to take on global biomedical research priorities, what they are, and how we get those get funded.
Let’s start with Maria Isabel Bueso. I cant believe really I am having to do this. This section is less of a podcast or news item, as more of an urgent call to action.
RARE GENETIC DISEASES AND IMMIGRATION DEFERRED ACTION
BioMarin Pharmaceuticals and its academic partners around the US, including the UCSF Benioff Hospital in Oakland, began in the very early 2000s reaching out to people born with the very rare genetic disease - muco-poly-sacch-arid-osis type six, or MPS 6. Asking them to participate in a new clinical trial into an experimental new enzyme replacement therapy.
This condition is so rare, that researchers have to scour all over the world to find people to participate in these trials.
And one girl, Maria Isbael Bueso and her family, agreed to participate in the trial. Maria is Guatemalan, and the researchers asked her and her family to move to the US, to the SF Bay Area in fact, so they could have her participate in the trial
The drug was an experimental enzyme replacement therapy, the very one she lacks. And the drug trial Maria participated in received orphan drug designation by the US Government (which as we will see later allows for US federal funding, and fast-track review).
And in 2005, the USA FDA approved this new treatment, that Biomarin then brought to market under the commercial Naglazyme. In 2018, Naglazyme’s income for Biomarin was 345.9 million US dollars. It has been, not entirely a block buster, but has made a very decent return for an investment into this rare genetic disease.
Getting people with MPS type 6 to participate in clinical trials is very difficult, and without Maria, Biomarin would have found its path to approval and marketing much harder.
And not to put too fine a point on it, Nagalzyme has kept Maria alive, and she has been taking it every week, as an infusion at the UCSF Benioff Hospital in Oakland, under the care of her doctor, Paul Harmatz. Last week Maria’s family received a letter from the US Government that she and her family has 33 days, literally until the 14th of September to leave the country. She lives here, just up the road in Concord, as a result of a “deferred action” program that allows immigrants like her to avoid deportation while they are having lifesaving treatment. And just like that, without telling anyone at all, The Trump administration decided to terminate this Obama-era program and just sent letters like these to Maria and family, and god knows who else.
All kudos to the New York Times (which piggybacked off local Bay Area and Massachusetts news outlets) for bringing this to our attention and to the fantastic Rachel Maddow who not only aired a detailed analysis of Maria’s situation, but called – on air – for everyone to write to Fox News, to get Fox to report on her case, in the hope that the President might listen and take notice. If you go to my twitter handle @shotarmpodcast you will find the call retweeted regularly to every decent journalist we can find at Fox (and this is no place just now at any contradiction between decent journalism and Fox News).
Please retweet if you can, contact Fox, contact Fox News’ CEO Suzanne Scott, who is supposed to be decent human being who regularly gives to children’s charities. Please reach out to them and ask them to air Maria’s situation, and ask specifically for the President to intervene and take action.
Because – while Trump’s Department of Homeland Security to which this ultimately rolls up to, has set out no information about this silent program (by the way Homeland Security doesn’t have a leader at the moment. Its acting director is Kevin McAleenan). ICE is responsible for the policy’s implementation. An agency spokesperson Paul Prince said “ICE reviews each case on its own merits and exercises appropriate discretion, after reviewing all the facts involved.”
This is why bipartisan outcry is important.
Homeland Security, and the two agencies that report to it, US Citizenship and Immigration Services and ICE do not accept applications for reconsideration, and they do not provide public guidance on what their process for reviewing cases actually is.
In addition to supporting Rachel Maddow’s call to contact everyone at Fox News, A Shot In The Arm is also joining calls to ask that every California elected official weighs in, from the Congressman in the very district Maria lives in, Marc DeSaulnier (who has already begun speaking out) to Congresswoman Barbara Lee, Congressmen TJ Cox and Jerry McNerney, and
our own Congresswoman Jackie Speier, and Leader Nancy Pelosi, as well our Senator and Presidential hopeful Kamala Harris, and senior Senator, Dianne Feinstein.
You will find on our website www.ashotinthearmpodcast.com how to reach out to these elected officials, and I hope you will join the thousands that have already starting demanding action.
