Pandemic reveals weakness of a pharmaceutical research system built on profit
By Charlotte Greenhill. Dr. Jonathan Quick talks to the Thematic Working Group Medicines in Health Systems about the COVID-19 pandemic and medicines and health systems challenges
The coronavirus pandemic has turned normal life on its head and left few communities untouched. Worldwide, leaders and professionals in every discipline grapple with the implications of COVID-19 on their work and their communities. On May 13th, the Medicines in Health Systems Thematic Working Group hosted a virtual conversation with global health leader Dr. Jonathan “Jono” Quick to examine the pandemic’s influence on access to medicines. The discussion brought forth observations that extend far beyond this particular field of interest.
Pandemics kill three ways, says Quick: by the virus, the disruption of health services, and the disruption of economic activity. Diagnostic testing, historically the “poor orphan” among medical technological innovations, has risen to a top priority for successful coronavirus response. Widespread access to testing provides key information to public health workers and facilitates contact tracing, effective isolation, and international coordination. Inequities and gaps in diagnostic capabilities are a major concern for reopening around the world: without sufficient diagnostic coverage “we’re flying half-blind globally” says Dr. Quick.
The virus has launched a flurry of innovative activity as scientists leverage existing medicines and technology creatively in search of new solutions. Under time pressure, some researchers evaluate already-developed drugs for effectiveness in coronavirus treatment which saves time that would otherwise be necessary to validate the safety of new products. But intellectual property rights often block efforts to repurpose known drugs; in response, patent pools–agreements between multiple parties to share intellectual property for a joint purpose–are negotiated. Dr. Quick argues that the pandemic makes a strong case for sharing rights and furthering the “transfer of technology” to the global South. Others are concerned that this will dis-incentivize private pharmaceutical firms from costly research and development. These are the limitations of a research system built on profit, a product of the complex relationship between scientific innovation and intellectual property. The race for a vaccine-and the uncertainty of who could access it once developed-is yet another instance of the ever present tension between private, national, and global interests.
Among the tools that scientists are using to measure pandemic risk and coordinate information is the Global Health Security Index, compiled by the NTI in conjunction with Johns Hopkins University. The GHSI analyzes factors like health system strength, risk environment, and accountability to collective international guidelines, then assigns each country a score. Dr. Quick calls the index a useful “advocacy tool” to pressure governments to address particular health security weaknesses and to “invest in managing those risks.” This knowledge empowers the public in new ways, affirming the oft-quoted refrain what gets measured gets done. Nevertheless, the index’s importance should not be overstated; the U.S. scored highest overall, yet it was slow to roll out national COVID response efforts. Key weaknesses in response that contributed to America’s high volume of coronavirus cases also reveal the critical importance of “unified, clear, decisive leadership” in a pandemic.
Uniformed messages are essential; in fact, the CDC developed key principles for communication during health crises following the 2003 SARS outbreak. Dr. Quick notes that among these is to be first to inform the public, which in our era of misinformation, feels even more imperative. Perhaps more rudimentary is to be truthful, with what is known and what is still unknown, and be credible. Quick affirms the necessity that leaders establish unity of primary messages, even if differences remain among secondary messages. Pandemic response requires functional, unified leadership at every level, from local communities to the G20.
Dr. Quick’s book The End of Epidemics: The Looming Threat to Humanity and How to Stop It, published in 2018, now seems tailor-made for the bestsellers list. At the time, the book represented a professional pivot for Quick from focusing on essential medicines and health systems strengthening to epidemic preparedness. In the webinar, he describes how the “explosion of panic” during 2014’s Ebola crisis brought about few lasting reforms and motivated his efforts to make epidemic research more accessible for policymakers and the general public. In the midst of COVID-19, the urgency of pandemic response and recovery is obvious, but Quick entreats listeners to also call for greater pandemic preparedness going forward. More broadly, he hopes that our current pandemic reality will reinforce the gravity of multiple “threats to humanity” and push society to recognize that quite simply, “we gotta listen to the scientists.”
Recurring coronavirus outbreaks will continue to disrupt until there is an effective vaccine. For health systems, the objective is to maintain as close to normal routine services and treatment levels as possible while handling the coronavirus response. For true pandemic recovery, Dr. Quick believes “pioneering countries can inspire others.” Already, the lessons learned through COVID-19 are numerous. As the language of social distancing and proper hygiene is normalized, as frontline health workers and community members learn vigilance and report unusual occurrences or outbreaks, as global health security is measured and tracked, popular understanding of favourable public health measures improves.
Normal life as we once knew it feels unimaginably distant and the pandemic’s impact on the future is unknown. Yet without a doubt, this crisis reveals the importance of public health leadership, health systems and access to new and established medicines and vaccines like never before.
