Henry McKinnell: A battle that must be won

The problems of public healthcare are too complicated for any one group to solve alone. Fighting the health problems that threaten global security and prosperity will require the broadest possible coalition of public and private interests. Henry McKinnell looks at the progress being made, the new partnerships that are forming and the pitfalls that lie ahead

When Chrissy Sinoya entered St Gabriel’s Hospital in Malawi in late 2002, it wasn’t clear that she would leave alive. It wasn’t simply that this young woman was one of the 30 million Africans who are now HIV-positive. She also had an advanced case of cryptococcal meningitis, a brain infection that causes agonizing headaches and often leads rapidly to death.

In one respect, Chrissy was typical of many Aids victims whose weakened immune systems leave them prey to opportunistic infections.

In another, though, she was not. For Chrissy was lucky enough to find a hospital able to treat those infections. Doctors treated her with Diflucan, a powerful antifungal medicine donated by Pfizer as part of a new partnership with the Malawian government. Chrissy’s struggle is far from over, and it would be misleading to portray her case as evidence that we have turned the corner in the fight against Aids. But her recovery has been impressive, and the staff at St Gabriel’s has been inspired by her pluck and determination.

She has returned home to her work and family, visiting the hospital once each month to refill her Diflucan prescription. Chrissy symbolizes both the promise and the enormous obstacles for modern medicine as we map out our global agenda for the decades ahead. The promise extends far beyond the battle to beat back Aids, although that epidemic – among the most devastating in human history – rightly dominates our concerns. We are poised to find solutions to other diseases that kill millions. And we can find answers to other pressing health challenges.

How can we help poor countries achieve the high life expectancy that prevails in the developed world? How do we meet the threat of bioterrorism? How can we ensure Europe’s ageing population has access to innovative medicines that will enable people to remain healthy, active and productive well into old age?

How can we treat and prevent the three illnesses – heart disease, cancer, and stroke – that more than any others deprive people of decades more in which to enjoy life?

To understand why the future offers such promise, we must understand some of the changes that have brought us to this point. Future medical advances are possible only because of dramatic breakthroughs that we have already made.

Recent advances in scientific knowledge have certainly been amazing. The mapping of the human genome has opened up not just new avenues but also broad highways of research. The internet means that such research is available as easily – and as quickly – in Nepal as in New York.

Ironically, the battle against Aids has been an important source of that progress. In the mid-1980s there were no medicines to treat Aids; today there are 74, with another 83 in development.

Less well known is how much that research will contribute to other health advances, through our understanding of T-lymphocytes, renewed attention to vaccines and other developments.

Computers are revolutionizing the pharmaceutical sector as well. An enormous obstacle to success has been the high attrition rates in research. The vast majority of compounds fail in testing before we find the needle in the haystack that actually works.

But many of the compounds we discard could be needles for another haystack. Now we can use computers to research different problems simultaneously, keeping “libraries” of potential compounds that don’t work against a particular disease but might against others.

Finally, we are forging new public-private partnerships to address basic health needs in developing countries. Governments worldwide are recognizing that the challenge of providing medicines to all who need them is too great for any single party to handle. Governments, non-governmental organizations, academic groups and others are increasingly open to partnering with the private sector to expand access to medicines.

The programme helping Chrissy Sinoya is one such public-private partnership. Another is the International Trachoma Initiative, through which our company is providing medicines and other assistance to help eradicate the world’s leading cause of preventable blindness. These initiatives dovetail well with the theme of this year’s annual meeting, “Partnering for Security and Prosperity”. A healthier world will be both safer and more prosperous.

But we must not be sanguine about the challenges that lie ahead. Forces are at work that threaten to undermine this global advance to a healthy future.

We see those threats in accusations that the pharmaceutical industry puts “patents before patients”. And we see them in the actions of governments that fail to make healthcare decisions based on patients’ needs, but rather make cost-containment the sole goal of healthcare policy.

Why should we be suspicious of these ideas? First, because the undeniable truth is that while there are wonderful discoveries ahead, they don’t come cheap — and those who can bear a fair portion of the costs of research and development should be willing to do so. It takes $800 million and about 12 years to turn a molecule into a pill on the pharmacy shelf. Because fewer than one-third of all medicines earn enough to pay back the costs of research and development, the private sector needs incentives to engage in the high-risk, expensive and lengthy process of pharmaceutical discovery.

Similarly, research that is performed by others who are helping to address the world’s healthcare needs also comes at a premium.

While there are arguably other ways to create research incentives, the tried and true way to support these efforts is through patent protection. That is what makes possible new medicines like the one that is keeping Chrissy alive.

Collectively, we can take a number of practical steps to manage the challenge of providing quality healthcare at a reasonable cost. Some of these solutions emerge from our own experience in research and business.

First, let’s use outcome data to define what works best for patients. Pharmaceutical companies cannot make unsubstantiated claims about their medicines. Every assertion must be backed up by data that undergoes rigorous review.

Similarly, governments should be guided by research – and the conclusions of experts – when they consider what medicines to make available to their citizens.

