COVID19 - A WAY FORWARD FOR THE GLOBAL HEALTH ECOSYSTEM
Covid19 is not just a source of anxiety and despair brought by the twin health and economic crisis. It can also be “our finest hour” for the global health ecosystem, helping shape the After Corona New Normal.
A shortened version of this article had been published by the European Business Review and can be read here: Leadership and people outreach for the Global Health Ecosystem — EBR Analyses.
People first but Reputation opportunity as well
In a quest to define the known unknowns, opinion leaders have widely agreed that the COVID-19 crisis is unprecedented in terms of scale, impact and challenges. The immediate threat to public health is pushing key industries to rethink their ways of action, adapt to the new environment and reconsider funding priorities. Governments worldwide are committing significant chunks of their public budgets towards mitigating the public health and economic impact of the crisis and ensuring a swift — albeit difficult to grasp — recovery.
Naturally, part of the public funding, joined by private contributions, are now being put into research and development towards identifying the right treatment solutions, meant to win the fight against COVID-19 but in terms of health and in terms of trust and reassurance. The Global Health Ecosystem (from companies to health foundations) has therefore both an opportunity and a challenge: to serve people first, with generosity, in the pandemic emergency; then advance in pushing health as an industrial priority for the future, in the context of economic concerns and fundamental choices amid scarcity of resources.
Perhaps there has never been a time, at least in our recent collective memory, for the pharma business sector to be under this level of pressure. Pharmaceutical companies (but also their biotech “updates”) play a special role in finding solutions to delay and contain the immediate effects of COVID-19 and offer some perspective of safe recovery for all. From this perspective, pharma represents one of the few business sectors set to benefit from this crisis by driving innovation, access to medicines and, ultimately, financial gains. For this sector, it is a time of opportunity not only to reaffirm the key importance of an in-depth dialogue on healthcare as a global priority, but also to perform an exercise of positive reputation management.
The COVID-19 pandemic comes at a time when pharmaceutical companies are dealing with major reputation issues, public criticism and pressure related to pricing strategies and perceived lack of transparency, as well as multiple scandals that have poisoned the industry in the public’s eye in recent years. Last year, for example Americans answering a Gallup poll on what industry they liked least, overwhelmingly indicated the pharmaceutical industry.
The situation is not much different in Europe, but it is safe to say that the EU’s and EU member states’ penchant for regulations has shaped the relation between pharmaceutical companies and governments in different ways. However, it is still unclear whether there is a model of partnership between governments and pharmaceutical companies that would allow for success or not in the current context — what we know so far is that such technicalities make little sense for those who expect fast and affordable access to medicines and vaccines. Curevac for example will test EU trust and funding.
The Hero versus Villain dilemma
Following the publication of a 10 million euros call in January, the European Commission has added another 37.5 million euros for urgently needed research on COVID-19 vaccine development, treatment and diagnostics, as part of the coordinated EU response to the public health threat of COVID-19. The 47.5 million euros emergency call to fight the COVID-19 outbreak allowed the selection of 17 projects involving 136 research teams from across the EU and beyond, which will start working on developing vaccines, new treatments, diagnostic tests and medical systems in order to prevent the spread of the Coronavirus.
On the development of vaccines, the EU envisions the development of a prophylactic and a therapeutic vaccine, while on new treatments a dual approach will be adopted — firstly, accelerating the development of new treatments currently in the pipeline, and secondly, screening and identifying molecules that could work against the virus, using advanced modelling and computing techniques.
Globally, pharmaceutical consortium and accelerators, such as the COVID-19 Therapeutics Accelerator launched in early March by the Gates Foundation, Wellcome, and Mastercard are leading private sector efforts to drive the development process of COVID-19 treatment solutions. Companies such as GSK, Johnson & Johnson, Pfizer and Sanofi have all announced intentions to drive the development of a COVID-19 vaccine, while multiple pharmaceutical giants, such as AbbVie, AstraZeneca, Eli Lilly, Novartis, Pfizer, Roche, Takeda and more — are leading treatment adjustment efforts. Many other pharma players have made available their research capabilities or have contributed with necessary materials to the fight against the COVID-19 pandemic.
Under normal conditions, some of these development processes can take up to a decade, involving several conception and trial stages. Now, experts hope that a COVID-19 vaccine will be available in 12 to 18 months. Typically, according to experts, approximately one in ten experimental vaccines are actually approved by public health bodies and administered to the people.
Considering this global mobilization effort, the question of over-promising versus under-delivery arises. There are many unknowns as regards the evolution of this Coronavirus, which will influence the way pharmaceutical companies will act further on, depending on their individual background, ongoing and niche priorities and current portfolios. If the pharmaceutical industry actually holds the potential of becoming the dealers in hope we need in the current crisis, regulatory processes must also be adapted in order to ultimately allow for access to efficient treatment solutions. In parallel, all technical things must be doubled by popular hope management in order not to disappoint or become the lame ducks some politicians are actively looking for.
To this end, pharmaceutical companies must look in-depth into scenario planning and work locally, regionally and globally to take on, like the rest of us, what we will define as a fair share of the common burden. The pharmaceutical industry needs, more than ever, to invest efforts into the war of ideas that is inherent to any crisis, under conditions of scarcity of resources. However, empathetic and timely leadership on their behalf, doubled by the words that work amid crisis, is one way to bounce back from the hero versus villain dilemma.
