Catalyst for Change

The healthcare gap between the world's rich and poor is well-documented. Diseases such as HIV/AIDS, tuberculosis (TB), and malaria disproportionately affect poorer countries and continue to stall economic and societal development in many regions. Every year, millions of the world's poorest people die from curable or preventable infectious diseases or suffer unnecessary illness because they do not have access to basic healthcare services, including essential medicines and vaccines.

Chris Strutt

The challenges in these countries can seem insurmountable. Many people living in poverty do not have enough food or clean water, not to mention access to medical care. In many developing countries, the distribution network for medicines is weak and hospitals, clinics, and healthcare professionals are scarce. In some cases, a lack of political will results in a funding crisis across all levels of the healthcare system.

Commitments and partnerships

Progress is possible. For instance, a decade ago, the international community would not have thought it possible to get more than three million HIV-infected people on antiretroviral (ARV) treatment. GlaxoSmithKline (GSK, London) began to implement sustainable preferential pricing for ARVs in 1997 and introduced not-for-profit pricing of ARVs for 64 of the world's poorest countries in 2001. Other organizations have established similar programs, and substantial progress has been made.

Despite this, we need to do more. Business needs to continually challenge itself to develop the products that address the needs of the world's most vulnerable groups.

GSK recognizes that we need to be more responsive, flexible, and open. We need to take risks and commit to not just meeting society's expectations, but to exceeding those expectations. In short, we need to stop thinking in terms of what we must do; and start thinking of what we can do.

No single organization has all the answers, but there are areas where industry has been making a difference in addressing the healthcare needs of the developing world. GSK, for example, has committed to develop pediatric formulations for as many of our medicines as possible. Our research and development (R&D) laboratory in Tres Cantos, Spain, is dedicated to discovering cures for diseases of the developing world, and we have invited others to join us in an "open laboratory"—a shared facility and infrastructure where researchers can collaborate.

In May 2010, we published the results of a screening of more than two million proprietary compounds that resulted in the identification of 13,533 "hits" with potential activity against malaria. These compounds are now freely available to scientists around the world for use in malaria research. GSK also launched an R&D unit in 2009 that is focused on developing products and formulations for diseases that affect populations in Latin America, Africa, and Asia. This unit champions the needs of patients in the developing world across GSK's R&D operations. In addition, we are working with external partners to deliver a product portfolio more suited for the disease burden suffered by patients in resource-poor countries.

Perhaps the greatest example of partnership as an innovative approach to global health has been the pathway that GSK has pursued with its malaria vaccine candidate, RTS,S. This vaccine was created in 1987 by scientists working at GSK Biologicals' laboratories, with early development undertaken in close collaboration with the Walter Reed Army Institute of Research. In January 2001, GSK and the PATH Malaria Vaccine Initiative (MVI)—with grant monies from the Bill & Melinda Gates Foundation—entered into a public-private partnership to develop the vaccine for infants and young children in Africa. The majority of the nearly one million annual malaria deaths are among children under the age of 5 living on the continent, and thus, this is the group that would most benefit from a vaccine. Today, RTS,S is the most advanced malaria vaccine candidate in the world.

This type of partnership can encourage the private sector to engage in medicine and vaccine development for resource-poor countries. However, it is not enough to just develop new treatment options. We need to ensure that vulnerable people have access to those products.

Innovative models

Tiered pricing allows pharmaceutical and vaccine manufacturers to make our products more accessible to developing populations. For instance, the least developed countries (LDCs) in the world pay as much as 90% less for GSK's vaccines than developed areas such as the US and Europe. This model has enabled us to provide 80% of our vaccine volume to the developing world and focus a third of our vaccine pipeline on diseases that disproportionately affect resource-poor countries.

Additionally, in 2009 GSK reduced its prices for patented medicines in LDCs to be no higher than 25% of developed-world prices. Since that time, we've seen significant increases in uptake for the majority of products. In some cases, sales are eight times higher than they were the previous year. In a further effort to tackle barriers to access, GSK aligned its social investment and community engagement. The company has committed to reinvesting 20% of profits made on medicines in LDCs to support infrastructure for local healthcare delivery. This project has already generated some exciting projects, including providing motorcycle ambulances for pregnant women in Sudan.

In wealthier developing areas (i.e., middle-income countries), healthcare is often paid for by patients out-of-pocket and the wide range in income levels can prevent many from accessing necessary preventive care and treatment. Therefore, we have also started to rework our prices in middle-income countries to ensure our products are available to those people who have lower incomes.

This year, the Global Alliance for Vaccines and Immunization (GAVI) launched a new funding mechanism, the Advance Market Commitment (AMC), for pneumococcal vaccines. AMC provides another example of how industry can think differently about access and sustainability. GSK and Pfizer (New York) have each agreed to supply as many as 300 million doses of their pneumococcal vaccines over the next decade to GAVI countries. This contract will help protect as many as 100 million children on GSK's side alone and has allowed the company to build a new manufacturing facility in Singapore that will eventually supply hundreds of millions of doses. Although the program is still in its infancy, AMC is working to close the time gap between access to vaccines in developed countries compared with the world's poorest countries.

Industry as a catalyst for change

Overall, by refining one's core business practices, companies can help tackle barriers to access head-on. Although GSK was recently ranked at the top of the 2010 Access to Medicines Index, we recognize there is no room for complacency.

The global community, including industry, must provide the political will, a significant mobilization of additional resources and a spirit of partnership if we are to see an improvement in healthcare and quality of life across the developing world. The challenge of narrowing the healthcare gap is enormous and far too complex to be addressed by any one group or organization alone.

By working together, we can build on existing efforts and find new ways to help people everywhere break the cycle of decline from illness. If we keep them well now, we can improve the health and economy of future generations.

Chris Strutt is senior vice-president of government affairs, public policy and patient advocacy, at GlaxoSmithKline, London, UK.