If a tree falls in the forest and no one hears it, did it really fall? That’s the expression Sue Desmond-Hellmann, global Chief Executive Officer of the Bill and Melinda Gates Foundation, uses to explain the troubled relationship between innovative, even breakthrough medicine, and its access to patients who most need it.

“If I make a medicine and people can't get it, it’s like the tree in the forest,” says Desmond-Hellmann in an animated conversation with BusinessLine , delving into strategies available to tap into the “oomph” of private industry for greater public good. Or in this context, getting medicines and healthcare to the many more people who need it.

She has seen innovation up close and personal, having been part of the team that developed the breakthrough breast cancer drug Herceptin at Genentech (1998). (The company has since been bought by Roche.) And it is from this experience of developing “precision medicine” that Desmond-Hellmann calls for “precision public health”, where treatment is targeted to those who need it using tools including data analytics.

Goal is access

The HER2-Positive type of breast cancer was the “scariest” one to treat, says Desmond-Hellmann, a cancer specialist. But Herceptin targeted and treated this aggressive cancer in one of four affected women, she says, recalling the heady experience of working with her team on the medicine.

But this also meant that three in four women with breast cancer should not have got this medicine, she says, pointing to how targeted treatment can, in fact, save the patient from being burdened with an added cost or exposure to unnecessary drugs.

But it is “heart breaking”, she admits, that women who may need the drug may not have access to it or cannot afford it. And here's where the different procurement strategies kick in.

Differential pricing

Tiered or differential pricing of innovative drugs for different countries depending on the economic landscape and paying capacity of its population has made a difference in HIV/AIDS treatment, says Desmond-Hellmann. The other strategy adopted by organisations like the BMGF is that of volume guarantees. Companies give their best reduced price because they are assured a volume procurement by multilateral or philanthropic organisations.

“The goal is access,” she says, explaining that there was nothing wrong in engaging with private industry that had the “money, talent and pace” to address a problem. The Gates Foundation aspires to be an “honest broker”, she says, taking medicines from companies and supplying to those who need it at subsidised prices, a task private industry may not be able to undertake since it was answerable to shareholders. GAVI, a global vaccine alliance, does that with vaccines and BMGF was talking to companies including Serum Institute who can supply global requirements, she said.

Answering questions asked by the government on their foreign funding is something the organisation must do, Desmond-Hellmann said responding to a query. The real challenge in India, she adds, is the inequity existing in some States.

But frugal innovations or as Desmond-Hellmann prefers to call it “citizen science” was generating solutions that could make diagnosis and treatment of diseases like tuberculosis, for instance, more accessible. And that's where she addresses young minds in the country to “do something with their brain” and not forget the giving back to society.

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