Besides the disgust and moral outrage, there is secondary reason for telling this story. Maria’s treatment, Naglazyme, was developed by a small biopharmaceuticals company based in San Raphael in the North of California’s Bay Area, back in 1997. Nagalzyme was developed by the company itself pooling science Okcoming from a range of researchers (and therefore presumably patents) including the University of Adelaide in Australia.BioMarin develops new treatments for life-threatening and rare genetics diseases, from MPS Type 6, to muscular dystrophy, rare cancers and sickle cell anaemia. It is very much a niche industry, and quite different from the grand diseases of global public health that we have been exploring in the podcast and blog.
But like many of the companies that develop drugs and technologies to prevent, treat and diagnose global public health priorities, it relies on the same kind of partnerships with academics to develop research concepts and compounds, and the same kind of incentives to bring these technologies to market.
Which brings us back to the newly approved TB drug.
TB DRUG GETS APPROVED
On August 14th, 2019, the US Food and Drug Administration approved a new TB treatment called Pretomanid, used in combination with some other TB drugs, and approved to treat what’s called highly treatment resistant Tuberculosis.
Highly resistant TB is a curse.
It is appearing in more and more countries, particularly in the global south, where the numbers of people with increasingly resistant TB are greater, therefore the need for new TB drugs. These are also the countries with less immediate financial resources to invest in the basic healthcare systems and treatments needed to treat TB. If we don’t tackle the problem of highly drug resistant TB, we will be sent hurtling back over 100 years, when TB or “consumption” was a terrifying, commonplace killer. So a drug that effectively treats highly resistant TB. That should be good news, right? A new treatment - one of the first new TB drugs in over 50 years that is strong enough to eliminate even the toughest, most resistant strains of the bacterium?
And yet, the news of the approval of Pretomanid, revealed a deep uneasiness in the medicines access community about how R&D is incentivised.
MSF said it was premature to celebrate, and that the TB Alliance should sell Pretomanid’s the Priority Review Voucher that came with the approval to the highest bidder and use proceeds to registering the drug as rapidly as possible in all global markets and getting generics to manufacture the drug at the cheapest, most affordable price.
What is a Priority Review Voucher – PRV – and why does it matter. Over the last few decades, the government of the USA – has created all sorts of incentives to reward research and development (R&D) into diseases that tend to be neglected. And The TB Alliance has brilliantly exploited these incentives in their submission to the FDA for pretomanid. They obtained firstly a Limited Population Pathway for Antibacterial and Antifungal drugs, which was agreed by the US Congress in 2012, and allows as the FDA describes, “smaller, shorter or fewer clinical trials.” The TB Alliance also obtained for pretomanid designation as a “qualified infectious disease product.” Pretomanid also received orphan drug designation, release US federal funding and speeding up approval timelines. But, perhaps most importantly, pretomanid’s approval granted the TB Alliance a tropical disease priority review voucher (PRV) , which is key. Because a PRV enables you to get FDA priority review of any other drug you may have in your research portfolio. Even better, PRVs can be bought and sold. PRVs have already been sold – the very fine Biopharma Drive news website reports that Biohaven Pharmaceuticals bought a PRV from GW Pharmaceuticals in March 2019 for 105 million US dollars with a view to hasten the review process for its experimental migraine drug.”
And that is exactly what MSF wants the TB Alliance to do.
In theory, MSF’s request is but one of a number of options that are open to the TB Alliance. We asked the TB Alliance what their plans are for the PRV, and they are still looking at all options, which makes absolute sense.
They could also hold onto it and use it for another drug in their pipeline (although presumably, as they focus on TB treatment research and development, those other candidates ought to benefit from the same incentives as Pretomanid. They could also sell the PRV, and use the profits to pay for the development of those drugs in their portfolio. It is interesting is that MSF’s uneasiness is shared by many in the global health community. It provides an invaluable insight into how policy makers and advocates think about R&D and Access – well, don’t think about them together actually.
What this story tells us is that the global access to medicines access community might have been highly mobilized to promote R&D and Access, but our efforts have been separate, inadequately connected, and we are now seeing the results.
So if you dont develop a drug with plans already in place to provide rapid, expansive access the moment you get approval - why should you benefit from these kind of incentives in the first place?
GLOBAL RESEARCH PRIORITIES
What areas in health do we actually need therapeutic, preventative and diagnostic innovations for? In other words, what are our research priorities. I think we can answer this question fairly confidently. There are four areas that are of primary importance
The first is immunology - or the functioning or not of our immune system. An area of clinical science, where our understanding is all too medieval. I know this personally as someone living with severe crohns disease – which is caused by a dysfunctional immune system. But it also includes a cancer, which the US National Institutes of Health defines as “some of the body’s cells beginning to divide without stopping and spreading into surrounding tissues.”
