A year after Zhengchen Liu was diagnosed with cancer, he found the US drug regulatory had approved Gleevec for Chronic Myeloid Leukaemia (CML). Zhengchen Liu got onto a trial of this drug, in China.
It’s been 15 years since, says Zhengchen Liu with New Sunshine Charity Foundation, recounting his experience where his wife was later diagnosed with CML. She got onto trials for the next generation of this drug and benefited, he says, adding much to his audience’s relief, that she too is cancer-free and the couple now are expecting their first baby. Touching on a challenge that is true of China and the region, he says that there is a timelag before a new drug gets to the country.
And that becomes a key worry, especially considering that Asia is home to 60 per cent of the global population and half the world’s cancers.
The grim reality puts pressure on policymakers in the region to facilitate the development of new drugs and design innovative economic models to get more medicines to more patients. And governments are responding, say experts from different Asian countries gathered at an interaction at Novartis’ research facility in Shanghai.
Some governments work with drug companies to source medicines for its citizens through free or co-pay schemes. Others explore efficient methods to evaluate and fast-track clinical trials and approval timelines.
As India grapples with balancing medicine prices and access to new medicine examples emerging from Malaysia, Singapore, China, Pakistan and South Korea may hold some answers. They are approaching similar challenges but with a different toolbox. The end result is that governments are footing the medicine bill or paving a smoother pathway to making medicines available to patients.
Explaining Asia’s cancer profile, Novartis Senior Vice-President and Head (emerging markets) John Ketchum says it’s a byproduct of economic success that leads to smoking, inactivity, sedentary lives, change in diet, etc. Prof Ann-Lii Cheng, Director (oncology), National Taiwan University College of Medicine. points to environmental and genetic causes as well.
Patient voiceOutlining the importance of patient participation in the clinical development of new drugs, Geoff Cook, Novartis Global Head (external and patient relations). points out that it is the only option left for some patients who have tried other available medicines. Globally, not enough people participate in drug trials and that is a challenge, he said, as it is required to develop new medicines.
But patients need to know the benefits and downsides of participating in a drug trial, adds Giuseppe Saglio, Professor (Internal medicine), Turin University. Giving examples of some efforts underway to speed up getting new drugs to patients, Thomas Weigold, Novartis Head (Asia-Pacific, South Africa), says that with lung cancer, Singapore registers a drug if the company furnishes Phase II clinical trial data done elsewhere. South Korea is open to fast-tracking reimbursement on a drug classified by US regulators as a “breakthrough”.
Another effective tool is health technology assessment that evaluates whether a medicine is more effective than existing ones, but that requires countries to have a strong data base, he adds.
Malaysia has ongoing partnerships on a blood cancer and ghalassemia drug, where the Government pays for it and not the patient. This “shared contribution” model, says Weigold, is based on data defining the need of the local population, making it a transparent decision. Pakistan has a similar model for a blood cancer drug and is exploring expanding the partnership, he says.
China is reportedly increasing its health expenditure from 5 to 7 per cent of its GDP, besides expanding reimbursement schemes for medicines.
India too has some collaborations in States and with the Defence services, say company top-brass. But Saglio, an expert on Glivec (a drug that saw a high-pitched battle in India over patent exclusivity and price), sums up the predicament: “I would not like to think about price, but we are not living in an ideal world.”
Governments and companies need to be flexible in the interest of patients, “first patients, second pocket,” he says, and smiles, touching on a concern that worries governments across the world.