2023-08-21 21:03:29
Innovation in the medical field has progressed exponentially over the past fifty years. But despite this, the persistence of inequalities in health limits the potential benefits of scientific and technological advances that can save lives or improve others.
The debate over the allocation of vaccines and therapies during the Covid-19 pandemic is a striking example of these inequalities. In September 2022, WHO Director-General Tedros Adhanom Ghebreyesus once once more insisted that ending the pandemic would require equitable access to vaccines. At the time, only 19% of the population in low-income countries were vaccinated, compared to 75% in high-income countries.
Despite this imbalance, richer countries have suffered greater per capita losses than poorer countries – a paradox that brings to the fore how inequalities exist at multiple levels. In the United States, for example, cumulative data shows that people of color have suffered higher rates of Covid-19 infection and death than white people. This disparity goes back to the social determinants of health, those non-medical factors that play a critical role in clinical outcomes. Suffering from institutional and structural discrimination, a lower level of health information or cultural and language barriers are all obstacles to a long life in the enjoyment of the best possible level of health.
Reducing health inequalities and helping disadvantaged populations requires innovators to address these issues. There are still several diseases for which appropriate therapeutic interventions are limited or simply non-existent. This is particularly true for rare genetic diseases, but also for more common pathologies: barriers that prevent patients from adhering to existing treatment regimens for hypertension, for example, can have a detrimental effect on outcomes.
The biotechnology industry must allocate sufficient funding to research and development related to diseases that disproportionately affect specific ethnic communities. While we often say that communicable diseases know no borders, genetic and non-communicable diseases unfortunately discriminate. In today’s age of medical innovation, breakthroughs that might help these patients are within our reach.
In the same vein, we need to rethink how we conduct clinical trials. We need to include diverse communities that are representative of the disease state. Studies should take into account the socioeconomic status and level of insurance of the participants and these studies should be designed to recruit people from underrepresented groups. Developing culturally appropriate recruitment materials, reducing travel times to trial sites, reducing the frequency and number of assessments, allowing telemedicine visits where appropriate, as well as introducing creative methods of targeting, collecting and disseminating information are all steps in the right direction.
In addition, regulators and health authorities can do better to encourage innovation that helps provide answers to societal problems. As advances continue in gene therapies and technologies, public opinion and private organizations must work together to ensure that these technological advances and the treatments they make possible are available to all patients who need it. Creative pricing and reimbursement strategies might enable equitable and sustainable access for patients and for health systems. For example, the Value Negotiating Framework, supported by my company, intends to solve some reimbursement challenges in Europe. This framework lays the foundations for faster negotiations between payers and manufacturers with a view to improving patient access to innovative products.
Finally, biotech companies can and should be corporate citizens. In other words: invest in organizations that work to address the social determinants of health – stark disparities in income, education, transportation, exposure to violence, among others – and provide equitable access to diagnostics and therapies. Global nonprofit Acumen, for example, uses its patient capital model to invest in companies that focus on meeting the needs of low-income consumers, ranging from housing issues to alternative energy and access to water.
Merck is moving forward in its decade-long dedicated work to its Merck for Mothers program, which seeks to promote safe, high-quality maternity care around the world. Sanofi Global Health, a non-profit unit founded in 2021, also supports disadvantaged communities by selling them medicines at affordable prices in 40 low-income countries.
The biotechnology industry must continue to expand humanitarian programs and collaborate with nonprofit organizations that provide access to much-needed treatments. There are enough successful programs in this industry that can allow us to explore new perspectives and identify best practices, such as the partnerships Gilead has forged with generic drug manufacturers to produce high quality drugs at low prices. Or like Merck’s agreement with the Medicines Patent Pool to diversify the supply of prescription drugs to low- and middle-income countries.
We must approach health inequalities with the same passion, determination and level of innovation that we devote to drug development. The current gigantic gaps in access and outcomes are all the more unjust because they are avoidable. And as we have seen during the pandemic, everyone has their problem to solve. Collective action to improve health equity, including addressing its social determinants, can increase the lifespan and quality of life for millions of people. This is the goal that all health service companies should strive to achieve.
* Yvonne Greenstreet, PDG de Alnylam Pharmaceuticals
© Project Syndicate, 2023
Innovation in the medical field has progressed exponentially over the past fifty years. But despite this, the persistence of inequalities in health limits the potential benefits of scientific and technological advances that can save lives or improve others. The debate on the allocation of vaccines and therapies…
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