In my 20 years with the Hep C Trust, it was probably persuading the NHS in the UK to really get behind the idea of using peers as a central, indispensable component of hep C elimination. In my time with the World Hepatitis Alliance, which I set up in 2007, I guess I am most happy about three things: that we got hepatitis onto the global public health agenda by persuading 193 countries to make World Hepatitis Day an official WHO day (one of only four official disease specific WHO days); that we established the World Hepatitis Summit as a unique event, unlike all the existing medical conferences, that brought together governments, patient organisations and WHO to address all aspects of hepatitis; and that we got the elimination of viral hepatitis accepted as a global goal.
I firmly believe that once a charity has served its purpose it should be shut down rather than morphing into something else. There are many people who are invested in creating new charities to bring awareness to a cause they feel passionate about rather than adding their expertise to existing organizations. Just as the Hep C Trust moved closer to achieving what it set out to do, an opportunity at the MPP came out of the blue. I chose to accept the Executive Director role because I felt I could do more for people here than at the Hep C Trust – there are an estimated two billion people in low- and middle-income countries without decent access to medical treatments and healthcare technologies, which, in my view, simply cannot be allowed to continue. Regardless of a country’s economic status, its citizens deserve consistent access to medicines.
The MPP’s role is to negotiate with patent holders to obtain licences to produce and distribute affordable but high-quality generic versions of life-saving medicines for low- and middle-income countries. The licences also enable the production of fixed-dose combinations and formulations for children. The MPP’s manufacturing partners recently rolled out a first-line treatment for HIV, Dolutegravir, based on a licence with ViiV Healthcare, and we’re beginning to see millions of people benefiting from it. Our most recent licence is with AbbVie to expand access for glecaprevir/pibrentasvir, which is a WHO-recommended first-line treatment for hepatitis C.
The industry is beginning to recognize that, on a global scale, it needs to ensure better access to medicines for patients. I like to compare the situation to the current climate around electric cars. Car manufacturers recognize the importance of electric cars for a greener future. With complete certainty, many people, including myself, believe that petrol-engine cars will simply not exist in coming years. Pretending that they will is to deny an inevitable fact about the state of the industry and its trajectory. In the same way, pharma must acknowledge that medicine access is the future of the industry. It matters to advocacy groups and charities but most importantly it matters to patients. As the industry talks more about patient-centricity and meeting the needs of those it serves, this aspect of the sector has to be given greater consideration. What is the point of making medicines that are out of reach of the majority of patients in many parts of the world? By working with the MPP, companies are actively choosing to find strategies that genuinely help to put patients first, focusing on the most neglected patients living in low- and middle-income countries.
That no new medicine is launched without an access program, so that everyone who can benefit is able to do so. This may be through the MPP’s public health licensing model, but not necessarily so. Our model is only one access model – and is only appropriate in certain circumstances. I also think we will need a means-assessed framework that outlines what governments should be paying for the medicines its citizens use. As countries become richer, they should contribute more to the cost of medicines. Cheap medicines are great, but governments around the world need to think about how they will expand their budgets so that they are making contributions befitting of their GDP; the issue is critical for the health and wellbeing of entire nations. If a country is capable of spending 10 percent of its GDP on healthcare (including medicines), why does it only spend three?
By giving governments the incentive to do this, we should be able to tackle some of the most pertinent issues faced by the pharma industry; escaping the drug discovery rut, creating the funds to foster innovation, and providing the means to tackle global crises, such as antimicrobial resistance – these can be better addressed if we have the right frameworks in place. The MPP is all about creating win-win solutions for patients, governments and pharma companies. Some have been sceptical about the MPP’s role (some companies believed we were out to take the profits they made from patented drugs), but I think they are increasingly coming to understand our aim and vision. And the more we can change the industry’s perspective on this issue, the closer MPP will get to achieving its goals.
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