Big enough not to fail? Monopolies, supply chains and geopolitics
The question of intellectual property in the pharmaceutical sector is likely to be challenged and, in some ways, governments have already started a silent war against patent-based monopolies, which may be hindering their ability to fight the COVID-19 crisis. Some Western governments have even started reviewing patent protection legislation to introduce limitations on patents, pointing at wider trends in this regard. Others have started issuing compulsory licences for medicines that could be used against the new Coronavirus. Such moves show clear intent of driving generic competition through policy options viewed as rather extreme before the COVID-19 crisis.
Against this backdrop, some generics producers have been working on effective narratives, pointing at their locally-based capacities to rapidly produce medicines needed for the treatment of COVID-19 infections. While their response to immediate needs is timely and necessary, in addition to governments worldwide banning exports of essential medicines, this trend may eventually hinder market competition. In this situation, innovative drugs producers should tap on their capacity to partner with the public sector to provide expertise and ensure equal access to innovative solutions, especially as the Coronavirus crisis took us to a point in which few sectors of activity allow for innovation and the healthcare sector is among them.
Other trends to consider, with a geopolitical flavour, concern the resilience of pharmaceutical supply chains. India and China are extremely important in terms of market share for low-cost generic drugs in the United States, making up for around 90 percent of the prescriptions. China is the second-largest exporter of finished drugs to the United States, while also the largest source of Active Pharmaceutical Ingredients (APIs), with a market share of around 80 percent. Pharmaceutical supplies are extremely difficult to replace in the short term, as this process requires research, development and certification, among other steps.
Parts of this trend are also applicable in Europe, where temporary bans on drugs exports, for example, have made it very difficult for pharmaceutical companies to rely on storage facilities placed in one country, to ensure supply in the wider region. It goes without saying that disruptions in supply chains are difficult to handle worldwide and, from this perspective, resilience is mandatory.
Building up resilience as competitive advantage plus avoiding human drama
Much of the pressure on pharmaceutical companies to deliver will ultimately come from consumers, under the conditions of a fast-developing crisis. In times of uncertainty, there is no one-size-fits-all solution to reassure patients and lay the foundation stone of effective partnerships with governments. Trends to consider when it comes to rethinking the public-private partnerships that have ensured market access so far include the access to stakeholders and the need to accommodate their changing priorities. People will become even more central in a world of increased discontent provoked by covid19 crises.
Tackling COVID-19 infections and providing treatment are difficult and costly tasks for all countries. In this context, the redistribution of funds is the natural next step. Unfortunately, considering the limited resources that some healthcare systems operate with, there is real danger of a potential postponement of medicines acquisitions for chronic diseases such as cancer, diabetes or hepatitis. In this situation, issues with medicines supplies must be avoided at all costs, through effective engagement towards driving the clarification of regulatory aspects. Is a covid19 patient more “entitled” to access a hospital bed than a suffering cancer patient, or not? Ethical dilemmas are starting to appear beyond the drama we saw in the coronavirus context: “ventilators should be used on those with more chance to live”.
The pharmaceutical sector should work with hospitals and clinics and the wider health stakeholder system to build up resilience in this context and make sure there is no need to make dramatic choices. This is both humanly compelling and a competitive advantage for this industry and system, which could lead and shape the new normal for other industries.
Showing leadership of thought and action. The role of foundations
The opportunity to show real leadership of thought and action in the pharmaceutical sector is tied to companies’ response to the needs of patients and consumers. Investments in research and direct medical aid to countries and communities in need must be part of a wider effort to educate stakeholders and wider audiences while helping them cut through misinformation and drive positive partnerships. For this purpose, the foundations set up by world famous billionaires or major pharmaceutical companies represent the right vehicle of engagement, as well as the right voice to show leadership.
Educating stakeholders. Engaging with stakeholders to share information on the latest developments related to COVID-19 research, available solutions and capacities is not a useful exercise of transparency, but also a way to build the trust needed to overcome this crisis without pointing fingers. Supporting stakeholders in preparing guidelines and recommendations specifically for the most vulnerable categories of population is also a good exercise of understanding the true public health implications of the current crisis, which will ultimately impact our societies’ recovery and path to a new normal.
Educating wider audiences. Pharmaceutical companies, innovative and generic, hold the credibility to reach wider audiences, including patients and consumers, with messaging that is reasonable and can give hope amidst the infodemic that is currently unfolding. Informing audiences about the usage of products and facts and fiction, while supporting governmental efforts of informing the public about protective measures can provide exposure to the industry’s authentic interest to help overcome the crisis.
Supporting local efforts. Whether it is by making donations, supporting research groups, providing pharmaceutical ingredients or facilitating contacts with other markets, those who are contributing to easing the burden on governments and local authorities will be remembered in terms of value added to the markets they operate in. Playing a visible, purpose-driven role can breed goodwill in the long-term. Some negative trends may peak simultaneously across regions and continents, such as manufacturing challenges, medicines shortages, competition over supply and allocation of COVID-19 treatments — thus, the focus right now should be on collaboration, shared expertise and preparedness.
Positioning as the one that guides in times of crisis, offers support to the most vulnerable ones, and professional advice to the leaders in charge to fight the COVID-19 pandemic will help championing the positive role of the industry in driving hope and transforming data into curing medicines. Tackling serious concerns for patients, such as potentially escalating prices and the inability of patients who need medicines to find or afford them are the key to leadership of thought and action in times of crisis.
The global health ecosystem is a complex and complicated one, and so are the challenges of the After Corona Age. But with solidarity and smart ideas, people and health stakeholders have a chance to win. For them, and for humanity as a whole.