[Ip-health] SwissInfo: COVID-19With no prospects for profits, big pharma neglects new infectious diseases

Thiru Balasubramaniam thiru at keionline.org
Fri Mar 6 02:14:21 PST 2020


COVID-19 With no prospects for profits, big pharma neglects new infectious

By Jessica Davis Plüss
THIS CONTENT WAS PUBLISHED ON MARCH 6, 2020 9:00 AMMAR 6, 2020 - 09:00

The experience of developing vaccines for diseases like Ebola has led some
companies to be more cautious with their investments.

More companies, including some big Swiss drugmakers, are shifting resources
away from emerging infectious diseases into more lucrative areas like
cancer treatment. Their business decisions risk leaving gaping holes in the
fight against epidemics such as the one caused by the novel coronavirus.

Despite Switzerland’s position as a pharmaceutical and biotech hub,
companies based here have so far abstained from high-profile commitments
related to the global coronavirus outbreak.

The World Health Organisation (WHO) lists of Covid-19 vaccine and treatment
candidates contain no Swiss company. And none of the Switzerland-based
drugmakers have announced major plans to boost R&D into the virus that has
so far infected around 100,000 people in some 80 countries.

COVID-19Coronavirus: the situation in Switzerland

Switzerland is one of the dozen countries most affected by the coronavirus
worldwide, with more than 100 known cases and one confirmed death.

The wider lack of interest doesn’t come as a surprise to Bernard Pécoul,
executive director of the Drugs for Neglected Diseases Initiative (DnDi), a
non-profit organisation dedicated to finding treatments for diseases that
are not a priority to the industry.

“A large number of big pharma companies have abandoned the field of
infectious disease. It’s a big concern because we don't think that this is
the end of infectious disease as we see with the latest outbreak,” Pécoul
told swissinfo.ch in Geneva, where his organisation is based.

Since its founding in 2003, DnDi has been on the front lines of efforts to
attract investment in populations and diseases that are often ignored. By
seeking to re-wire the market-based R&D model, the group has been able to
develop eight new treatments for diseases like sleeping sickness, which
threatens millions of people, largely in sub-Saharan Africa.

Their efforts are still miniscule compared to the billions pharmaceutical
companies pour into cancer research and rare, deadly diseases like spinal
muscular atrophy in hopes of big gene breakthroughs. At the same time,
investments in emerging infectious diseases – those outside HIV, malaria
and tuberculosis – have dwindled.

+ Swiss foundation launches ‘emergency call’ for coronavirus research

The latest Access to Medicines Index found that nearly half of R&D projects
by the 20 biggest pharmaceutical companies target cancer while there were
no projects on coronaviruses at the time the report was published.

Novartis sold its vaccine division to British pharma company GSK in 2014
after operating at a loss for years. The company no longer has critical
mass of expertise in virology, and no laboratories are working on
antivirals or diagnostics. Consolidation in the vaccine business has left
four big players controlling some 80% of the nearly $45 billion market.

“Companies concentrate on the market that is attractive in terms of profit.
Oncology is a market that has been very profitable. Now even orphan
diseases [rare disease classification by the US government] are marketed as
profitable because they could offer a price that is very high.” says

Investment in coronaviruses

Policy Cures, a health thinktank in Australia, has been tracking global R&D
investment in emerging infectious diseases.

Preliminary findings of their report that will be released later this year,
suggests that overall coronavirus R&D funding (focusing on MERS, but
including SARS R&D and research targeting multiple coronaviruses) was US
$27 million in 2016, grew to $50 million in 2017 and fell significantly, to
around $36 million in 2018 – far below the levels of funding received by
Ebola and Zika.

Paul Barnsley a Senior Analyst at Policy Cures, told swissinfo.ch that
“there has been very little reported private sector funding for coronavirus
R&D over this period.” But qualifies that the nature of investment highly
depends on whether there is an outbreaks, and the ability to conduct
clinical trials.

“The small share of private funding for coronavirus R&D likely reflects, in
part, the absence of opportunities for clinical testing over the period
covered by our data”, Barnsley explains.

Diverging priorities

Medicines policy expert Ellen ‘t Hoen argues that “pharmaceutical companies
don’t necessarily set priorities according to what global health priorities
are.” The trained lawyer who worked for Doctors without Borders and the WHO
says that shareholders are used to big rewards and their priorities don’t
often converge with public health priorities.

