Q&A:Thomas Cueni, DG of IFPMA shares an industry perspective on access to treatment

Many pharma companies are involved in developing therapies against cancer. How large a share of the combined pharma industry pipeline would you estimate is focused on cancer treatments?

There are currently over 1,9001. drugs in development for treating cancer. Not only drugs to treat common cancers such as lung, prostate and breast cancer, but treatments for many many others, including rare and orphan indications. The scale of the oncology pipelines reflect just how challenging it is to combat the more than 200 different forms of cancer. The complex nature of cancer means that clinical research for medicines takes on average 1.5 times longer than treatments for other diseases", says Thomas Cueni.

In the past 50 years our understanding of cancer has advanced considerably. Treatments are fortunately far more effective than they were. Previously terminal cancers, now can be slowed down or even cured. These gains have been hard won and follow our greater understanding of the disease, with incremental advances and some great breakthroughs. Research into the role of the body’s immune system in fighting cancer has yielded some of the most exciting advances, resulting in a new wave of targeted immunotherapies. This reflects the success of the scientific method and the persistence of many courageous individuals. The fight, however, is far from over. Cancer remains the second leading cause of death globally, and approximately 70 % of deaths from cancer occur in low- and middle-income countries", he continues.

WHO’s most recent list of essential medicines includes 41 cancer treatments. In a review of which medicines are available in countries with a GNI per capita below 25 000 USD, a median of only 20 were available2. Only three of the countries could for example ensure access to the target anti-cancer therapies imatinib, rituximab and trastuzumab.

How can the pharmaceutical industry’s ”Access Accelerated” program help channel these essential medicines to patients?

Treating cancer is a multidimensional challenge, particularly in lower income countries where there is a lack of infrastructure, trained oncology professionals and diagnostic capacity. To bring innovative cancer medicines to patients in developing countries is one of the next frontiers we need to tackle and we need a holistic approach. Let’s take for example breast cancer which is one of the cancers where most progress has been made in the last 20 years. A holistic approach requires awareness programmes, screening, laboratories for testing of biopsy samples, skilled breast cancer surgeons, radiotherapy, cancer nurses and innovative mefdicines.

Access Accelerated (AA) is a unique cross-industry collaboration that seeks to reduce barriers to prevention, treatment and care for NCDs in lower- and middle-income countries. It does so by helping to strengthen health systems and aligning with Universal Health Coverage (UHC) objectives and priorities. Whereas we always had and will have individual company programmes to improve access, for the first time, these 24 global biopharmaceutical companies are bringing their collective global reach and local expertise in partnership with countries, civil society, international organizations and NGOs to drive on-the-ground implementation of action plans to address NCDs. Access Accelerated recognizes that only by putting the needs of people living with NCDs first and acting in collaboration with key stakeholders that the global community can make measurable and sustainable progress against NCDs in developing countries.

Access Accelerated is working, for instance, with the Union for International Cancer Control (UICC) to pilot their City Cancer Challenge to improve health in four Learning Cities (at present Cali, Colombia; Asuncion, Paraguay; Kumasi, Ghana; Yangon, Myanmar) and reduce inequalities in access to quality cancer care. At urban and national levels, stakeholders have completed technical needs assessments in both Cali and Asuncion, with similar assessments underway in both Yangon and Kumasi. UICC will then draw up implementation plans for each city combining the efforts of stakeholders, development agencies and supporting partners – including private sector – to achieve a core package of cancer services in each city by 2025. And in Kenya we are working with the World Bank, the Ministry of Health, and NGOs in health systems strengthening in two pilot counties, trying to apply the learnings from success in treating communicable disease to the NCD area", says Thomas Cueni.

Initiatives like the cancer moonshot initiative have been criticized for focusing too much on advanced technology, and high cost research instead of investing in implementation of therapies and treatments that are known to be effective. At the same time, one could argue that we need to invest in advanced technology to be able to afford cancer care in the long-term. What is your perspective on this question?

Over the last 50 years there has been incredible progress in health. What was once an innovative medicine out of reach for millions has become a standard of care. It is vital that we continue to invest in medical advances, and just as critically, find ways to reach patients faster – particularly in lower income countries.

The innovative biopharmaceutical industry can boast not just quantity of new medicines and vaccines, but also quality. On the occasion of the 50th anniversary of IFPMA (the voice of the biopharmaceutical industry), we have commissioned a report on "50 Years of Global Health Progress”. We have seen transformative progress in biomedical research over those 50 years, a lot of it in the last 20 years where HIV/AIDS was turned from a deadly disease into a chronic disease, new vaccines can prevent cervical cancer, there are cures for Hepatitis C, and tremendous progress was made in treating a debilitating disease such as rheumatoid arthritis and many cancers.

I am deeply conscious of the fear that some of these new treatments are very costly when they are launched and the fears about new highly innovative medicines busting the budgets and making quality healthcare unaffordable. Looking at the debates about the price of truly disruptive innovation – the new drugs for Hepatitis C, drugs for rare diseases, cancer or immuno-oncology treatments – it may be surprising that aggregate drug spending as share of overall healthcare spending has not gone up on average across OECD countries. Obviously funding such treatments provides different challenges in developing countries and societies where most patients have to pay out of pocket for their treatments. That’s why I personally believe in the importance of Universal Health Coverage (UHC), in the importance of health systems strengthening, and in the importance of companies being able to operate with tiered pricing models", says Cueni.

Which are, in your view, the main concerns/obstacles for implementing new treatments (diagnostics and medicines) developed by pharma industry?

It is widely agreed that, given the complex nature of the disease, adequate cancer care goes well beyond treatment and requires an integrated approach that embraces the whole continuum of care, from prevention and diagnosis to treatment and palliative care. Improving cancer treatment and meeting challenges of access require a holistic and intersectoral approach, in which all key stakeholders are encouraged to work together.

Inequalities of access are felt most keenly in developing countries where an ageing population, urbanization, and unhealthy lifestyles mean that cancer and other NCDs are on the rise. A lack of Universal Health Coverage, of capacity for prevention, public education, screening and early detection, diagnosis and treatment, whether involving surgery, radiotherapy, or chemotherapy, means that the response to this public health issue is limited", says Thomas Cueni.

In principle all healthcare systems, whether financed by public or private means, work under budgetary constraints and priorities must be made, implicitly or explicitly. So, if spending more is not an option, how can individual countries cope with the increasing numbers of cancer cases?

There is no denying of the daunting task. The burden of non-communicable diseases (NCDs) in general is huge and whereas tackling this burden is notionally top of the priority list of global health leaders as well as of many national governments, this does not (yet) translate in budget allocation. At present, little more than 1 % of global health development assistance target NCDs, and national spending is similarly insignificant in relation to the size of the challenge. There is ample evidence that investing in health is also investing in wealth and that’s why the WHO emphasis on achieving UHC is so important. However, we also have to look into new ways of partnerships to develop new innovative ways of financing health care needs as discussed at the recent dialogue organized by the Danish Government and WHO in Copenhagen. Experience shows that the collectivity of individuals is generally willing to pay more for health care than government budget allocation provides them. In this context, new insurance models for cancer care as developed with the support of international and domestic insurance companies as well as provincial governments in China are as interesting as social impact bonds.

One way of securing sustainable health systems is also tackling the inefficiencies in the system be it in supply chains or, all to often in developing countries, a shocking number of low quality and falsified medicines. Furthermore, with around one-third of cancer deaths due to behavioural and dietary risks, prevention should remain a key priority for health bodies and governments alike. We need to empower people so that they can take control of their health and minimize risk-factors", says Thomas Cueni.