4 key steps to improving healthcare in Asia

Chester Drum
Assistant Professor, National University of Singapore
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Leprosy, a curable disease that results in the uncontrollable sloughing of skin from those afflicted, has been documented since biblical times. It is one of 17 neglected tropical diseases (NTDs) prioritized by the World Health Organization (WHO) and thrives among the world’s poorest. Although mostly eradicated in the industrialized world, 232,857 new leprosy cases were detected in 2012 alone, according to WHO estimates.

NTDs affect 1.4 billion people worldwide, yet elude the most sophisticated R&D programmes because many of those 1.4 billion simply will not be able to afford the costs of a single treatment course in their – or even their children’s – lifetime.

The need for a profit motive commensurate with the costs of taking a breakthrough therapy from discovery to regulatory approval, in the end, leaves NTDs outside the classic business model of traditional pharmaceutical companies. Thus, healthcare innovation is essential in Asia in both policy and technology spheres. Here are four key steps that Asia must take to provide for the healthcare needs of its population.

Broker public-private partnerships to subsidise drug development

The extreme cost of drug development, often estimated at $1.8 billion per drug, incorporates the cumulative costs of all the failed experiments along the way in addition to the drug that is finally approved. Thus, one strategy to make NTDs more appealing is to offset the risk of initial R&D to balance smaller returns from NTD treatment sales.

“There are millions of people suffering from malaria and tuberculosis (TB), but they just don’t have the purchasing power. If a multinational makes those products, they won’t necessarily be able to capture the cost. But if they sell at a high price, then nobody can afford it. This is where we come in,” said Dr. Ray Yip, director of the China office for the Bill & Melinda Gates Foundation, and who represents the Foundation in Asia, in a January 2015 interview with Asian Scientist Magazine.

In 2003, the Gates Foundation partnered with the government-owned China National Biotec Group (CNBG), a subsidiary of China National Pharmaceutical Group Corporation (Sinopharm) to develop a new vaccine for Japanese encephalitis, a mosquito-borne viral disease. One decade later, the vaccine became the first Chinese-made vaccine to receive prequalification status by WHO, a seal of approval in terms of quality, safety and efficacy. It is sold at only $0.25 a dose; the next-cheapest vaccine made by Vietnam is sold at $2 a dose.

Develop technologies to improve supply and compliance

Many vaccines need to be kept at a narrow temperature range from manufacture to the point of immunization, a process called a “cold chain”. But strong cold chains are tricky to maintain, especially when electricity supply and equipment are unreliable. As a result, damaged vaccines have to be discarded – or even worse, unknowingly administered by healthcare workers, leaving people vulnerable to disease. Organizations like PATH are therefore seeking to improve cold chains and develop vaccines that are less susceptible to temperature damage, while the United Nations Children’s Fund (UNICEF) has established solar power and temperature monitoring technologies.

India is the world’s fastest growing market for mobile phones, with more than 900 million subscribers alone. Cheap and readily-available mobile technology may help solve serious problems such as multidrug-resistant TB, which is caused by the poor mismanagement of TB treatment and person-to-person transmission. In November 2014, Andrew Cross of Microsoft Research India was awarded a Grand Challenges Initiative grant to improve adherence to TB medication using mobile technology. In a randomized controlled trial, opening the pill blister packet exposes a unique number that users need to report via a free mobile phone call. If a dose is skipped, individuals will be contacted by healthcare workers.

And even the most ubiquitous of technologies – paper – can spur new innovations altogether. Developed at Harvard Medical School, microfluidic paper-based analytical devices (μPADs) are similar to pregnancy test kits and can be used for diagnostic assays using a finger prick blood sample or urine sample. At an estimated three to five cents per assay, these devices may someday diagnose liver failure, acute cardiac conditions and other diseases without the need for a healthcare worker to be present.

Develop innovative and sustainable financing mechanisms

While vaccines are still the least expensive way of controlling the spread of infectious diseases, it is more often the rule than the exception for children in developing countries to die of common childhood conditions such as measles. According to WHO Director-General Dr. Margaret Chan at the 2011 Pacific Health Summit, “a vaccine that is too expensive for the developing world is worse than no vaccine at all.”

When profit margins are slim, innovative financing mechanisms, such as those by Gavi, the Vaccine Alliance, come in. Using long-term pledges from donor governments, Gavi sells what are known as “vaccine bonds” to the capital markets. The money raised from investors provides predictability for countries’ vaccine programmes and even generates “extremely good returns” for investors, according to Gavi. Through these socially responsible investments, Gavi has funded the introduction of vaccines for measles-rubella, pentavalent and human papilloma virus in countries such as Cambodia, Indonesia and Laos.

Achieve self-sustainability through the transfer of technology

Despite dramatic price reductions of vaccines in the developing world, the recipient community may still be unable to fend for itself during a public health crisis such as an influenza pandemic. Self-sustainability, therefore, is the goal of the WHO Technology Transfer Initiative (TTI), which has a mandate to promote increased access to health products through technology transfer and local production.

Traditionally, technology transfer is a bilateral agreement between a pharmaceutical company and a manufacturer, or between a university and a manufacturer. To make the project resource effective, TTI sets up hubs that teach multiple manufacturers how to make the product, and even national regulators how to regulate the product. Seed grants vary from one country to another, and leverage on local public or private buy-in, which is usually 17-20 times the original funding. In one instance, the Indonesian government contributed 50 times the WHO seed funding.

As one of the six initial grantees of TTI, the Serum Institute of India Ltd (SIIL) began with no experience in manufacturing influenza vaccines. Using a seed strain and a royalty-free license for public sector sales, both provided by TTI, SIIL received regulatory approval in early 2010 for a locally made live-virus pandemic influenza A (H1N1) vaccine (Nasovac). By November 2010, more than 2.5 million people in India were vaccinated with Nasovac with no serious adverse reactions or vaccine failure.

Authors: Juliana Chan is the Editor-in-Chief of Asian Scientist Magazine and Nanyang Assistant Professor at Nanyang Technological University, Singapore; she is a member of the 2015 intake of World Economic Forum Young Global Leaders. Chester Drum is a consultant with the National University Heart Centre, Singapore, and an Assistant Professor at the National University of Singapore.

Image: A girl gets tested to ensure a malaria bug she caught a month ago is no longer in her system at malaria clinic in Sai Yoke district, Kanchanaburi Province, October 26,2012. REUTERS/Sukree Sukplang

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