Key problems in medical research and development and proposals for changes to improve the efficiency of the current system

Abstract

Background: The pharmaceutical system is failing in its role of responding to public health needs. The current R&D model is driven by profits rather than the public interest. As a result, while the public funds the highest-risk research and incentivises the industry’s involvement in the public health sector, the gap between the R&D agenda and medical needs is growing, new medicines are unaffordable for health systems and patients, and global access to new therapies is vastly unequal.
 Research purpose: The article looks into the root causes of this situation and the problems with the status quo to suggest potential solutions – from straightforward choices that are applicable within the existing system to transformative options that can bring back the balance between public and private interests.
 Methods: The reflections and recommendations presented in the article are based on scientific literature, materials developed by governmental and non-governmental organisations and discussions with experts.
 Conclusions: The article concludes that the most important factor is the increased involvement of the public sector, which should take greater responsibility for pharmaceutical R&D rather than leaving innovation, access, availability and pricing of pharmaceuticals to be driven solely by profit-maximisation strategies. At a minimum, the public sector must ensure that R&D is aligned with public needs, the end products are affordable and equally accessible, and the public gets a fair return on its investment. Structural and profound changes include altering the governance of private companies operating in the pharmaceutical sector as well as expanding the role of public institutes and companies in the system. Existing inefficiencies are not the result of scientific limitations or technical barriers, but of political choices. Ultimately, improving the pharmaceutical system comes down to choosing the public interest over private profits.