Engaging With Big Pharma: An Interview With Suerie Moon

The pharmaceutical giant Eli Lilly announced recently that they would be selling Humalog, their most popular fast-acting insulin, at half price—a reduction that still leaves the drug at $137.35 a vial. This decision comes in the face of intensifying criticism over consistent increases in the drug’s price: according to the Healthcare Cost Institute, the cost of insulin doubled from 2012 to 2016. Public outrage has only grown as a drug pricing lawsuit against Eli Lilly, and fellow insulin manufacturers Sanofi and Novo Nordisk, has proceeded.

In the U.S., where lack of drug price regulation allows costs to rise far higher than in other developed countries, headlines like these dominate the news cycle. However, drug pricing is only one of many problems perpetuated by the global pharmaceutical industry. Amongst poor countries, there are ongoing questions of access to the medicines widely available in wealthy states. Moreover, due to the need to recoup development costs, pharmaceutical companies invest little research into diseases that primarily affect the world’s poorest populations. The power and wealth of the pharmaceutical industry complicates ongoing efforts to combat rising drug prices, inequities in drug access, and lack of research into orphan diseases. Particularly as international law is diffuse and often unenforceable, it is not immediately clear how policymakers should optimally engage with the pharmaceutical industry to reach global health goals. Should private corporations be shut out of global health solutions entirely, or are they powerful potential partners in such arrangements?

Policymakers  have three general ways to engage with industry. The first is direct regulation of the industry, such as the drug pricing regulatory boards present in many countries. The second is reliance on industry self-regulation—in which corporations embark on corporate social responsibility efforts or other decisions that attempt to promote the public good, such as Eli Lilly’s decision to sell cheaper Humalog. Finally, policymakers can create mixed regulatory schemes—in which government entities form public private partnerships with industry actors to provide a public good or service. Given the insufficiency of self-regulation and the difficulty of directly regulating international corporations, the public private partnership is an increasingly common form of global health delivery today.

I sat down with Dr. Suerie Moon, director of the Global Health Center at the Graduate Institute of Geneva, to discuss current challenges to and opportunities in pharmaceutical engagement in global health policymaking.

TRANSCRIPT:

This transcript has been lightly edited for brevity and clarity.

Sabrina Wang: You’re on campus to give a talk about drug pricing and access to medicines, a policy domain that often involves the pharmaceutical industry. In light of the growing prominence of public private partnerships in global health, what do you believe is the idea role of private industry in global health governance?

Suerie Moon: That’s a complex question—let me take a step back before diving in. The pharmaceutical industry is not just a set of companies that research, develop, market, and price and distribute medicines. It’s also a very influential political player – I think it is regularly the highest donor in campaign contributions to US members of Congress. And the industry is enormous: the global pharmaceuticals market is 1.3 trillion dollars, about 10-15% of all health spending.

So, ideally, I would want a socially responsible pharmaceutical industry to invent, and develop safe, efficacious medicines that meet unmet health needs. And to ensure that the products that they develop are affordable to all populations, from the poorest countries in the world to the wealthiest. I think it’s possible for the industry to do that, but I don’t think that is what the industry is doing right now.

SW: Right, I read an article just a few months ago about Merck pulling out of a rotavirus vaccine supply agreement with Gavi. So we see that these companies are not always cooperative. Do you believe that there are any fundamental or overarching ways we can ensure that companies occupy this ideal role, or at the very least move closer towards it?

SM: First, I would say that the industry is diverse, so I don’t want to paint with too broad a brush. Oftentimes the diversity of views on public health within the industry is not reflected by lobbying bodies, because a lobby group often has to cater to a consensus position that all companies can support.  The second caveat I would put on the table is that I do think the industry has changed significantly, and companies are now more aware that they’re expected to make their medicines affordable in developing countries—and in high income countries—than certainly 20 years ago. The third important distinction to make within the industry is between the largest firms and the small to medium enterprises, which are usually much less politically powerful but where more of the innovative activity is currently happening. Many of the large firms are now acquiring and buying up small companies to fill up their pipelines. The drug industry has become very disaggregated today: you have different companies doing early-stage R&D, later stage clinical trials and registration, marketing, manufacturing and distribution—so you have less vertical integration.

So what will it take to get the industry to function and behave in a way that meets public health needs of a global society—I really think at the end of the day it is in the hands of governments. I don’t think we’re going to get the kinds of changes that we need only through persuasion, nor through corporate social responsibility initiatives. Especially today with high drug prices in the core markets of the US, Europe, and Japan, where these corporations make the lion’s share of their revenue. If we want to change their pricing practices, it’s not enough to change norms about responsibility. It’s certainly not enough to tweet. It’s not enough to scold publicly. You have to change laws and policies and incentives, and that of course is in the hands of governments, and [also] where I think we have some big problems. Because if governments are unduly influenced by the industry—through a form of political corruption—then the chances of us getting the laws and policies that we need diminish pretty quickly.

SW: And you also hear about former drug company executives are later appointed to positions of significant power in the public sector—you hear of conflict of interest situations.

SM: Right. The current secretary of HHS is the former President of [Eli Lilly], a company responsible for raising insulin prices, and he’s now responsible for doing something about the problem of high insulin prices. It makes the entire enterprise seem a bit ridiculous on the surface. So it’s in the hands of governments, but I have concerns as to whether our political systems in this country or elsewhere are up to the task.

Sabrina Wang ’19 studies in the College of Arts & Sciences. She can be reached at s.d.wang@wustl.edu.