Secondly Pandemics - whether new or existing, viral or bacterial. Pandemics have been a subject of much debate on this Podcast – ebola, HIV and tb for example. And my view that Pandemics are the greatest threat to humanity in the 21st century are well known.
The third priority area is Mental Health. Like immunology, our understanding of human mental health is in its early stages. We know very little about it is caused, how we treat it. And how it relates to other diseases -
Our fourth priority should be non-communicable diseases, such as diabetes and heart disease. Sometimes these are called diseases of “modernization” – as they seem to affect increasingly urbanized and industrialized societies.
In summary, however, a question which bugs me, and which we will come back to in future episodes, is whether non-communicable diseases - and indeed immunological, mental health and infectious diseases – are actually on the increase, or whether we are just getting better at diagnosing them.
What should not be on the list? I confess to having no interest in shaky-led syndrome or skin-tightening technology - even if it does keep our over-fifties pop stars looking relevant and more fabulous every day. But - if a side effect of investment in personalised or peculiarized medicine (which to me is the antithesis of public health), was a dramatic advance the way we design and deliver new compounds, in ways that we could use for other priorities, then I would be right behind that. Money well spent.
Having said there are four priorities, there is a different kind of priority which we might consider as well, an area, where clinical research crashes straight into other aspects of technology, namely delivery.
Whether computer-assisted, AI or other design of molecules for us to research, or electronic medical records and rapid, more efficient and effective data monitoring, or innovative ways of getting medicines and diagnostics to people in need - and thinking of zipline, which delivers drugs and tests by drone, or Facebook’s Blood Donation campaign.
Delivery is going to be as important as the very diseases we are tackling.
We will continue to see exceptionally strong bodies of scientists and other researchers coming from all regions of the world. It is worth noting that major pharmaceutical companies have invested heavily in research hubs in south and south east Asia. Africa is next. My point here, is that, as more and more brilliant scientists emerge in the global south, we can expect at least some of them to be drawn to the healthcare challenges around them. The same is to be said of the marketeers. They will see local opportunities, where existing business thinking sees thorns. And this will help increase commitment and interest in global public health.
CLINICAL RESEARCH MODELS
Will the way we develop medicines change? I was going to say no.
The Pole star of pre-clinical, phase 1, phase 2, phase 3 trials and onwards, would continue to guide us, I thought. There might be some tinkering at the edges, but why would that change in principle? We might get better at moving things from pre-clinical and phase one into patients… but the phases themselves would still seem the right ones.
But now Im not so sure. Lets go back to pretamonid.
Its approval was based on preliminary data from a phase three trial of six months treatment and then six months follow up of 109 or 107 patients. Over 95 per cent were successfully treated, which is great news. But the news here is that it was not a three year or longer trial of thousands of people. It is an example of what is happening more and more in R&D. There are significant obligations imposed on the TB Alliance by the FDA to continue to monitor and evaluate the drug – but these come after the drug’s approval – not before.
I wonder, in fact, whether approval by regulatory authorities will come earlier and earlier in a drug’s development. And that as society we will become OK with that, as we learn more about how classes of drugs respond to diseases, and as we have a better handle on how to monitor and work with participants in the trials themselves.
One area where I am passionately devoted to dramatic change is in the use of animal testing in clinical research. When we hear presentations at conferences, or we talk about refer to murine models, or canine or primate models. Let’s be clear. We are talking about mice, dogs and monkeys. In the cold light of day, I think it is fundamentally unethical, and it should be becoming increasingly obsolescent. But according to the US Dept of Agriculture, research on non-human primates (and just think about that phrase – non-human primates) - research on non-human primates increased in 2017, to 76000. The extremism in the advocacy movement opposed to animal testing is offensive and dangerous. They have made the situation much worse. And there is a lesson for us in that. But My hope is that technology will help us make animal testing unnecessary and irrelevant.
A moment that sticks in my brain is when lab colleagues in the Belgian town of Mechelen shared with me their excitement at how the development of a new HIV protease inhibitor (now a market leader, ten years later) had been speeded by computer design- literally designing a molecule to fit tightly into the virus, and incapacitate it. We talked about the need for less safety and efficacy data from animal “models”. And I will never forget that moment.
The wave of HIV drugs for people with HIV able to access them has transformed their human lives. And there is no doubt that animal lives have been taken to achieve this. Would I change this? Really?