Second, let’s ramp up our efforts to find better solutions to the problem of paying for the healthcare of those who cannot bear the heavy cost of disease. The enormous scale of the health crisis facing the developing world makes it essential to find innovative ways to finance healthcare.

A tremendous example is the UN’s Global Fund to Fight Aids, Tuberculosis and Malaria. In view of the daunting challenges posed by epidemic diseases, governments and other donors worldwide must spare no effort to ensure that this fund has adequate resources. President Bush’s proposal for emergency Aids relief – a five-year, $15 billion initiative to prevent and treat HIV/Aids in developing countries – is also a very hopeful start.

But most important, let’s form partnerships among all stakeholders in healthcare – governments, the medical community, non-governmental and multilateral organizations, the private sector and others.

We need public-private cooperation in fighting the health problems that threaten global security, and in developing the next generation of innovative medicines. The private sector must work together with governments, multilateral organizations and NGOs in delivering healthcare to local communities.

Partnership is particularly important in fighting Aids, especially in sub-Saharan Africa, where 70% of the world’s HIV-infected people live. Free medicine alone cannot eradicate the disease there, because even the most stable countries lack a developed healthcare infrastructure.

We will need coalitions to find the resources necessary to train health workers, build hospitals and clinics, and provide the other elements of an infrastructure that can diagnose patients and deliver needed medicines.

From criticism to cooperation
Is such partnership realistic? Can groups that have been critical of each other in the past now cooperate to fight disease? Yes. Because we are doing it already.

At Pfizer, we see this cooperation in the Diflucan Partnership Program, our alliance with ministries of health, local clinicians, and non-profit-making organizations in sub-Saharan Africa to help people like Chrissy.

We see it in Uganda’s Infectious Disease Institute, a path-breaking Aids treatment and training facility that our company is helping to establish.

We also see it in the dedication of Pfizer employees who have volunteered to join our Global Health Fellow Program. Under this initiative, Pfizer colleagues work with non-governmental organizations in developing countries to fight the conditions that give rise to HIV/Aids.

Other companies in our industry – and indeed, in the entire private sector – are using their skills and capabilities to address the challenge in their own ways. The World Economic Forum’s Global Health Initiative provides a stellar example of how a cross-section of companies can work together to raise the bar on corporate responsibility in fighting disease.

Scientific breakthroughs, public-private partnerships, idealism, recognition of the need to foster innovation: these are some of the ingredients for success. And sometimes those elements combine to produce results in wholly unexpected ways – as they have for Pfizer’s research programme to develop a new front-line treatment for malaria.

Malaria is an age-old disease that kills more than one million people each year, mostly children under five years old in sub-Saharan Africa. In many of the world’s poorest countries, the malaria parasite has become resistant to chloroquine, which has long been the standard front-line treatment.

But a few years ago, researchers at Walter Reed Army Hospital did some studies combining chloroquine with Zithromax, a Pfizer-discovered antibiotic.

It was only an experiment in a test tube. But the results piqued the curiosity of Mike Dunne, the head of Pfizer’s infectious disease research team. He was impressed enough to persuade the company that – though this would never be a profitable medicine – we should test that combination on human beings.

We began testing in India, where malaria is on the upswing. Although the initial results were encouraging, our researchers struggled to hold their excitement in check.

“At first you think this is a fluke,” Dr Dunne remembers. “Then – oh boy.” “Oh boy” was right. Following the first round of tests, cure rates went from 35% with the old drugs to 96% with the new combination.

We’re still testing. But it’s already clear that if the follow-up studies confirm these initial findings, we will have an entirely new way to treat one of the greatest scourges in human history.

How did that come about? Certainly Pfizer played a role. Certainly Mike Dunne’s insight and energy were indispensable. But he would be the first to acknowledge that he was part of a large team at Pfizer.

And we were part of an even larger team. Where would we have been without the researchers at Walter Reed? Or without the cooperation of the Indian government? Or without the hard work of thousands of unsung health workers conducting the tests? From an Aids victim like Chrissy, to thousands of malaria victims all over the world, none can be helped by a company, a government or a philanthropic group acting alone. We all must work together.

Chrissy is home now, tending to her family and her work. She appears at St Gabriel’s every month to get her refill. In fact, she has been known to show up when the pharmacy is closed and walk around, refusing to go home until she finds a doctor able to give her the medicine she needs to stay alive.

There are millions of people like Chrissy who need help. As someone who enjoys reading history, I am reminded of the time in 1940 when president Franklin Roosevelt sent a message to Great Britain’s prime minister Winston Churchill, urging him not to give up. Churchill replied: “Give us the tools and we will finish the job.”

My industry wants to do its part in the war against disease. We only ask to be given the tools. With those tools, and working in partnership, we can win many battles for the millions falling prey to a deadly virus, for young people who deserve a better future, for the elderly who merit the rewards of a comfortable old age – and for one young woman in a Malawian village who has received new hope for a longer life.

Henry McKinnell
Henry McKinnell is chairman and chief executive officer of Pfizer Inc.