Public health innovation: Biopharmaceuticals lost in translation?
By: John Doyle, DrPH, MPH | August 24, 2016
This is the tenth in a series on trends impacting the biopharma industry.
Taking treatments from bench to bedside requires a viable pathway connecting molecular science to global need. This peer-reviewed article, which I co-wrote on Public Health Innovation presents a systematic analysis of the effectiveness of translating basic science into reduced global burden of disease as a proxy for systemic public health impact. In it, we pose a compound research question: Is the current drug development pipeline aligned with current and future global burden of disease, and, if not, where do the disconnections occur?
Perhaps it is in how we measure success. Sandro Galea, MD, dean of the Boston University School of Public Health, argues that “if we simply measure overall population health, we can almost certainly improve it by…improving the health of groups that are easily accessible and most amenable to changing their behavior.” However these efforts will inevitably widen health gaps leaving marginalized communities behind. Galea notes that health is a public good that forms part of the social fabric, but such health inequities “fray that fabric, contributing to broader resentments of social inequities.” Galea concludes that payers and providers could broaden their expectations about outcomes to include equity, which ultimately benefits everyone.
In valuing research and setting funding priorities, the operating assumption is often that conditions representing the highest burden receive higher research priority, positing that burden of disease rankings are roughly translated into a demand for research. However, pharmaceutical R&D ‘gaps’ remain. To address these, there is a need for greater collaboration between stakeholders. Biopharma R&D should be viewed from a public health perspective, incorporating new epidemiological, population and health system variables, in order to take translational medicine from bench to bedside.
The West African Ebola outbreak is a poignant example, illustrating the far-reaching benefits of a unifying global health system framework. A Commission on a Global Health Risk Framework for the Future has been set up to recommend a more effective global architecture to mitigate infectious disease threats.
In a similarly supportive argument for a global health system, Bill Gates asserts, ‘Of all the things that could kill more than 10 million people…the most likely is an epidemic stemming from either natural causes or bioterrorism.’ The world needs a global warning and response system for outbreaks, writes Gates. The World Bank projects that a worldwide influenza epidemic, for example, would reduce global wealth by an estimated $3 trillion.’ Gates advocates for investment disease-surveillance and laboratory-testing capacity.
It’s not a new idea. This 2013 Lancet article set out an ambitious investment framework for achieving what the authors called a ‘grand convergence in global health’ by 2035. As highlighted in a March 2016 PLoS paper, this ‘prospect of achieving a grand convergence in global health within a generation, averting about 10 million deaths annually from 2035 onward, represents an unprecedented opportunity to boost human development worldwide. This opportunity can only be realized through a serious, renewed effort to step up investments in R&D to tackle the health conditions of poverty.’
What does this mean for biopharma?
Drug development is not optimally poised to reduce the global burden of disease. For breakthroughs to reach patients, stakeholders must collaborate for greater innovation and reengineer their approach to meeting public health needs. While the globe becomes more connected, the challenge to collaborate across and within increasingly complex and localized healthcare systems can be immense.
There is an opportunity for a ‘Public Health Index’ to guide efficient and effective healthcare resource allocation. Such an index should incorporate not only burden of disease metrics and new drugs in development, but also variables such as the number of available interventions, economic impact, medication adherences, education, and prevention. The index can determine unmet medical need from various stakeholder perspectives, build evidence to support adoption, and prioritize target disease areas.
The accelerating growth in healthcare spending, compounded by an intensifying focus on prescription drug prices, mandates biopharma companies to prove the value of their products in addressing unmet medical needs within the healthcare system. By solving for population health goals that include quality, efficiency, outcomes and equity of care, biopharma can optimize their value contribution the global healthcare system. When these system goals are focused on the most pressing burden of disease considering the advantaged and disadvantaged communities equitably, public health can be optimized. System reform needs to ensure adequate return on biopharma innovation to fuel this population health optimization to ensure it can be sustained in the face of political and economic pressures.