The past 5 decades have seen monumental strides in healthcare; from the discovery that aspirin prevents blood clotting to the eradication of smallpox. In this exclusive interview, Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) reflects on 50 years of innovation from the associations housed under their umbrella and looks towards the biggest challenges healthcare is set to face in the future.
Originally an association of associations, the IFPMA has expanded to include pharmaceutical companies and over 50 national associations. What is the mandate and function of your organization today?
The IFPMA is the representative body of the research-based pharmaceutical industry. Our overriding mission is essentially to support the industry’s business model – encompassing discovery, research and development of innovative new treatments and vaccines – with the ultimate aim of making life better for patients around the globe.
The pharmaceutical industry’s business model has been tremendously successful and has delivered immense value for patients across all continents. We are keen to demonstrate that our members are much more than just researchers, developers and sellers of drugs. They fully understand the need to take a more holistic approach to healthcare in an époque where healthcare systems are under increased financial strain. They understand that the responsibility is upon them to play a more proactive role in ensuring sustainable access to their innovative products. This last mile of securing access is not an easy part and necessitates engagement, which is something that our members are increasingly willing to do.
Given our strategic location within Geneva, the health capital of the world, our function includes representing the industry’s views within international organizations such as the World Health Organization (WHO). As such, we are advocates for the industry business model and ensure that our members’ voices are heard at international fora. A large chunk of our work is devoted to establishing partnerships, building consensus and aligning interests so that the concerns and ideas of the innovative pharmaceutical industry get a decent hearing.
Promoting ethics and business integrity across the pharmaceuticals industry is another of our key objectives and IFPMA possesses a very commendable track record. Our Code of Practice was first drawn up in 1981, almost 40 years ago, and it was the first one of its kind for any sector. Our Code was born out of our industry’s mindfulness that when we are promoting our products we must consider the responsibility of healthcare professionals to their patients. Our members are getting prepared to implement an updated version of the Code, which will be effective next year. Because the healthcare community and the public must be confident that our employees, wherever they operate, communicate and act in an ethical manner, IFPMA’s role is to provide a beacon for the whole sector and to work to uphold ethical standards.
This year, IFPMA celebrates a half-century of existence and has recently released its report: “50 Years of Global Health Progress.” What are the main takeaways from this report?
Right now, healthcare providers, payers, patients and drug developers are facing many challenges ranging from epidemics such as Zika and Ebola, and unmet medical needs (such as finding a cure for dementia, or new antibiotics), stressed budgets and market access hurdles. Notwithstanding all of this, the report demonstrates that over the past 50 years, we have witnessed a tremendous advancement of healthcare globally. In the same vein as Hans’ Rosling’s work, “Factfulness”, we are able to challenge some of the misconceptions around the pharmaceutical industry and its contribution to global health progress.
IFPMA invites people to reflect on the sheer improvements that have been realized. Since the establishment of the WHO in 1948, average life expectancy has risen from 47 years to 72 today, and diseases such as smallpox have been eradicated. The past 50 years have also seen the transformation of HIV from being a deadly disease to a chronic one. Previously terminal, cancers now can be slowed down or even cured. Today, we have vaccines to prevent 26 diseases. These steps are, quite frankly, remarkable.
Moreover, many of the critical public health challenges faced today are borne out of these successes. The increased prevalence of dementia and central nervous system disorders is in part down to the fact that many more people are surviving infectious disease and living longer. It is entirely logical that demand for diseases relating to ageing should increase exponentially in an ageing society. People’s expectations have also evolved. These days, adequate access to quality healthcare is considered a human right in many jurisdictions, so demand is much stronger.
The 50th anniversary provides a good juncture to take stock of how far the world has come and to consider future pathways that respond better to prevailing needs. Today’s complex health challenges call for out-of-the-box thinking. To continue the trajectory of progress it will be very important to continue to build bridges between key actors across the health system. Stakeholders will have to go beyond their comfort zone. Drug developers must not rest on their laurels and be content with pushing pills, but will need to think holistically: our industry has learned that global health is about much more than medicines and vaccines – it requires building and supporting strong health systems, delivering education to communities to promote prevention, strengthening standards and regulations and creating innovative finance models. Healthcare providers, meanwhile, will need to show themselves ready to partner with private industry, and payers prepared to reward value.
Under the prevailing business climate, market failure appears to be preventing the discovery of new antibiotics in the sense that risk-reward ratios are not appealing enough to drug developers. What can be done to remedy this?
IFPMA has been the proponent of replacing early-stage research subsidies with market entry rewards, but we also need to correct some of the misconceptions around industry’s work on antibiotics R&D. People tend to think the pharmaceutical industry more or less quit the antibiotics segment, but the reality is that big pharma alone invested some 2 billion dollars in antibiotics research in 2016, which is 4 times as much as the main government-sponsored programs. In the same year, the UK, US and Germany together invested only around 500 million.
Pharmaceutical companies are not only active in R&D, but are taking many other tangible steps across the continuum of care – from prevention, monitoring, and screening to treatment. There are many examples of how the industry is operating right on the front line in trying to halt the spread of AMR. Historically pharmaceutical companies enlist large cohorts of sales representatives, but the role of the representatives has been broadened to an educational function in raising awareness amongst the local medical practitioner’s communities about the dangers of overprescribing antibiotics.
One has to acknowledge that this is one of the most challenging innovation environments. High-risk investments will be hard to sustain under current conditions where novel antibiotics will remain on the shelves as reserve, meaning there is a very limited economic return on these products. Actions taken by governments to support innovation today have an immediate impact on companies’ investment and therefore influence the development and availability of treatment options 10 or 15 years from now.
What other issues are shaping the life of your members?
Vaccines are proven to be one of the most cost-effective medical technologies ever invented, as immunization saves between 2 and 3 million children’s lives per year. Additionally, in terms of pandemic preparedness, substantial progress has been made by industry in partnership with bodies like the World Health Organization. Nevertheless, the investment case for enhanced vaccine programs in places like Africa is very compelling and can impact economic growth in a major way
Meanwhile, sweeping technological change and the coming together of the digital and pharma worlds is disrupting the drug discovery process. There is a great need to master data processing and be able to interpret and exploit data collected so as to make both the development and delivery of medicine more effective. After the convergence of the chemical and biological, we are now at a stage where we are getting closer to identifying treatment pathways for the great illnesses of our time like cancer and dementia.
Finally, the importance of promoting systemic change in terms of health system strengthening is becoming ever more apparent as non-communicable diseases are sweeping the entire globe, and the science becomes ever more advanced and requires strong infrastructures. Countries need to put health as a top priority on their agendas and make the necessary investments.