We’re all familiar with the challenges we have in low and lower middle-income countries for essential medicines for cancer. Roughly 50% of the essential medicines list that the WHO recommends are in those countries. We’re also familiar that lots of great organisations have spent many years trying to address that challenge, often working with one company at a time on donation drug models. We felt, probably at the beginning of last year, that maybe there was a new way of looking at it and could we get a coalition of all of those organisations currently working in those countries, talk to the industry, and say, ‘Let’s try and do this as a collaboration, industry and players with that experience,’ and bring in all of those individual organisations that can deal with pathology, diagnostics, supply chain, procurement etc. so that we can deal with it in a long-term sustainable way rather than a short-term way which it feels like at the moment.
So that coalition pulled together, we now have 26 organisations including eight or nine companies; that’s going to grow shortly. Our ambition is to help low and lower middle-income countries to raise the number of medicines they have up to the recommendations from WHO and then go beyond that with new medicines through voluntary licences which could be taken by the Medicines Patent Pool and be brought into those countries under voluntary licence within a three to four year period, rather than at the moment it could take many, many, many years.
What are the key aims?
The challenge we have is varied. So if you talk to some partners they’ll say pricing is the key issue; others will say it’s registration; others will say it’s the pathology, diagnostics, the availability of oncology trained individuals. It’s true in every aspect with every medicine to get to the right patient at the right time. But if we bring together a coalition of organisations that individually have the experience, knowledge or capability to address that and you wrap on top of that the local UICC membership, the engagement of WHO and the Health Minister and such organisations as, say, Project Echo which does online training and support around the world, get the American Society of Clinical Pathology committed to helping each of those countries get the right pathology and diagnostics in place, get direct relief to help with the supply chain issues, then actually all of those barriers which we all know exist, we can just knock off one by one, hopefully country by country over time.
What are the short term plans?
The coalition was launched on 22nd May and the partners have agreed four or five key things to do in the next six months, which is basically a lot of groundwork. One of those will be working with the World Health Organisation to see if it’s possible or feasible to get to a position where all ATOM countries can actually use a single registration process. So instead of one country each time registering a particular medicine, can we take a medicine that has been approved in America and in Europe, approve it in one of the ATOM countries and therefore be available, hopefully, in all ATOM countries over time. So that’s a key one to get going straightaway because that’s a benefit to everyone.
The second one we’re looking at is working with companies to see where their medicine portfolio is currently available and where it could be available. And where it could be available how, i.e. could it be donation, cost, tier pricing or through a voluntary licence? Collecting all that information and then assessing where we have some countries within the ATOM portfolio where there’s consensus that we actually make a lot more medicines available and then setting how we do that next year and the year after.
The third area is actually fundraising. We need a lot more funds to actually do the work that we want to do in the next five to seven years. Whilst we’ve got enough money now to get going, we have now got an organisation with incredibly powerful, renowned and respected organisations around the table – 26. I don’t think any access programme has ever been able to pull together such a diverse group of multisector organisations together at one time. But we need significant funding to do the capacity building we want to do country to country. So that’s the next step is to go out there and say, ‘Look, we’ve arrived; look at the organisation; look at its ambition; look at the way it’s going to operate; look at the governance structure and now will you provide the funding for us to do the work that we know we can do because many of us have been doing it for many years?’
What challenges might be faced?
When we set out on the journey to create the coalition, which was only a year ago, I don’t think we expected to have 26 organisations signed up on day one. But when you’ve got such tremendous organisations like ASCO joining in, you’ve got organisations like Project Hope, the Max Foundation, as I mentioned Direct Relief and others who say, ‘Do you know what? This looks really different, innovative. It’s a challenge but let’s work together,’ I don’t think that we imagined that 26 organisations with diverse views and perspectives on the access challenge would come together, but they have.
The next challenge, and there are many, is obviously to work with those countries to see what their interest is in the ATOM coalition itself. We can’t assume that they would like to work with us. But our target is low and lower middle-income countries and therefore we have to, over the next few months, start talking to them and say, ‘This is what we want to do, would you like to be involved in the ATOM coalition’s work?’
What is the ideal endgame?
There is no endgame. I genuinely say that. We have all those partners decided we want to create the coalition as the market access go-to for future medicines that are produced by the biopharma industry. We want the CEOs of those companies to sit down and say, ‘Right, we’re launching our new medicine and we would like to put it into the ATOM countries,’ targeting about 46 we think will be in the first batch, 46 countries. So that we can then work with them to get those medicines into those countries in a three to four year timeline rather than the current model which is maybe never or in 20 years’ time or 15 years’ time.
So we see this as an ongoing solution to make sure that new meds can get into countries in which those companies currently don’t operate and probably don’t want to operate, but they will if they can see there are quality organisations addressing the issues of government engagement, funding, registration, supply chain, diagnostics, pathology and the implementation and training for oncologists to get the right medicines to the right patient at the right time.
So that’s the ambition; this is a long-term solution for a problem that has been around for a long time which hasn’t really been cracked. Having said that, why is it so important? Because 70% of deaths are occurring in low and middle income countries and 70% of the growth is in low and middle income countries. So, as a society, if we are passionate about addressing the issue of cancer and people dying unnecessarily from a cancer diagnosis, then that’s where we have to focus our attention.
