As pharma is to people, so infrastructure is to cities

Abstract

The pharmaceutical industry is a profit-making sector of the healthcare system and has grown into a self-regulating complex system over the years. Starting from the pre-clinical to clinical development of drugs to the authorisation and marketing thereof, a typical multi-national pharmaceutical company of today operates in complex ways which partly emerge from the multiple interactions within and without the company. The complexity is further given by the unpredictability of the outcomes: merely 1 out of 10 drugs that are in development are likely to be approved. The plethora of regulations by authorities such as the European Medicines Agency pose a negative feedback on this complex system which is further aggravated by the reimbursement landscape of each country, taking a toll on the innovative side of this privately funded sector.
 By analogy, infrastructure operations with distinct supply systems delivering specific critical products and services, pharmaceutical companies have become the exclusive suppliers of drugs within the healthcare system. Increasingly traditional public sector infrastructure provision has been privatised, as has national health services drug development, resulting in high levels of regulation in each, constraining innovation and profitability, hall-marks of the private sector. Just as infrastructure delivers the life-blood of cities, pharma delivers medicines for the health of individuals: both aim for public health and societal good. Failures in infrastructure delivery, such as unaffordability by the poor, match with pharma failures to provide equitably to all individuals: the poor cannot afford the best drugs. The urban sprawl in cities and the rise of informal settlements without sufficient infrastructure, can be observed in health care by the rise in use of alternative and unreliable medications by sections of the population who are excluded from pharma penetration.
 Our work studies such analogies between infrastructure and pharmaceutical companies in the hope of a better understanding of the operations of and connections with each other and inspirations about finding solutions from these two similar, yet distinct complex systems.