Source: The Lancet, Volume 373, Issue 9665, Page 693, 28 February 2009
Author: staff

Tensions between provision of and payment for health care are familiar. Though doctors assume principal responsibility for patients’ health, those who work for pharmaceutical companies view the patented medicines they design as key components of health care. Creative ways are continually found to make such drugs available to as many patients in high-income countries as possible, the profits contributing to future investment in development and leaving national drug budgets affordable, just. Yet, a few hours’ flying away, patients in developing countries usually have no access to these very same patented drugs.

GlaxoSmithKline (GSK) has grown in size and influence by successful drug development, timely takeovers, and shrewd management. Andrew Witty, who ascended to the vertiginous position of chief executive at GSK in the past year, has attracted attention by a surprising presentation at Harvard Medical School on Feb 13. He promises that GSK will now not only make its medicines available much more cheaply to patients in low-income countries, but also make a bolder commitment to research into neglected diseases. As one blogger puts it, “arise Sir Andrew Witty (or is it Saint Andrew?)”.

Does this announcement mark a sea change in pharma’s attitude to the provision of drugs in poor countries, or could it be more reminiscent of the zany hybrid vehicles that distract attention from car manufacturers’ shamelessly polluting stock in trade? Witty’s words were carefully weighed to cast a rosy glow around GSK’s existing efforts. He namechecked the company’s Spanish centre focused on research into “diseases of the developing world”, including tuberculosis, and the company’s malaria vaccine programme (a vaccine that will in any event need to find its main markets in low-income and middle-income regions). But a statement of intent was made, and some clear ideas put forward. In the 50 poorest countries, patented medicines are to be sold at no more than a quarter of their price in developed countries, and a commitment has been made to reinvest 20% of GSK’s developing-country profits back into local health-care infrastructure. Most intriguingly, the idea of a patent pool has been floated, by which holders of intellectual property rights would share them with others to invigorate research into neglected diseases.

GSK has made philanthropic gestures in the past—witness its ancestor SmithKlineBeecham’s donation of albendazole for treatment of lymphatic filariasis—and positive publicity might help to lift some of the dark clouds that have been gathering on pharma’s horizon, including depleted development pipelines and increased regulatory oversight. To be sure, Witty is not intending to alarm shareholders. GSK (2007 annual revenue £22·7 billion, profit after tax £5·5 billion) currently earns annual revenues of just US$43 million in the poorest countries, suggesting that the money to be reinvested locally will be less than 0·1% of overall profits. Flaws have been spotted in Witty’s new way too. Médecins Sans Frontière’s campaign for access to essential medicines notes that, despite a need for new pediatric and combination antiretroviral drugs to combat HIV, GSK does not plan to share its HIV patents with other researchers. Voluntary price reductions seem unlikely to match the dramatic falls in price, and consequent transformational increase in poor-country access, wrought by generic competition on antiretrovirals in the past decade.

Those committed to the forbidding task of improving health care in developing countries should commend Witty’s stance, but continue to press for more, and broader, action. GSK is not offering to give away its drugs and vaccines—someone will need to pay for patented medicines that can now be made available to patients in poor countries more cheaply, and likewise development of patent-pooled orphan drugs is yet to be planned, pursued, and paid for. And who will pay, amid a financial ice age of unknown extent? To convert a promising soundbite into improved health for people in developing countries, GSK must work openly with funding bodies, governments, and other stakeholders to identify clinical and public health problems that offer the greatest potential benefit to human health. These efforts will need close scrutiny to ensure that they register measurable achievements and, given the substantial obstacles of unstable health systems and uncertain funding, gather momentum.

Now that Andrew Witty has chosen this particular agenda, as a test of GSK’s resolve he can be presented with one straightforward preventive challenge—to make GSK’s licensed human papillomavirus vaccine affordable for girls and young women in low-income countries, and work proactively with funding agencies to deliver the vaccine in countries with suitable health systems.