First there was Ebola and now there is Zika; two official World Health Organization (WHO) Public Health Emergencies of International Concern (PHEIC) within as many years. Whenever global health crises such as these emerge, the pharmaceutical industry comes under intense scrutiny for not having an immediate solution available. Part of the problem is that prevention is not always financially viable; the substantial R&D costs of developing vaccines or treatments for all known and potential threats that may or may not one day develop into global pandemics is not a feasible burden for the industry to carry alone.
Coming up with a solution to more effectively stem such crises requires collaboration. Increasing attention is being given to new models of funding, involving governments, public funders, NGOs, private donors and pharmaceutical companies, to try and tackle the world’s greatest healthcare challenges. These various stakeholders need to find ways to work together better in order to successfully tackle these threats as and when they emerge, proactively rather than reactively.
We are under no illusions of the impact that Ebola and Zika have had on a social, political and economic level. Earlier this year, Ebola was estimated to have caused the deaths of 11,315 people across two continents, while the World Bank has totalled the economic impact of the disease at $3.5 billion. The disease has also had a profound impact on the healthcare systems of the countries that the pandemic has swept through. Casualties of Ebola in West Africa were disproportionately concentrated in healthcare personnel, resulting in a skills shortage within the HCP workforce. By May 2015, 0.02% of Guinea's population had died due to Ebola, compared with 1.45% of the country's doctors, nurses, and midwives, which helps to highlight the notion that pandemics such as Ebola have a direct impact on the level of care the state is able to provide. Zika is estimated to have had a similar economic impact to Ebola in Latin America alone, and with 32,724 cases reported across the US, the effects of Zika have been felt in the developed world as much as the developing world. These two outbreaks represent some of greatest public health tragedies in modern times.
To date, it can be argued that the measures taken by the pharmaceutical industry to lessen the impact of crises such as Ebola and Zika have been somewhat reactive; the evidence suggests that pharma is not currently proactively developing solutions for crises before they strike. Because most pharmaceutical companies answer to shareholders, they are required to balance providing solutions to world healthcare challenges with making sensible business decisions.
Developing solutions for viruses such as Ebola and Zika are not always cost-effective for pharmaceutical companies, as the example of vaccinations provides. Vaccinations provide a good return on investment, typically only if patients have the means to pay for them; in the areas that Ebola and Zika have had the most impact (the developing world), levels of healthcare affordability are much lower. Thus, proactively pursuing the development of a vaccine to mitigate against the effects of a potential health crisis such as Ebola/Zika might not always be the most financially viable decision, and it is clear that the contribution a pharmaceutical company can make to such crisis is a delicate question of balancing the need to run a business versus the need to safeguard the health of the world’s population. It is also clear that pharma companies are under pressure to provide solutions for crises that are less publicised areas of healthcare that may or may not one day become the next “big” healthcare crisis.
One such area that could benefit more attention is in the area of Neglected Tropical Diseases (NTDs). NTDs are healthcare issues prominent in the developing world and encompass conditions such as Dengue fever, Chagas and African sleeping sickness. Across the planet, these diseases are estimated to collectively affect over a billion people bringing long term disability or morbidity, hindering wage-earning capacity and helping to accentuate a vicious cycle of poverty among the world’s poorest. Despite the global sweeping impact that these NTDs have, pharmaceutical companies have been accused of “not pulling their weight”, contributing just 12% of global funding, with R&D investment in NTDs falling by $193m (£127m) in 2013. According to the Lancet Commission on Investing in Health, much of the burden posed by NTDs could be prevented for an annual cost of between $300m and $400m.
Despite this delicate balancing act, the pharmaceutical industry has made a positive contribution towards fighting the effects of global pandemics reactively, as seen with Ebola and Zika. Takeda has been selected by BARDA, the Biomedical Advanced Research and Development Authority, to develop a vaccine to support the efforts against the Zika virus in the US and across other parts of the world. BARDA, as a wing of the US Department for Health and Human Services, is pledging $19.8 million to help the vaccine pass through Phase 1 trials, as part of a potential $312 million commitment to developing a vaccine if the vaccine is brought through to complete a Phase 3 trial. Similarly to this multi-stakeholder partnership, Bayer and the CDC (Centers for Disease Control and Prevention; the leading national public health institute of the United States) is helping to lessen the effects of Zika, specifically in Puerto Rico. Bayer has recently committed to providing women with improved access to a range of contraceptive methods and mosquito-repelling bed nets as a preventative measure against the Zika outbreak in the region. This public-private partnership will help to provide the 50,000 mosquito nets and 40,000 oral contraceptive units that the CDC estimates are needed to help the 138,000 of Puerto Rico’s women who are at risk of unintended pregnancy. This provides evidence of a concerted effort by pharma, the CDC, Puerto Rican health officials and other partnering organizations to reduce the impact of the Zika outbreak.