No. It is a dichotomy I have to live with. But, At heart, I believe we are better than this – and – if we are wise enough, science will offer us a way forward. And we must push for it. So, my hope is that clinical trial design is actually something that is going through revolutionary disruption – and it is a subject we will come back to in future episodes.
HOW DO WE PAY FOR THIS?
If our science and scientists are up to the challenge, what about how we pay for it? Well believe it or not, the issue of public health financing has fascinated me all my adult life. Realistically, I see four options to incentivize and control biopharmaceutical research and development for global public health.
Ill describe what I think of them, but the task for us is to encourage, foster and if necessary, force collaboration between these options.
THE PUBLIC SECTOR WILL NOT SET US FREE
For a number of years now, I have realized – although not always been prepared to come out about it, so to speak, is that the public sector alone will not set us free.
There is no pretending that biopharmaceuticals have a private sector-free future.
This will make me sound like a real nob, but it really only hit me in the early 1990s that drugs were developed by companies not the UK National Health Service. And yes, this realization was a result of being in the wave of AIDS activism that spread to the UK from the US. I dread to think how long it would have taken me to realize this otherwise. I was shocked and horrified, then tolerant and finally made peace with this.
In fact, profit has always been made in the field of healthcare in one way or another, since the dawn of recorded history. Even my hero, Nye Bevan, understood and incorporated the private sector into his vision of health for all. And the lesson to be learned from countries as diverse as Nigeria and Laos, is that private sector can be a force for good. It is a matter, as in so many things, of how societies control markets.
So, I will just come out and say it. The first and my preferred option is for private sector leadership in pharmaceutical R&D. This is not a call for an unfettered, unregulated private biopharmaceutical sector. I mean who would want that right? Right? Well, OK, maybe we will have to wait until after the US presidential elections in 2020 to be absolutely confident that we really mean it.
But seriously, the whole point about the success of pharmaceutical industry has been its integration with and regulation by the public sector.
It has been one of the greatest successes of the post second world war period. What it does - to take exciting new scientific possibilities - and translate them into market powerhouses is nothing short of amazing.
But that is just the start of the story. The pharmaceutical industry model is magnificent at developing and marketing new drugs for rich communities - where there is a clear path to market-with the promise of rich financial returns. But If there is one lesson the AIDS epidemic has taught us, it is that the private sector pharmaceutical model might have saved lives for richer communities, but it could not do the same for poorer communities. And note, we aren’t talking countries. There are poor communities in many supposedly industrialized nations.
It is also true that many of the “block busters” that have made billions have had their origins in academic and public sector basic research hubs. Sometimes journalists and activists behave as if they have just uncovered this as some nefarious corporate behavior. But actually, this is a thoroughly established and mutually beneficial relationship, that helps universities and allows the public sector to invest tax-payers funds.
One aspect of the pharmaceutical funding model that gets overlooked is the role of venture capitalism. I had some exposure to the some-times well-meaning and sometimes cut-throat of East Coast US pharmaceutical VC. its people are fascinating to observe, at times they understand the value of long-term investments, and at other times they get frustrated that the envelope cannot be “pushed” more rapidly. At times their lawyers appear religiously attentive about adhering to the letter and spirit of the law. At other times, they are characterizations of “Saul Goodman”, the chancy lawyer from Breaking Bad.
In recent years there has been a new source of funding from Silicon Valley-based venture capitalism, which at the risk of over-simplifying, has been less tolerant of failure, has expected clearer metrics, with quicker paths to the market. but it has also been victim of a “fake it, until you make it” alternative reality that has been best exposed by the very sad story of Theranos.
But, a desire to do more, do it faster, and with better results is inherently good. It has also led to the emergence of the Bay Area as a hub of biotech and global health. You can also point to Genentech, Gilead, Chen Zuckerberg, and from the VC side, Third Rock Ventures. On the not for profit side, look at Tech 4EndingHIV or the Bay Area Global Health Alliance. Im looking forward to chatting with pharmaceutical VC titan, Marianne De Backer in a future episode in this second season.
None of this is to say that the pharmaceutical sector does not need to change. I think a seismic reshaping of the industry’s priorities is required by its investors and scientists to diseases that affect the most, not those most able to pay. The time is ripe, this is an industry in flux. No question that in ten to twenty years, this field is going to be very different. Will the Mercks, Janssens be succeeded by Applehealth or Googletreat? Or FacebookWell… or even, dare I mention it Hunuvat?
