Throughout this series, we have been exploring how the pandemic has put further strain on existing issues within the healthcare sector, accelerating the pace of change. We are changing tempo a little this week to focus attention on socially responsible issues that continue to weigh in healthcare: access and equality.
The progress and imminent rollout of a COVID-19 vaccine makes the discussion of access & equality particularly poignant. A world where only the select receive the vaccine, will be unlikely to eradicate the virus. Through this article we will discuss accessibility broadly, take a closer look at pharmaceutical companies roles during the pandemic and the inequality risk from potential vaccines.
healthy futures for all
One of the UN’s central tenets for sustainable development is to “leave no one behind”, specifically aimed to eradicate poverty and inequality in our global society. Whilst not explicitly directed at healthcare, it’s an important reminder to take care of our vulnerable cohorts - no real change can be achieved if it’s not for all. Within healthcare, issues of accessibility perpetuate inequality.
A useful tool for evaluating accessibility is The Access to Medicine Index, which is an independent ranking of the world’s largest pharmaceutical company’s efforts to improve global access to medicine. The index evaluates access based on multiple metrics including pricing, market influence, patents, and donations. We seek to invest in companies constructively supporting healthcare access & equality globally, and as such the Amity International Fund invests in the top two companies listed on The Access to Medicine Index; GlaxoSmithKline and Novartis.
We also need to consider that the innovations of today take into account the needs of the economies of tomorrow. The Access to Medicine Index found that 63% of the most urgently needed R&D projects is conducted by only five companies. The Amity International Fund invests in three out of these five companies. The high-priority projects are defined by specific medicines, vaccines, diagnostics etc. where there are treatment gaps and are also high priority for low-middle income countries.
Looking back at the pandemic so far, at a time when it was needed most, the scientific community has responded with formidable speed. The first genome sequencing of COVID-19 was publicly available just 9 days after a cluster of unknown origin pneumonia cases were reported in Wuhan. This was key to enabling the quick development of tests to monitor and track the spread of the virus.
Just over two months following the first detection in China, Roche (Amity International holding) was the first company to create a test for COVID-19 receiving both emergency approval in Europe and the US. Not only was this the first approved test, it was to be used on existing Roche testing machines which were already widely used across the world and could also run up to 384 results at a time. Testing has been essential to containing the spread, guiding government decisions and will likely remain vital until it is eradicated.
Whilst improvements in testing and treatments are welcomed, our pandemic exit strategy appears to be in the form of a vaccine. Over the past few weeks we have seen data on 3 different vaccine candidates, the most likely to be first approved and deployed. So far, the vaccines have exceeded the WHO target efficacy of 50%, or in other words the percentage of symptomatic cases it prevents. However, there are several other considerations for evaluating the vaccine that impact its accessibility – cost, ease of distribution and storage requirements.
*Dose regimen of half dose followed by full dose 1 month later showed highest efficacy of 90%
Whilst the Pfizer vaccine has the highest efficacy, it presents serious logistical challenges given its freezing requirements to -70C, which will require specialist freezers. This poses a significant barrier for emerging markets and delivery to rural areas, not to mention increasing costs. The Moderna vaccine is nearly as effective as the Pfizer vaccine but without the need for specialized freezers, however it is also the most expensive. To vaccinate the whole of the UK population with the Moderna vaccine, with a 2 dose regimen, it would cost £2.5 billion. The AstraZeneca vaccine on the other hand, can be stored in a standard refrigerator long term and could vaccinate the whole UK for under £350 million. AstraZeneca has also pledged to sell at cost during the pandemic.
Even though none of these vaccines are approved yet, COVID-19 vaccines are already another example of inequality. Wealthy governments have already signed deals with leading vaccine providers and have reserved over half of the promised doses, despite only accounting for 13% of the global population.1 Moderna has promised doses of its vaccine exclusively to wealthy countries, likely a function of cost, where in contrast AstraZeneca has pledged two thirds to developing countries. The health of entire nations are currently dependent on only a handful of corporate companies, which is why choosing those who act in a responsible manner matters enormously.
looking beyond covid-19
The healthcare battles that were here before the pandemic will likely remain after. A report by WHO and World Bank Group found that 400 million people have no access to essential health services and 6% of people in low-middle income countries have been tipped or further pushed into extreme poverty due to healthcare costs.2
Accessibility isn’t just a problem in poorer countries, in the US, 11% of adults don’t take prescribed medicines because they cannot afford it.3This is another instance where companies have made headlines for poor behaviour, such as Mylan’s 400% price hike on EpiPen, used to treat serious allergic reactions. Indeed with an incoming democratic Joe Biden administration the years of debate on US drug pricing may just turn into action.
As we have seen in times of great change, progress has to be equitable to be sustainable. In healthcare this means addressing accessibility and equality. Whilst we cannot control government policies, we do control the choice of the companies we decide to allocate capital to. In healthcare, corporate decisions on affordability and accessibility can impact health, the stakes could not be higher in vaccines. It is crucial to support and engage with these companies in order to provide accessible medicines and to innovate to provide better, more cost effective treatments.