The Global Right to Healthcare

The Othmer Gold Medal was given to me by Carsten Reinhardt, President and CEO, CHF

 
My Speech at The Chemical Heritage Foundation (CHF) 


I am deeply grateful to the Chemical Heritage Foundation for awarding me the 2014 Othmer Gold Prize.  This is an honour akin to being invited to join an extraordinary league of scientists, engineers, entrepreneurs, thought leaders and philanthropists, an emotion that is both proud and humbling at the same time.

As a citizen of the developing world, I am only too aware of the power of science and technology in innovating and enabling the alleviation of poverty and building social inclusion in economic development.  As an entrepreneur who is driven by a sense of purpose to make a difference to global healthcare, I would like to use this platform to share with you my thoughts on the global inequity that exists in accessing basic healthcare needs.

Nearly 2 billion people — or a third of the world's population — lack access to essential medicines. We need to ask ourselves: what use is our scientific endeavour and innovation when they do not come to the aid of people who need it the most? Should a drug be described a “blockbuster” by a billion-dollar label or a billion-patients label?

Today, we have an all-oral treatment for Hepatitis C, a bionic eye that restores sight to patients of retinitis pigmentosa, 3-D printing that helps build personalized joints for replacement, precision treatment and targeted therapies that bust cancers etc.etc. Science has indeed propelled us a long way forward in our quest to guarantee our health.

However, to a vast majority of the global population, these and other such medical advances are not the wonders of science but of science fiction. For, these developments are far removed from the reality of millions across the world. Forget access to state-of-the-art treatment, these people do not even have access to basic healthcare. And when healthcare does exist, it is unaffordable

So if we view these medical advances through the prism of social equity, we will see dispersed amidst rays of hope and progress, diffracted rays of poverty, helplessness and inequity. If drugs are developed for only those who can afford them but not for those who need them – isn’t it immoral, and, well… unconscionable? In 2014, shouldn’t the right to healthcare be a given for every citizen of the world?

Not according to some: The CEO of a large pharma company recently said, “We did not develop this medicine for Indians. We developed it for western patients who can afford it."

Is the pharma industry so heartless? There was a time when pharma companies addressed humanitarian concerns. George Merck said in 1929: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.””

When the twentieth century dawned, we had one widely available modern medicine: aspirin. Today, we have a range of medicines to manage or cure a variety of illnesses. But more often than not, the cost of these medicines is so high that they are pushed out of the reach of most patients, especially those in low and middle income countries where common regimens cost several months’ wages and the cost of treatment for chronic diseases is simply unaffordable. In most developing economies, drugs account for 20-60% of healthcare costs, and 50-90% of these costs are paid out-of-pocket. An illness in the family is the surest route to indebtedness and bankruptcy.

I believe with all my heart that the healthcare industry has a special responsibility to society. Our products are not apparel or automobiles. We sell essential life-enhancing and life-saving medicines and provide life-giving care. And we cannot tolerate this deplorable reality where people with money get medicine, and the rest of the world must manage without it.

The cost of many new drugs is unsustainable for even the wealthiest countries in the world and the burden of disease lies heavy on the coffers of developed nations too.  It is estimated that an astonishing $1 trillion will be spent globally on medicines in 2014.

In 2012, USFDA approved 39 drugs. Of the 12 for cancer, 11 cost $100,000 a year and most recently, a breakthrough Hepatitis C pill won approval with a $1,000-a-day price tag. Yes, drug innovation is expensive and an inordinately long drawn out process which must be compensated through market mechanisms that allow pharma companies to recoup such investments. But the question is how much should this return on investment be?  By putting a price on a drug, we are putting a price on life. And what we see in the price of many drugs is that life, and, by extension, health is therefore unaffordable to most people in the world.

It is imperative to divorce affluence from healthcare and marry affordability and healthcare to enable access. This more than anything will help us make a global right to healthcare a reality. And it is possible to do this even while continuing to innovate in drug discovery and development.

India is a vital producer of affordable medicines and the world’s largest producer of generic drugs. The Indian pharma industry accounts for 20% of the world's pharma industry in value terms and constitutes a significant 80% in volume terms which is how it should be if we are to claim our rightful place as the “Pharmacy of the World”.

Generic producers in India have brought down the prices of life saving drugs used to treat diseases such as HIV, TB and cancer by as much as 90%. In the 1990s, HIV/AIDS drugs cost $12,000 per patient a year which saved patients in the US but not in Africa. The world seemed to accept the unacceptable until in 2001, an Indian pharma company produced a three-in-one HIV/AIDS treatment for one dollar a day.

Today, most of the antiretroviral medicines purchased by the United States’ global AIDS programme come from India, and more than 80% of the HIV drugs that  Medecines Sans Frontieres uses in 21 countries are generics from India.

Indian generics account for a 30% share of the US market and are critical to President Obama’s affordable healthcare programme. Data from the 2013 Generic Drug Savings in the US report shows that generic pharmaceuticals saved the US health system and patients $217 billion in 2012 and a staggering $1.3 trillion dollars in the most recent decade.

India’s contribution to affordable healthcare goes much beyond being a pharmacy to the world. It extends to affordable innovation which goes to the core of ensuring a global right to healthcare. In this, we seem to be drawing lessons from Donald Othmer’s practical and low-cost approach to innovation.

Helped by a significantly lower cost base that supports a large talent pool of scientists and engineers, India’s research engine is now driving a new model of innovation that adds the condition of affordability.  With returns on investment plummeting to unsustainable levels in the West, companies are now rapidly leveraging India’s ‘affordable innovation’ platform through outsourcing, risk-sharing, and co-development partnerships.  GE’s Research Centre in India  has developed a number of low cost bio-medical equipments from scanners to ultrasounds as has Bristol Myers Squibb developed a number of promising  novel drugs at its partnered research center in Bangalore.  My own company Biocon has delivered two affordable novel Biologics for the benefit of Cancer and Psoriasis patients in India.  India is therefore now a laboratory for the world that can deliver affordable innovation and a .growing number of collaborative efforts are succeeding in delivering products and services that can go a long way in ensuring that the right to healthcare becomes truly universal.

Today technology and globalization are creating a world that is a boundary less bazar of equitable opportunities interconnected and supported on a shared platform of knowledge. I truly believe that the world will surely belong to those who learn how to share knowledge and wealth in an inclusive and equitable way and thereby provide the global right to healthcare.

Thank you. 

This is Dr. Kiran Mazumdar-Shaw's acceptance speech for 2014 Othmer Gold Medal, presented by The Chemical Heritage Foundation. She delivered this speech in Philadelphia, PA at The CHF on the 15th of May, 2014.