Where old pathways to innovative cancer care fall short, a new model emerges
Ignoring half the people in the world cannot be good for business. Yet, for too long industry has relied on a business model based almost exclusively on commercial focus in a handful of countries. This business model has left half the world behind. Availability of treatment hasn’t meant patients can access them. Innovation hasn’t automatically led to application, and people diagnosed with cancer in half the countries of the world continue to suffer without access to innovative cancer treatments.
The work of delivering lifesaving therapies to the people who need them is as important as the work of developing the therapies themselves, especially now, when market forces are shifting, and health inequities are no longer acceptable to younger generations. We are overdue for a full reset.
We know cancer is the second-leading cause of death around the globe. It claims more than 10 million lives each year. But the risk and resources aren’t distributed equally. About three-quarters of cancer deaths occur in low- and middle-income countries (LMICs) - yet, this same group of countries receives only 5% of global cancer spending.1 This inequity in global health is an unacceptable burden on patients with cancer around the world who deserve access to the most innovative options for care.
Where traditional approaches to commercialisation and distribution leave gaps in access to innovative and affordable therapies, the need for a new approach is clear. There are ways to reach traditionally underserved patients that don’t involve the familiar sales model. That’s why The Max Foundation and BeiGene are working together, using our respective resources and capabilities, to provide access to CLL therapy to patients in underserved markets.
A matter of solution, not blame
Once leading health authorities have approved a therapy, it has historically taken years to reach patients in other parts of the world. In many cases, it never reaches patients at all in LMICs, as lack of reimbursement makes commercial access impossible. Surprisingly, we have even seen that even after generic versions of a therapy become available, lack of established commercial pathways, diagnostics, and reimbursement have often prevented access to those alternatives as well.
No one plans or intends for access to be as inequitable as it is. We all work in a global environment where regulatory pathways, commercial infrastructure, market incentives, and planning have evolved in ways that made sense at every step - they just don’t perform equally well in all parts of the globe. One example of this was the COVID-19 vaccines, which, despite receiving emergency authorisation and accelerated access for use in high-income countries, faced steep hurdles with distribution and access in LMICs.
Diagnostics play a huge role in treating cancer patients. Distribution, implementation, and maintenance of diagnostic infrastructure remain a significant challenge in LMICs, and any successful access strategy must address these barriers to help patients. Once a targeted therapy is available, you need access to advanced molecular diagnostics2 or the right imaging tools to determine which patients can benefit.3 Working with local healthcare systems to overcome these barriers, so that patients can benefit from novel therapeutics, is critical.
The effort currently under way reveals a valuable lesson: we are all in this together, and global markets require global strategies that address the unique challenges of access in LMICs. No one entity has all the answers, but, together, we each hold valuable pieces of the puzzle. If we come together in non-traditional ways, we can break through previously intractable barriers to create sustainable access models for patients.
Where we can go from here
Perhaps most significantly, the therapy we’re working to deliver to patients is one of many that can be managed safely in a low-resource environment. Therapies that require specialised handling, storage, or administration may be a next step in the development of this access model.
What changes can the pharmaceutical industry make that will continue to ripple out to faraway places in need? For one, industry should take a broader look at a therapy’s potential when it is new. There are choices that can be made early in the commercial cycle that may get closed off later. Second, industry should join patient organisations and NGOs in raising awareness of the significant need of cancer patients and caregivers in underserved markets, and the opportunity and benefit of addressing this urgent health inequity. Together, we have a stronger voice and greater stature we can put to use.
Above all, we should recognise the many areas where our commitments to health equity cross the boundaries that usually guide our work. These are times when commercial entities and non-profits can achieve more together than either can apart.
Geography should not be destiny. Inequity should have no safe haven in the world. When we put our strengths together in the interest of helping people in need living with cancer, neither distance nor economics nor old assumptions should stand in our way.
About the authors
John V. Oyler co-founded BeiGene in 2010. He has served as CEO and a member of the Board of Directors from the company’s start, and was appointed board chair when that position was created in 2016. Oyler joined the Board of Directors of the Biotechnology Innovation Organization (BIO) in 2019 and is a member of its Health Section Governing Board. He received his BSc in mechanical engineering from the Massachusetts Institute of Technology and an MBA from Stanford University.
For more than 20 years, Pat Garcia-Gonzalez, CEO of The Max Foundation has been dedicated to improving the lives of cancer survivors around the world. A native of Argentina, Garcia-Gonzalez has a Master’s degree from the University of Washington and a technical degree in nursing. She is the co-founder of The Max Foundation, established in 1997 in honour of her stepson, Max, who was diagnosed with chronic myeloid leukaemia (CML) at the age of 14. He survived until the age of 17, and his legacy lives on in the hearts of thousands of cancer survivors whose lives have been touched by the organisation.
In 2021, she became chairperson of the Access to Oncology Medicines Coalition (ATOM) Council, a global partnership sponsored by the Union for International Cancer Control, that brings together 40 leading organisations with the single shared goal of improving access to essential cancer medicines in lower-to middle income countries. Garcia-Gonzalez lives in Edmonds, Washington, where she raised her four sons.