Earlier today on Twitter, I passed along a link to a provocative article at New Scientist: “Rich-world diseases could hijack poor world’s biotech.”
A new wave of biotech firms in developing countries has sprung up to meet an urgent global need: affordable drugs and vaccines for the poor. But there’s a danger that market forces will push them to just make more drugs for the rich.
Biotech companies based in developing countries have been aggressively pushing ahead with developing vaccines and drug therapies aimed at tropical diseases and tuberculosis—diseases of great concern in poor tropical nations but traditionally of little interest in the rich world. The problem, New Scientist says, citing a new study in Nature Biotechnology, is that a wave of acquisitions and alliances between these biotech companies and major pharmaceutical manufacturers could potentially redirect some of those research efforts toward new drugs for the wealthy at the expense of drugs for the poor.
But shortly after my retweet of this story, I received a message from one of my followers (someone who works for the California Institute for Quantitative Biosciences, I should note) that the New Scientist was missing the major message of that study, “Global health or global wealth?” by Rahim Rezaie and Peter A. Singer (behind paywall, sorry), which was actually rather less downbeat.
Having read the study now for myself, I have to agree. The New Scientist story doesn’t seem to be factually incorrect, but it is emphasizing the gloomiest outcome of what Rezaie and Singer think could happen and skirting some of the more optimistic findings, including suggestions on how to avoid crippling the supply of drugs for the poor.
Here is how Rezaie and Singer describe their own findings, from the introduction to their paper (emphasis added):
A basic question is whether this movement toward innovative products would mean movement away from poorer market segments, both at home and abroad. Stated differently, as enterprises in the emerging markets take on more costly innovative projects, would they be compelled to choose between global health and global wealth? Alternatively, is it possible for health entrepreneurs in the emerging economies, as their firms become more sophisticated technologically and financially, to address the needs of the poor while simultaneously taking advantage of more lucrative markets?
Here we argue that the objectives of global health and global wealth can be achieved simultaneously, provided targeted support mechanisms are in place to enable product development for the poorest market segments, for which a purely entrepreneurial model may not be suitable.
That’s a more hopeful spin than I’d gathered from New Scientist.
Moreover, Rezaie and Singer conclude that affiliations with Big Pharma could considerably enhance the technological, financial and marketing strengths of the domestic biotech companies in poor countries, and that “efforts that strengthen domestic industries can ultimately advance global health by enhancing the ability of domestic enterprises to address locally relevant diseases in a more innovative manner.” They’re arguing that connections with Big Pharma could potentially improve the flow of drugs to the poor.
The cautionary part of their paper is their warning that simple market forces alone may not be enough to guarantee that emerging economies’ biotech companies will continue to emphasize drugs for diseases of local interest—an argument they make based on historical inattention to those illnesses. The authors therefore discuss a variety of mechanisms, from “orphan drug” types of legislation to specially targeted global health funds, that could help maintain that focus by creating financial incentives that might not emerge organically otherwise.
The New Scientist story does indeed mention those prescriptions, but that gloomy headline and lead paragraph sets a tone for the discussion that certainly affects a reader’s impressions of the rest.
I’m not judging whether the “glass half full” or the “glass half empty” interpretation of this Nature Biotech study seems more realistic. Depending on my own mood, I can easily see myself leaning toward either breezy confidence in economic and health progress or more sour suspicions that the poor’s needs always take a backseat. But whatever the case, it’s important for this study to be understood properly on its own terms as the beginning of a fair discussion about what these trends in biotech might mean.
Global health or global wealth? Rahim Rezaie & Peter A Singer. Nature Biotechnology, 28, 907-909 (2020) [doi:10.1038/nbt0910-907]