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William Looney looks at how Big Pharma is attempting to bridge the emerging markets' widening cancer divide.
IN CATALOGING THE LITANY OF WOES in Pharm Exec's 2012 forecast of industry prospects, we forget that the business of healthcare is also the source of a huge opportunity: improving the human condition. Other industries may falter in finding that essential connection between ethics, probity, and profits, but in our sector that connection is direct and measurable. Disease—and death—is the destination marked on the passport of all humanity, so the capacity to delay passage or ease the transition through innovations in science and medicine requires no hankering with the minutiae of a mission statement. The real question for pharma is finding the right places to make that contribution in a way that maximizes the value of its internal resources; meets an unmet medical need through useful engagement with patients and providers (the customer); and delivers an adequate return to shareholders.
All of Big Pharma today is focusing on how best to identify those right places in the growth markets of the future: the "pharmerging" middle- and low-income countries of the developing world. In turn, the international community is producing a bumper crop of alternative choices for engagement built around the demographic transition in the incidence of chronic disease, which now afflict developing countries to the same degree as has been the case for decades in the industrialized world. Perhaps the most compelling is the struggle against cancer, the incidence of which is skyrocketing as poorer countries grow more affluent. A new report from a global NGO task force, "Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries," affirms that many cancers common in these emerging markets are treatable (and often curable) with the added contributions made by affordable drugs and diagnostics. It claims that as many as 3.7 million people die prematurely or unnecessarily from cancer each year, and that 80 percent of these deaths occur in low- and middle-income countries. High mortality rates among children and women of child-bearing age are particularly glaring because medicines and vaccines have been developed that can extend life or produce a cure, assuming that health systems find a way where these vulnerable populations have access to them.
Significantly, the report notes that one path to bridge the divide between available technology and impaired access is through joint efforts involving multinational industry to identify "frugal innovations" in cancer treatment. The question that follows: Is Big Pharma willing to step up to the plate? One major player in the field, Swiss-based Novartis, is actively surveying the landscape under an internal effort known as LEAD, to facilitate the specific management skills and cultural sensitivities needed to create new business opportunities in emerging countries that might prove applicable in all markets.
I had the opportunity to observe a meeting of the LEAD team in India last month, which included direct involvement by CEO Joe Jimenez. His take on the optimal way to "bridge the divide" is through a deliberate business, rather than a philanthropic approach. In fact, the only way to make such initiatives sustainable is when you link them to profit, however modest it may be. "It's in the basic nature of the enterprise," says Jimenez, "no one will walk away from these programs if there is money left on the table." His time with the LEAD team included a fact-finding visit to one of India's most successful publicly funded regional cancer centers, which provides an integrated program of treatment and research for the southern India states of Kerala and Tamil Nadu. Discussions with the center's staff included how it is using its ONCONET telemedicine technology to identify cancers at an early stage and to expand low-cost access to basic chemotherapies and drugs, at a level still profitable to the Indian industry. Center staff said the bottom-line interest for them in a dialogue with Big Pharma is promoting any new ideas that stop people from getting cancer in the first place. "Too many people die of cancer due to causes that are entirely preventable," deputy superintendent Dr. Aswin Kumar told the Novartis team.
A worthy assessment to concentrate the mind, as Pharm Exec charts the start of another year in the cyclical dance of innovation.