Earlier this year, I facilitated a session on the future of global access programs at the BIO conference in Philadelphia. It was fascinating to see the enthusiasm about the emergence and potential uses of new technologies, but also to see the growing wave of anxiety - no, almost fear - of how research is going to be funded, and whether fortunes can still be made.
But ignoring global public health as a key business priority by industry will not be an option. Philanthropic initiatives will not be enough. Our elected leaders, and the tax-paying citizens who elect them will not be able to justify this status quo.
And later in the podcast, I demonstrate how I think this will change.
PRODUCT DEVELOPMENT PARTNERSHIPS
A second option that has emerged over the last thirty years, called “Product Development Partnerships” - or PDPs. These are non-profit drug development groups, with a very focused agenda - on new malaria or TB drugs, specific HIV prevention approaches - areas where the traditional pharmaceutical model had not been incentivized to deliver. They have been funded by some very strange bed fellows - including Nordic and west European ministries of foreign affairs (which usually house their country’s overseas development aid departments), pharmaceutical companies themselves - either with cash or with rights to develop compounds they themselves have no interest in pursuing, and finally by foundations - and one foundation in particular - The Bill and Melinda Gates Foundation. Notable successes of the PDP model include the TB Alliance, who we heard about earlier in this podcast. Another is the International Partnership for Microbicides (IPM), which is bringing to market later this year a prevention technology designed for women in developing countries. The PDP does the research, takes the risk, and commits to ensure - once approved the new medication is made available as cheaply as possible in developing countries. And it can license the medicine back to the pharmaceutical industry for marketing in the developed world, in the hope of generating royalties that would fund future investment. A virtuous circle, you might say. It is exploring the regulatory route to approval for dapivarine through the European Medicines Agency. It has not entirely been plain sailing – and we shall see how things finally shake out later this year.
But PDPs are not without their controversy – do they really deliver?
The thing that has fascinated me about them is their range of funders - each of them with fundamentally different agendas. How does a PDP reconcile their various, often different, and changing priorities - and from the sidelines, it has been at times maddening, and at other times hilarious, to see how the PDPs’ leaders have had to prioritize the management of funders’ expectations, rather than leading the research itself. It has been hard for the Gates Foundation, for example, not to remain a passive supporter, and not become more actively involved in both the direction and implementation of the organizations it supports. Notwithstanding the TB Alliance’s spectacular FDA success, we may also be at the end of a historic moment in time, when there were resources available to invest in new infrastructure, researchers and managers to devote themselves to single issues, whether they be microbicides or TB treatments.
Notwithstanding the TB Alliance’s spectacular success with pretomanid, are PDPs at risk of going out of fashion, losing their shiny edge. And the big foundations - as we shall see in a moment - have moved on to the next shiny objects.
Here is my tuppence worth: I just dont think we would have had a davirpine microbicide ring without IPM, and its leader Zeda Rosenberg. And we would not have the majestic pipeline of TB drugs if it were not for the TB Alliance, and its leader Mel Spigelman.
NON-PROFIT PHARMACEUTICAL COMPANIES
Another way of looking at research for the common good is to take the profit motive out of R&D, without nationalizing the hell out of the sector. We don’t have to privatize it – just avoid the worst excesses of the private sector and remove the overbearing bureaucracy of the public sector. Entities with such a mission do exist - another giant of the Pacific Northwest, comes to mind - PATH.
But the one that I find fascinating is Medicines 360. A non-profit pharmaceutical company run by women for women. it has taken priorities in women’s health that the traditional pharmaceutical sector has just not found compelling enough and brought them to market. Last year, Medicines 360 obtained FDA approval for Lilleta, a new intrauterine device, or IUD. - which provides up to five years contraception. I think Medicines 360 is really the one to watch. The question is whether this model is sustainable and is it applicable to other public health areas. Is it really a non-profit pharmaceutical company offering a new way, or is it basically a different shade of the PDP model – partnering with the private sector and willing to give up lucrative industrialized world markets, in exchange for developing drugs for emerging economies.
And one of the key drivers of Medicines 360, which we need to keep a keen eye on is how do they do over the medium term in continuing to generate and nurture the kind of investors willing to front research without the usual financial returns they have come to expect?
So, indeed. What about those investors?
This brings us to a strange, but deeply influential fourth option, born out of the fabulous wealth of individuals smart or lucky enough to have been at the forefront of the tech revolution. What happens when these individuals no longer make philanthropic contributions to existing or new non-profits, but create their own research institutions?