But some companies argue this explanation is too black and white, pointing
out that cancer is still the second-leading cause of death globally and
chronic diseases like diabetes are on the rise.

In an interview on the sidelines of the World Economic Forum in January,
Harald Nusser, who leads Novartis Social Business, told swissinfo.ch that
the company must consider where its pipeline and experience can make the
most meaningful contribution. It is heavily invested in treatments for
tropical diseases such as malaria, leprosy and leishmaniasis.

“These may at times not be the biggest public health threats or need at
this very moment, but people are still dying of them,” says Nusser.

The trouble with epidemics

Epidemics pose a unique challenge to pharma executives. There is a lot of
activity when an outbreak happens but when it tapers off, so does the
investment. This means that “promising medical technologies may fall by the
wayside because there is no one ready to pick up the bill,” says ‘t Hoen.

This was echoed by Novartis CEO Vasant Narasimhan in an interview on CNBC
earlier this year, who said "there is a lot of interest and activity but
then a lot isn’t happening and people lose interest and the investment
flows out. So, the question is how do you keep the investment in place in
the troughs of interest in pandemics, and these kind of outbreaks?”

GSK’s experience in Ebola is one often-cited cautionary tale. After
investing for years in three vaccines, progress stalled in the final stage
of clinical trials toward the end of the 2014-16 epidemic, due to a
dwindling number of Ebola cases. With no real prospect of a financial
return, the company eventually gave up and handed the candidates over to a
non-profit institute in the US last year. This was despite an Ebola
outbreak at the time in the Democratic Republic of the Congo.

+ A Swiss lab made the first synthetic clone of Covid-19

Companies suffered a similar fate during SARS, said Thomas Cueni, who heads
the International Federation of Pharmaceutical Manufacturers, on Swiss
public television RTS.  “Some 17 years ago, there were companies which
started to develop vaccines. But when it was time for clinical tests, there
were no more patients, because the virus was gone.”

These experiences have likely made companies more cautious about diving
head-first into the search for novel coronavirus vaccinations or Covid-19
therapies. Many companies have been donating supplies and offering advice
to local and global health authorities. Novartis, Johnson & Johnson and
Sanofi have indicated that they are reviewing existing products to see if
they can be repurposed for the coronavirus.

Roche’s arthritis drug Actemra has been added to the diagnosis and
treatment plan for COVID-19 issued by the China National Health Commission
on March 3 as a possible therapy for seriously ill patients. The company is
also working with a German company that uses Roche’s LightCycler® 480
System to speed up the diagnosis of coronavirus infections.

A company spokesperson told swissinfo.ch that it is delivering as many
tests as possible within the limits of supply.

While these efforts are significant, vaccine development would involve much
larger financial commitments on very short notice with very little
prospects of a financial return. That urgency also brings risks, including
legal liability for the companies.

Many investors are placing bets on smaller companies that are more willing
to take on the risks. When little-known company Vaxart announced it was
searching for a possible Covid-19 vaccine, its stock jumped 106.1%. Shares
also rose for other biotechs such as Novovax and Inovio after they
announced plans for testing and trials.

The WHO predicts a coronavirus vaccine would take 18 months to make, which
is less than the typical vaccine development process.

Fixing a broken model

Looking back on a 35-year-long career in global health, ‘t Hoen fears that
we still haven’t learned the lessons from the past. “The coronavirus seems
poised to join a lengthy list of health problems the industry turns its
back on unless additional incentives are made available,” she wrote in a
recent commentary in Barrons.

Ultimately some kind of public-private partnership is going to save the
day, says ‘t Hoen. She just hopes that affordability is addressed up front
and manufacturers don’t receive exclusive rights. This was already a source
of tension in the Coalition for Epidemic Preparedness Innovations, which is
seen as promising effort to drive investment into vaccine R&D for epidemics.

The group has struggled to get pharmaceutical firms to agree to be partners
without insisting on substantial profits or proprietary rights to research
that CEPI, funded largely by governments and charities like the Bill &
Melinda Gates Foundation, helped finance and produce.

Pécoul would hate to see a solution whereby companies simply donate drugs
and offer up some money. “We need some commitment that is much stronger
than charity."

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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