Medical R&D and essential medicines

Public funds should be for public health, not private profits

The global medical research and development (R&D) system that Doctors Without Borders/Médecins Sans Frontières (MSF) – and the rest of the world – depends on for new medicines must change if it is to prioritize public health over private profits.

COVID-19 vaccines and treatments must be accessible and affordable to everyone who needs them. 

#LivesOverProfits: Canada's public R&D funding should deliver public health outcomes

This system has created a world in which nearly all essential, lifesaving medical innovations become the intellectual property of giant, multinational pharmaceutical companies – even though virtually all new medicines benefit from public funding to discover them in the first place.

Many governments, including Canada’s, fund critically important medical R&D using public money – including current urgent efforts to develop a COVID-19 vaccine – but rarely demand that the resulting health innovations themselves be safeguarded for public health, or be made affordable and accessible to those who need them. Instead, the current system usually sees lifesaving medicines and other health technologies sold to private companies, who are then free to decide who gets access and at what price. Often that means selling their products back to the taxpayers who funded the development of these medicines in the first place – at increasingly high, unaffordable prices.

This is unacceptable. It leaves millions of people – from Canadians struggling to pay for new drugs to MSF’s patients in some of the world’s lowest-income countries – unable to access or afford the care they need.

Read more below:

COVID-19 and the urgent need for public access to lifesaving medicines

How the current global medical R&D system impacts MSF's patients around the world

Why this matters in Canada

COVID-19 and the need to develop a vaccine available to all

Excerpted from an op-ed published in The Conversation by MSF Canada Humanitarian Affairs Advisor Jason Nickerson:

"The race is on to develop a vaccine to protect against COVID-19. Germany, the United States, the European Union and others have collectively committed more than a billion dollars.

Public funds are the backbone of the underlying science that’s needed to develop the medical tools that we need and use. But today there is little indication — and no requirement — that the billions of public dollars being spent will result in a vaccine or treatment for COVID-19 that is affordable.

Instead, governments appear poised to let the private market sort out the details of who gets access and at what price. Their logic is that public funding should be used to support early stage discovery, but that the research should ultimately transferred to private companies in order to be fully developed and priced based on what the market can bear. This logic, whether for COVID-19 or for any other disease, is flawed.

For its own investment, Canada has yet to announce what safeguards it will enact to ensure that the vaccines, diagnostics and therapeutics it develops are affordable and accessible to the people and health systems that need them. Given the massive public contributions being made, governments must ensure that the return on these investments comes in the form of lifesaving health services that are free for patients and affordable for health systems — not in the form of high profits for private companies. This is not only the ethical thing to do, it’s also what makes sense as a matter of global public health policy."

Read more below:

Canada and the Ebola vaccine

The surprising truth about publicly funded medical R&D in Canada

What Canada can do differently right now

MSF’s patients need lifesaving medicines

MSF works around the world delivering emergency medical care to people affected by conflict, disaster, poverty or neglect. As a humanitarian medical organization driven by the belief that everyone, no matter who they are or where they live, should have access to lifesaving health services, MSF provides essential care, free of charge, to patients and beneficiaries in more than 70 different countries.

Unfortunately, the global medical R&D system is not set up to respond to pressing public health needs in places with limited resources. It is often driven instead by commercial considerations and guided by the priorities of the for-profit pharmaceutical industry. Too often, the health priorities of our patients are not commercial priorities for pharmaceutical companies, simply because our patients and their health needs are not profitable enough.

#LivesOverProfits: Canada's public R&D funding should deliver public health outcomes

Watch the MSF panel discussion: Ensuring Global Access to Medicines & Vaccines amid COVID-19

As a result of this system of profit-before-public health, one billion people around the world are at risk from neglected and other diseases. Tuberculosis alone kills more than one million people every year and infects an additional 10 million – most of whom must endure antiquated forms of treatment that are months-long, have toxic side effects, and are increasingly ineffective.

New drugs and health technologies that can meet the needs of patients are urgently needed. But as MSF has seen first-hand in almost every context in which we work, the profits-before-people model that underpins the pharmaceutical R&D system is not delivering affordable medicines and is not prioritizing many urgent public health needs – from neglected tropical diseases to infectious diseases, or even to desperately-needed new antibiotics.

'A surprising amount of publicly funded R&D in Canada ends up as the intellectual property of private pharmaceutical corporations.'