The first that comes to mind is the Bill and Melinda Gates Foundation. It has spent 3bn on global health to date, of which 1.6 billion has been very generously donated to the Global Fund to fight AIDS, TB and Malaria and outweighs every single other private donation, and indeed the contributions of many countries. It is an incredible contribution but it does beg the question what was done with the other 1.4 billion and what impact that has had? For the record, the organization I used to run, Pangaea, received a few tasty morsels of Gates funding.
It was only a matter of time before Gates set up its own biopharmaceutical research organization - whether for or non-profit. And last year, under the leadership of Penny Heaton (who used to be at Novartis) it did. Called the Gates Medicines Research Institute (Gates MRI) and based on the other side of the continental USA in Boston, the MRI’s mission is to develop products for malaria, TB and diarrheal diseases - which it considers to be major causes of mortality, poverty and inequality in developing countries.
It is going to focus on “transitional medicine” focusing its efforts on getting medicines out of the laboratory and into human research. Trevor Mundel heads the huge disease division at the Gates Foundation and like Penny (who reports to him) comes from Novartis. Trevor has compared the MRI in a recent article in Forbes magazine, to a hungry drug company but with success measured in lives saved, not dollars returned. And it is interesting that the MRI has centered on hiring researchers from the pharmaceutical industry, not from academia.
Back on the other side of the USA is the Chen Zuckerberg Bio Hub, which explicity partners with academic researchers in the Bay Area. It is led jointly by Joe Derisi, of UCSF and Steve Quacke from Stanford. And the lead on pandemics preparation is Cristina Tato, who we will meet in a future episode of A Shot In The Arm Podcast. With both models are newly conceived, it will be interesting to follow how they pan out. Maybe the future of global health biotech is going to be driven by the charitable contributions of people who have just made their fortunes in other business fields.
But even their billions feel…. Inadequate.
I keep coming back again to Trevor Mundel’s comments that success should be measured in lives saved, not dollars returned. I am not sure, in the final analysis, that this is enough. I would propose that future success will be measured on lives saved, and therefore dollars returned. And assuming western liberal economies are able to defend their democracies, I think their politicians – driven by voters – will demand a rebalancing of R&D, access and financial returns. Even if – no especially because – the number of those dollars is going to be very much less than what is currently expected from returns of pharmaceutical investments.
REINVENTING THE SOCIAL COMPACT
And as I look back at 25 years of experience, we need to come back to and revise the models we self-consciously and perhaps inadequately created in the late 1990s and early 2000s, that propose making global public health the heart of the biopharmaceutical industry, by creating new social compacts - where governments are investing much, much more in the health of their citizens, incentivizing private research into the diseases that really affect the majority of the world’s people.
And in return expecting, and legislating, where necessary, the industry and its investors to accept a lower, though perfectly acceptable rate of return, with higher volumes and lower prices, but for a much wider range of diseases and patients in countries and markets that had previously been ignored.
That will not be easy.
It means some restructuring of the industry (not the dramatic disruption some fear and others relish) and perhaps some short-term decline in the size of the overall market, as we have discussed. But as some of the participants at March’s Bio Conference in Philadelphia observed to me, something like this has to happen.
The social compact I am referring to is not a given. It is not inevitable.
Perhaps, we may muddle on as we are, with a pharmaceutical industry pressured from all sides to reduce prices, reduce costs, maximize profits, but invest in drugs for markets that don’t provide profits, while the rest of us hustle to get the a little of the funding we need from their corporate contributions departments, tax payers and philanthropists.
That will be a world that will please no one.
But I do think a revitalized social compact is very possible. In fact, it’s the only real option in front of us.
I wanted to end with a quote by Margaret Atwood (who’s sequel to the Handmaid’s Tale, the Testaments, is tantalizingly close to publication), Nye Bevan, or Aldous Huxley, or Joyce Banda, or Marina Mahatir. But for this blog, I am drawn to Paul Janssen, the late Belgian pharmaceutical researcher and business tycoon - why does global health always come back to Belgium?? It is a comment my colleagues ten years ago back in Mechelen often referred to, and it’s a not just a challenge for pharmaceutical researchers and executives, it’s a challenge to all of us
Paul Janssen said “There is so much more to be done, the patients are waiting’”
The patients are waiting. There is so much more to be done - by all of us.
So then, let’s stop assing around, and get on with it.