Life-Saving Drugs for All
PRINCETON – The
deadly outbreak of Ebola in Liberia, Sierra Leone, and Guinea that began
last year highlighted a problem in the production of pharmaceuticals.
Once it became clear that the epidemic would not be rapidly contained,
several firms quickly arranged for clinical trials of potential
treatments and vaccines, indicating that they already had the ability to
produce plausible candidates.
Ebola is not a new
disease: it was first identified in 1976. Prior to 2014, however, the
largest outbreak was in Uganda, in 2000, when 425 people were infected
and 224 died. Though Ebola was known to be both contagious and often
fatal, it was thought that only Africa’s impoverished rural population
was at risk. For pharmaceutical firms, the development of a vaccine or
treatment was not commercially attractive, and so it did not warrant
investment.
All that changed with
the latest outbreak. In September 2014, the United States Centers for
Disease Control and Prevention predicted that, in the worst case, 1.4
million people could be infected within four months. Media-fed fears
that the disease could spread to affluent countries led to extraordinary
precautions. In the United States, President Barack Obama asked
Congress for $6.2 billion, including $2.4 billion to reduce the risk of
the disease becoming established in America and set up 50 US Ebola
treatment centers.
The worst-case
scenario did not materialize. As of April 2015, the best estimate is
that about 25,000 people have been infected, with approximately 10,000
deaths. Outside West Africa, there have been fewer than 30 cases, and
only five deaths. Nevertheless, the fears, and especially the prospect
of a new and lucrative market, set pharmaceutical firms scrambling to
develop Ebola-related products, while health officials lamented that
nothing had been done beforehand.
I am not criticizing
pharmaceutical companies for not producing an Ebola vaccine when there
was no market for it. They are not charities. If we want them to make
products that will help the poor in developing countries, we need to
find ways of giving them – and their shareholders – a return on their
investment.
Whereas
pharmaceutical companies lack incentives to aid the poor in developing
countries, they have strong incentives to develop products for people in
affluent countries. One drug, Soliris, costs $440,000 per patient per
year. In contrast, GiveWell estimates
that the cost of saving a life by distributing bed nets in regions
where malaria is a major killer is $3,400. Given that most of the lives
saved are those of children, who even in developing countries have a
life expectancy of at least 50 years, this equates to a cost of $68 per
year of life saved. Should we really be valuing the life of a person in
an affluent country at more than 6,000 times the value of the life of an
impoverished child in a developing country?
Because the
overwhelming majority of medical and pharmaceutical research is directed
toward products that affect people in affluent countries, it targets
only part of the global burden of disease. Some government- and
foundation-funded research addresses diseases that primarily affect poor
people, but these efforts are not systematic and do not use the
incentives that work well to drive pharmaceutical innovation elsewhere.
One promising attempt
to correct this imbalance is the proposal for a Health Impact Fund that
Thomas Pogge, director of the Global Justice Program at Yale, and Aidan
Hollis, an economist at the University of Calgary, launched seven years
ago. If the Health Impact Fund could be adequately financed, it would
provide incentives to develop products in proportion to their impact in
reducing the global burden of disease.
It is not certain
that the existence of such a fund prior to the recent Ebola outbreak
would have led to the development of vaccines or treatments for the
disease. But pharmaceutical companies would have been considering such
products – as well as other treatments to save lives or improve health
anywhere in the world, regardless of people’s ability to pay.
Pogge and Hollis have
now refined their proposal to the point that it is ready for a
real-world trial. A company that develops a product would earn a share
of reward money based on its share of the health improvements achieved
by all the products competing for the available funds. What is still
needed, however, is sufficient reward money – perhaps $100 million from
governments, NGOs, foundations and the pharmaceutical industry – to
stimulate serious investment.
Such a pilot program
would benefit poor patients and would test scientists’ ability to
measure health impact fairly and accurately. It would also provide the
evidence needed to go to governments, foundations, and global
institutions for the much larger sums required to expand the present
system of incentives that guide pharmaceutical companies’ decisions. If
the pilot is successful, we will have found a way to support the
development of drugs and vaccines that gives equal weight to protecting
the lives and improving the health of all human beings, irrespective of
their nationality or wealth.
Peter Singer is Professor of Bioethics at Princeton University.
MAY 12, 2015
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