SECTION 5. Conclusions and recommendations

SECTION 5:

Conclusions and Recommendations

The shockwave unleashed by the COVID-19 pandemic opens a window of opportunity for the potential reform of the pharmaceutical R&D system. Proposals and initiatives such as global data, knowledge and technology pools (e.g., C-TAP) and global pooling of demand (e.g., ACT-Accelerator) were unthinkable just one year ago, as was the extraordinary global effort made by the public sector to advance the development and coordinate global purchasing mechanisms for therapies, vaccines and diagnostic tests, creating strong pipelines in a matter of months. Recognition of the role of the public sector as a market-creator and market-shaper, not only in terms of funding and de-risking early investments in R&D but also in terms of carrying out R&D up to clinical stages and developing demand-pooling mechanisms, has changed the traditional belief that the public sector cannot bring value to the economy and that market interventions crowd out private entrepreneurs. 6,9 The development of a preferred supplier model (and of other models that use the purchasing power of public institutions to shape the conditions of production, supply and access to pharmaceutical innovations) is consistent with the debates around the public sector’s capacity to shape markets through its procurement mechanisms in order to improve health, social and environmental outcomes. In addition, it is fully aligned with the sustainable agenda touching, as it does, on issues related to several of the Sustainable Development Goals. The design and implementation of a preferred supplier model should start by ensuring that all stakeholders involved are heard, including patient and civil society organisations, public-sector professionals and, of course, investment banks and pharmaceutical companies. The input of all these stakeholders is essential to an understanding of the possibilities of a new market model for health innovations. Patient organisations, civil society organisations and researchers should have a preferential seat at the table when decisions are being made concerning the direction the system should take. Their input is essential in the definition of the areas the R&D system should focus on and in ensuring accountability and transparency in both public and private institutions. Since the goal of a preferred supplier model is to create a sustainable model that can ensure the development of new pharmaceutical innovations based on public health needs and appropriate global access to the end products, it is vital to ensure that all the stakeholders understand the risks and benefits of participating in the model. While investments by public institutions in pharmaceutical R&D often play a key role in the development of new medicines, vaccines and diagnostics, these contributions are not conditioned by any sort of mechanism designed to ensure that society benefit from the value created with public money. It is, therefore, essential to implement

public purchasing mechanisms designed to create responsible, sustainable markets and to direct companies towards new, more sustainable, business models that will help to create social and economic value for society as a whole. ● For the public sector, the development and implementation of a preferred supplier model entails participating in a business model that could redirect the R&D System to improve its outcomes based on public health and public interest metrics. Using the current window of opportunity to strengthen its negotiating position by putting in place a preferred supplier model is paramount to ensuring that the outcomes of R&D improve people’s lives. ● For the funders, investors and shareholders in the pharmaceutical industry, it could be a way to guarantee the commercial interest of States or to fasttrack approval processes. Also, as a natural step forward in being seen as active shapers of new social business models: doing good and being financially sustainable by charging fair prices and satisfying unmet demand for innovative global health solutions. For pharmaceutical companies, as public scrutiny and accountability increases, the space for social, ethical and sustainable practices increases, leaving a narrow margin for practices that are clearly not aimed at improving the efficiency and efficacy of the system. ● For citizens, both as consumers and as workers, a preferred supplier model could more easily ensure that some of the globally relevant public health needs, such as the development of treatments, vaccines and diagnostics for rare diseases, neglected diseases associated with poverty or diseases with epidemic potential are addressed. All in all, a preferred supplier model could introduce new practices and behaviours in public contracting and corporative practices. The opportunities that may have been generated by the intersection of the Sustainable Development Agenda and COVID-19 R&D investments should be used to implement business models that incorporate social responsibility and accountability into company practices.