Jason NickersonMSF Humanitarian Affairs Advisor

Medical R&D in Canada

People living in low-income countries are not the only ones who bear the consequences of the flawed medical R&D system. Canada, too, depends on access to timely and affordable medicines to meet the health needs of Canadians. Today, Canadians are paying attention to medicines’ affordability and access more than ever, as the medicines they need are increasingly becoming unaffordable as prices have soared.

#LivesOverProfits: Canada's public R&D funding should deliver public health outcomes

Most new drugs benefit from public funding to support their discovery or development. Canadian public-funded research has led to the discovery of insulin and the only approved vaccine for preventing Ebola, among other successes.

But there are currently no policies or mechanisms requiring health technologies developed from publicly funded research to be affordable or accessible for Canadians or anyone else.

Right now, the way in which most discoveries move out of the laboratory and into the development pipeline is by commercializing them – by licensing or selling them to the private sector, often with no strings attached, meaning that companies are able to charge high prices and restrict access to lifesaving treatments, even when the public paid to discover them in the first place.  

Canada and the Ebola vaccine

In 2014, an outbreak of Ebola began in the West African country of Guinea, and soon spread to the neighbouring countries of Sierra Leone and Liberia. Unlike previous Ebola epidemics, this outbreak defied efforts to contain the spread, and soon became a massive and deadly international health crisis, causing more than 11,000 deaths before finally being declared over in 2016.

An effective vaccine could have helped stop the spread of Ebola and saved many lives. Today, one exists (and has played an instrumental role in fighting a more recent outbreak, in Democratic Republic of Congo). But the vaccine, known as rVSV-ZEBOV, is also an example of why assuming that health technologies developed with public funds should be transferred to the private sector with no safeguards attached is a flawed logic.

#LivesOverProfits: Canada's public R&D funding should deliver public health outcomes

That’s because rVSV-ZEBOV was discovered by Canada’s National Microbiology Laboratory in Winnipeg all the way back in 2001. But the government of Canada sold the commercial rights to the vaccine exclusively to a private company. As a result, development of the vaccine stalled and it was not available when it was most urgently needed during the West African outbreak.

“A surprising amount of publicly funded R&D in Canada ends up as the intellectual property of private pharmaceutical corporations,” says Jason Nickerson, Humanitarian Affairs Advisor for MSF. “That’s why MSF is calling on the government of Canada to include safeguards to its funding agreements for medical R&D that will guarantee the resulting discoveries will be accessible to those who need them most. This is something well within their ability to do.”

'There are no policies in place to ensure that the medicines developed with public funds will be affordable or accessible to patients – in Canada or anywhere else in the world that needs them'

Use public funds for public health

Canadians may be shocked to learn that although their government commits billions of dollars to health R&D each year, it currently has a no-strings-attached approach, meaning there are no policies in place to ensure that the medicines developed with public funds will be affordable or accessible to patients – in Canada or anywhere else in the world that needs them.

Moreover, Canadians may be equally surprised to learn that commercialization continues to be an objective of our health research funding agencies, without any safeguards to ensure that commercialization actually delivers affordable and accessible drugs, vaccines, diagnostics, and other health technologies. Canada is far from unique in this, but ought to be a leader in changing it to put patients’ access ahead of private profits.

It does not have to be this way. By identifying priorities for health research and development, and implementing common-sense safeguards that require that medicines and other health technologies developed with public funds be made available and affordable to patients in Canada and elsewhere, the Canadian government will have a significant impact on patients’ lives and can help alleviate suffering, both in Canada and around the world.

What Canada can do differently

MSF calls on the Canadian federal government to ensure that public research funds will deliver publicly-accessible goods, not private profits, by implementing the following:

1. Ensuring sustainable and affordable access to medicines, vaccines, diagnostic tools, medical devices and other health technologies developed with public funds should be a guiding principle of Canadian health research. This means that all patients and health systems that need them should have affordable access to health technologies discovered and/or developed in whole or in part with Canadian public funds.

2. Canadian government funding agencies should require that recipients of public money for health research have access and affordability policies in place for health technologies discovered and/or developed with public funds.

3. Recipients of Canadian public funds to develop or produce new health technologies should be required to report clear, disaggregated and verifiable information on R&D and manufacturing costs throughout the development process, to increase transparency with the view of ensuring fair prices for new medicines and contributing to knowledge of the true cost of developing new medicines and other health technologies