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Aligning pharmaceutical innovation with medical need

Nature Medicine volume 13, pages 304–308 (2007)Cite this article

How can we make vaccines and medicines for major diseases that have been largely ignored? How can we get vaccines and medicines to populations that cannot afford them? A fundamental solution to these problems requires aligning three basic processes—innovation, incentive and access—so that they become mutually reinforcing. The present patent system provides incentives for innovation by enforcing product monopolies that permit sales at prices far above production cost. Industry has little financial incentive to develop products for diseases that mainly afflict the poor, and the poor cannot afford products that industry develops for wealthier customers. Two reforms could correct these disparities and benefit all stakeholders. First, open-access drug companies—fee-for-service sites within drug companies for collaborations among academics and biotechnology and pharmaceutical professionals, funded by users and government—would bring new ideas and expertise to the development of drugs independent of market drivers. Second, a patent track that rewards innovation in proportion to its impact on the global burden of disease would provide an incentive for pricing near the cost of production and commit government and business to improving health care delivery. Allying open access and traditional drug companies and offering a credit-assignment patent track alongside the monopoly-enforcement track would increase the number and accessibility of medical interventions, industry's therapeutic and geographic opportunities, and global health.

We must reform how we make and distribute vaccines and drugs. This call is coming from diverse quarters: business school professors, economists, jurists and pharmaceutical executives. They write: “The global system of drug development and marketing is broken...”1; “The system is ill-adapted to develop products of great social need...”2; “In developing countries, life-saving medicines are priced beyond the reach of most people, a morally offensive outcome”3; the “flow of new drugs has slowed to a trickle...”4. Something is wrong when President Clinton had to devote much of his energies to negotiating price reductions so AIDS drugs could reach just a few of the children who need them5.

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Figure 1: Alternative relationships among innovation, incentive and access.

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Acknowledgements

Thanks are due P. Davies, C. Leaf, M. Kurilla, S. Nwaka, T. Pogge, A. Simpson, M. Sporn, O. Vandal and T. von Schoen-Angerer for guidance to literature and critique of the manuscript.

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  1. Carl Nathan is at the Weill Cornell Medical College, 1300 York Avenue, New York, New York 10021, USA. cnathan@med.cornell.edu,

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Nathan, C. Aligning pharmaceutical innovation with medical need. Nat Med 13, 304–308 (2007). https://doi.org/10.1038/nm0307-304

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