These reactive solutions have helped to greatly lessen the impact of some of the biggest health crises of our times. It is clear to see that these reactive solutions can provide relief to those most in need during health crises, preventing the spread of disease and mortality and further reducing the effects felt on society. However, by drawing on existing partnerships between pharmaceutical companies and bodies outside of the industry, it is clear that the industry will be able to “do more”, when it comes to mitigating against healthcare crises before they strike, thus minimising the impact of a pandemic such as Zika or Ebola.
One such proactive solution to a potential healthcare crisis is the partnership between GAVI and Merck. GAVI (the Global Alliance for Vaccines and Immunization) has recently signed a $5m (£3.5m) deal to buy an Ebola vaccine being developed by Merck. This partnership will enable GAVI to take the experimental Ebola vaccine through late-stage clinical trials, licensing, and WHO pre-qualification. If approved, Merck’s VSV-Zebov (vesicular stomatitis virus-Zaire Ebola virus vaccine) would become one of the world’s first licensed Ebola vaccines. GAVI has plans to create stockpiles of this vaccine as a preventative measure against future outbreaks.
Another such example is the recent partnership between Standard Diagnostics (SD) and PATH, a non-profit that specialises in global heath innovations highlights such an example of this. The two organisations have teamed up to develop a set of tools that will facilitate the rapid diagnosis of onchocerciasis and lymphatic filariasis, two conditions that are identified as NTDs and that have a widespread impact in the developing world. Onchocerciasis, or commonly known as river blindness, is estimated to globally affect 169 million people, while lymphatic filariasis (LF), spread by mosquito bites and identified as the major cause of elephantitis, is estimated to affect 120 million people worldwide, with a further 1.23 billion across the globe at risk from the disease. With the development and distribution of these diagnostic tools, SD is collaborating with PATH to take a proactive lead in the broader attempt by the WHO to eradicate LF in Africa. This demonstrates how healthcare companies are working in partnership with other organisations to help mitigate against these global health crises; they are able to work congruently rather than just standalone.
Another proactive solution currently being developed is illustrated by the work being done by Roche with Tamiflu (oseltamivir). Influenza pandemics have been a constant throughout history, with a pandemic experienced every 10-50 years since records have begun. The WHO has provided a series of recommendations to ensure governments take steps to protect against the threat of an influenza outbreak, with one such recommendation suggesting the establishment of stockpiles of antiviral medicines to ensure timely access to medicines during a pandemic. This recommendation has been actively supported by Roche, who offers a tailored pricing structure for the national pandemic stockpiling of antivirals, contributing to WHO’s Pandemic Influenza Preparedness (PIP) Framework. So far it has donated 5 million courses of antiviral treatment to be distributed as directed by the WHO, ensuring that the threat of influenza is well guarded against.
These collaborations help to highlight what can be done to protect against the impact of a healthcare crisis such as Ebola and Zika in advance of the pandemic striking, serving as evidence for the positive contribution that pharma can make to proactively protecting the world against healthcare threats. By drawing upon the examples of the successful partnerships above, it is clear that the pharmaceutical industry is able to play more of a prominent role in safeguarding the world’s population against the effects that a global health pandemic can cause. By collaborating congruently with a range of non-industry stakeholders, the industry can secure new methods of funding or draw upon a broader range of resources and knowledge in the fight against pandemics; thus, ensuring a constant state of readiness that can be maintained and preventing exacerbated economic or human impact as a result of a health crisis. It is up to the pharmaceutical industry to keep pursuing, and for the global health community to keep in mind that they can leverage pharma to develop, these collaborations to meet the world’s greatest healthcare challenges head on with the best possible solutions. However, while collaboration and new funding sources can help, there are no easy answers or solutions due to the competing interests and priorities of the various stakeholders involved in such partnerships. This is perhaps the most inherent global health challenge, and one which will not so easily be overcome.
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