Incentivising bio-manufacture
Universal quality health is a fundamental right of all citizens
The writer is a Howard Hughes Medical Institute professor of biomedical engineering, international health and medicine at Boston University. He tweets @mhzaman
When it comes to healthcare, envisioning a world where both quality and access are within the reach of every citizen, it is almost too good to be true. Of course, with deep pockets some have both quality and access. But that is not what our masses get to experience. Those who get access often don’t get quality. And then there are those who get neither.
If we unpack access and quality, underlying both is the rising costs of diagnostics and pharmaceuticals. In Pakistan, the diagnostic and medical device industry is almost non-existent. Nearly all medical devices, diagnostics and raw materials are imported. On the other hand, while the pharmaceutical industry does exist (and by some measures is thriving), the quality is highly variable.
Given this situation, which is fairly common among developing countries, there is an increased recognition in the public health and health economics community that one robust method of improving access and quality of healthcare is local manufacture of diagnostics and therapeutics. This not only allows for creation of jobs but also enables the local regulators to ensure that quality is maintained, for it is easier to regulate local market than imports. The bio-manufacture sector in Pakistan, however, is not in a particularly good shape. So what can be done to create and sustain manufacturing that directly impacts our health sector? Here, I would argue that there are three major pillars that can create a platform for a sustainable bio-manufacturing sector.
First, and perhaps the most obvious one, is incentives. Whether one is talking about companies that already have a footprint, or new ventures that want to enter the market, the incentives to create a stronger bio-manufacturing base is clearly lacking. For example, Pakistani pharmaceutical companies rarely produce vaccines. It is simply because most of the vaccines Pakistan gets are given through foreign aid via international agencies. The local companies simply cannot compete with those almost-free price points. While the affordable vaccines have enabled the government to reach far-flung areas, there is a danger that if the international aid were to dry up, our local companies wouldn’t be able to meet the national demand overnight since it takes time to develop the industry. The same argument could be made in other sectors such as rapid diagnostics for infectious diseases in rural clinics or during outbreaks. The argument here is not to make the vaccines or diagnostics unaffordable, but instead to create incentives for the private sector to invest in bio-manufacturing. A public-private partnership, tiered pricing or smart licensing are ways that can create such incentives. In the absence of incentives, the private bio-manufacture sector will simply not exist.
The second area is better, evidence-driven, and efficient regulation and protection of intellectual property. The Drug Regulatory Authority of Pakistan (DRAP) reform is long overdue. But it has to be more than DRAP. On the one hand, we have to protect intellectual property, and on the other, create regulation that is free from unnecessary bureaucracy. Protection of consumers should be the first and the central priority of our regulatory agencies. The regulators also need to come down hard on those who cheat and create substandard products, thereby diminishing consumer confidence in good products.
Third and perhaps most important for the long run is investing in and improving the higher education sector. We have to emphasise creativity, demand independent thought, expect higher standards and simultaneously prioritise basic and translational research. The long-term success of our bio-manufacture is directly linked to the strength of our higher education and its graduates.
Universal quality health is a fundamental right of all citizens, and for that we have to be self-reliant. However, we have to recognise that self-reliance has to be more than just a slogan. It is a combination of desire, action and perseverance.
Published in The Express Tribune, October 9th, 2018.
If we unpack access and quality, underlying both is the rising costs of diagnostics and pharmaceuticals. In Pakistan, the diagnostic and medical device industry is almost non-existent. Nearly all medical devices, diagnostics and raw materials are imported. On the other hand, while the pharmaceutical industry does exist (and by some measures is thriving), the quality is highly variable.
Given this situation, which is fairly common among developing countries, there is an increased recognition in the public health and health economics community that one robust method of improving access and quality of healthcare is local manufacture of diagnostics and therapeutics. This not only allows for creation of jobs but also enables the local regulators to ensure that quality is maintained, for it is easier to regulate local market than imports. The bio-manufacture sector in Pakistan, however, is not in a particularly good shape. So what can be done to create and sustain manufacturing that directly impacts our health sector? Here, I would argue that there are three major pillars that can create a platform for a sustainable bio-manufacturing sector.
First, and perhaps the most obvious one, is incentives. Whether one is talking about companies that already have a footprint, or new ventures that want to enter the market, the incentives to create a stronger bio-manufacturing base is clearly lacking. For example, Pakistani pharmaceutical companies rarely produce vaccines. It is simply because most of the vaccines Pakistan gets are given through foreign aid via international agencies. The local companies simply cannot compete with those almost-free price points. While the affordable vaccines have enabled the government to reach far-flung areas, there is a danger that if the international aid were to dry up, our local companies wouldn’t be able to meet the national demand overnight since it takes time to develop the industry. The same argument could be made in other sectors such as rapid diagnostics for infectious diseases in rural clinics or during outbreaks. The argument here is not to make the vaccines or diagnostics unaffordable, but instead to create incentives for the private sector to invest in bio-manufacturing. A public-private partnership, tiered pricing or smart licensing are ways that can create such incentives. In the absence of incentives, the private bio-manufacture sector will simply not exist.
The second area is better, evidence-driven, and efficient regulation and protection of intellectual property. The Drug Regulatory Authority of Pakistan (DRAP) reform is long overdue. But it has to be more than DRAP. On the one hand, we have to protect intellectual property, and on the other, create regulation that is free from unnecessary bureaucracy. Protection of consumers should be the first and the central priority of our regulatory agencies. The regulators also need to come down hard on those who cheat and create substandard products, thereby diminishing consumer confidence in good products.
Third and perhaps most important for the long run is investing in and improving the higher education sector. We have to emphasise creativity, demand independent thought, expect higher standards and simultaneously prioritise basic and translational research. The long-term success of our bio-manufacture is directly linked to the strength of our higher education and its graduates.
Universal quality health is a fundamental right of all citizens, and for that we have to be self-reliant. However, we have to recognise that self-reliance has to be more than just a slogan. It is a combination of desire, action and perseverance.
Published in The Express Tribune, October 9th, 2018.