That so much hope is being pinned on remdesivir, the drug Gilead is testing for Covid-19, reflects the failure of our system for new drug development rather than the unqualified success some commentators are making it out to be.
If anything, remdesivir is the poster child for why we need a new model of drug development for pandemics and neglected diseases that isn’t restricted by the current market-based model.
The Covid-19 pandemic has provided the pharmaceutical industry with a chance at bolstering its heavily tarnished image. Abbott Laboratories is winning effusive praise for its introduction of a rapid Covid-19 test. After decades of profiteering from the opioid crisis, Johnson & Johnson has ramped-up its advertising on Twitter to promote the company’s research into a vaccine for Covid-19. It is even airing an eight-episode reality television series showcasing its efforts.
The marketing offensive appears to be working. Recent polling shows that public perception of pharmaceutical companies is on the upswing after years of historical lows. The narrative emerging from the Covid-19 pandemic is that the market is responding to rescue us from global catastrophe, a public relations coup for an industry that has long known about the potential for another pandemic but hasn’t meaningfully invested in research until now.
Since 2002, epidemics caused by severe acute respiratory syndrome (SARS), swine flu (H1N1), Middle East respiratory syndrome (MERS), Zika, Ebola, and other viral diseases have killed nearly 600,000 people worldwide. Yet, in the aftermath of these outbreaks, and despite clear warnings that another viral pandemic could emerge, the pharmaceutical industry failed to sustain investment into new treatments and vaccines.
That may surprise the public, but it doesn’t surprise those working on public health issues. In today’s capital-driven market, investments in pandemic preparedness and in neglected diseases like tuberculosis and malaria are not, and never have been, a priority for pharmaceutical company drug development even though neglected diseases cause more than 2 million deaths per year, almost seven times the number of deaths caused so far by Covid-19.
There are several reasons for this disconnect between need and action. One is that outbreaks are unpredictable and may not last long enough to generate a sufficient market for a new therapy. Another is that diseases like malaria and trachoma predominantly affect poor people living in low-income countries that don’t constitute a sufficiently profitable market.
A company executive deciding between investing in a novel treatment to address a potential pandemic threat or buying back company shares to boost a company’s stock price will probably choose the latter. The practice of boosting shareholder profits and executive pay instead of investing in new products and services or employees has become the market norm, as the airline industry has shown.
In 2018, global funding for basic research and product development for neglected diseases was just $4 billion. Of this funding, 64% came from public tax dollars. Another 19% came from philanthropic organizations. The private pharmaceutical sector contributed just 17% —$650 million — a drop in the ocean considering that the revenue of the top 20 pharmaceutical companies was more than $661 billion in 2019.
The lack of investment by the pharmaceutical industry is not limited to neglected diseases and pandemic preparedness. Many of the largest pharmaceutical companies have stopped investing in the development of new antibiotics to treat drug-resistant infections, which is already a global health crisis that is costing lives and threatening modern medicine, including routine surgery and chemotherapy. Rather than conducting research and developing genuinely new drugs that could help solve some of the biggest public health issues now and in the future, companies spend more time finding ways to keep existing drug franchises profitable. This includes filing hundreds of patents on a single drug under the guise of medical innovation, as detailed in a report published by I-MAK, an organization one of us (T.A.) co-directs.
If we are serious about being prepared for future pandemics and addressing neglected diseases, we need a new economic model of drug development that does not rely on the prerogatives of the market.
First we need existing research to take place in a more open and transparent manner, even if it is protected by intellectual property. The pharmaceutical industry sits on libraries of patented molecules and research, some of which originates from public funding, but which is not developed unless market opportunities arise.
To Gilead’s credit, it has collaborated with a select consortium of universities in researching remdesivir funded by at least $70 million from the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. But a more transparent and open science platform could have motivated broader research participation earlier and potentially saved valuable time and improved collective understanding of the drug.
For example, Gilead recently announced that it is exploring the possibility of developing an oral or inhaled form for remdesivir instead of the current intravenous application, which must be administered in a hospital. Had Gilead collaborated earlier and more broadly, scientists could have explored the viability of these delivery forms sooner, making the drug easier to use and more readily available those in poor countries who have less access, or sometimes no access, to hospitals.
Second, there is an overreliance on the “private” component of public-private partnerships. Instead of governments simply pledging billions of dollars to pay for new Covid-19 treatments and then abandoning that knowledge to private hands, which are governed by incentives other than public health, they should be building their capacity to turn basic research into actual end products to meet urgent public health problems. Before the next pandemic arrives, we should start building for such an approach now.
Governments are ultimately responsible for the system that incentivizes the pharmaceutical industry to behave the way it does. The last 40 years has seen a rapid global expansion of intellectual property. This has resulted in longer monopolies and progressively more privatization of scientific research and knowledge, including government-funded research done by universities. It is past time to address the proprietary issues within science and re-balance intellectual property regimes that stand in the way of public health progress.
The consequences of failing to change course are real. Reality television, as we all know, is not.
Tahir Amin is the co-executive director of the Initiative for Medicines, Access & Knowledge (I-MAK) a global nonprofit organization working on systemic changes to intellectual property and the political economy of pharmaceutical innovation. Rohit Malpani is a public health consultant and former policy director of the Medecins Sans Frontieres/Doctors Without Borders Access Campaign.