Leading pharmaceutical companies are neglecting to address many other infectious diseases that pose a pandemic risk, amid a surge in research into COVID-19, a report has found.
In the 20 drugs companies scrutinised by the Access to Medicine Foundation, there were empty R&D pipelines for ten out of 16 emerging diseases identified by the World Health Organization (WHO) as a threat to public health.
The number of experimental drugs and vaccines targeting COVID-19 swelled from zero to 63 since the start of the pandemic in early 2020, the report found. However, there were only 13 projects focused on all the other infectious diseases put together, including five for Ebola and four each for Zika and chikungunya.
The level of drug development is “alarmingly low” for these diseases, says the report, despite the WHO identifying them as priority diseases for R&D and the COVID-19 crisis highlighting the importance of readying strategies for potential outbreaks.
Jayasree Iyer, executive director of the Access to Medicine Foundation, said: “The current way that the industry looks at pandemic preparedness is not going to save us from all these new pathogens that are coming our way. We urge companies to make sure that they fill their pipelines with projects targeting R&D priorities.”
Along with COVID-19, HIV/AIDS, tuberculosis and malaria account for more than half of projects in the communicable disease pipeline, while cancers dominate the pipeline for non-communicable diseases.
Incentives for investing in research in other areas are currently limited, said Iyer, though governments and investors are increasingly aware of issues and global partnerships such as the Coalition for Epidemic Preparedness Innovations have been established to tackle future epidemics.
More positively, pharma companies are moving to “systematically make new medicines rapidly accessible to the poor”, according to the Access to Medicine Foundation. Eight of the 20 companies covered have strategies to ensure all projects are paired with plans to increase access in lower-income countries soon after launch, compared to one in 2018.
However, at present, less than half of the medicines and vaccines analysed are covered by such an access plan, the report found. Even those that do are often targeted at middle-income countries, such as Brazil, China, India and Mexico.
Novartis was the only company found to provide equitable access strategies in at least one low-income country for all products assessed, while GSK had the widest pipeline of late-stage products incorporating access plans.
“What I think we’re in right now is a pivot point where companies recognise that they can no longer design products only with high-income populations in mind,” said Iyer. “But that also needs to translate into practice.”
COVID-19 has raised questions about equal access to medicines due to fears that it could take years for vaccines to reach some developing countries. The report found “little evidence” in the early months of the pandemic of structures that would ensure access to treatments in these countries.
“The COVID-19 pandemic has exposed some of the chronic problems with access to medicine and the industry’s response to it. It makes us understand how fragile supply chains are, and how fragile R&D is,” said Iyer. “Unless we take access planning and prioritisation seriously… then we’re not pandemic-prepared as a society or industry.”
Thomas Cueni, director-general of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), and chairman of antimicrobial resistance body the AMR Industry Alliance, said he was confident that much was being done to strengthen access to medicines, including international collaborations.
He pointed to global partnerships such as COVAX, which aims to ensure equitable access to COVID-19 vaccines, and Access Accelerated, which seeks to improve access to treatments for non-communicable diseases.
Many pharmaceutical companies will use differential pricing to improve access to COVID-19 products in lower-income countries, said Cueni: “IFPMA and its members are committed to delivering COVID-19 vaccines to national populations on an equal basis, regardless of their ability to pay.”
He added: “The COVID-19 pandemic has made it very clear that the world needs to be better prepared for global threats posed by infectious diseases”.
The report also highlights the continued threat of antibiotic resistance, while it says the pipeline for antibiotics is running dry. In 2020 there were just 34 antibiotics projects for eight infections by 12 companies.
“There has been little progress in addressing the economic drivers of declining private investment in antibiotic R&D, such as valuation, reimbursement and incentivisation,” said Cueni. “Concrete action is thus needed to accelerate the creation of a vibrant and sustainable innovation ecosystem to support R&D for new antimicrobials and avert a pandemic of the future.”