Susi Geiger

On the Human Health, Impact and Technology webinar series on 24 Sept 2024, Professor Susi Geiger, Full Professor of Markets, Organizations and Society at UCD Smurfit School of Business spoke to host Professor Patricia Maguire about "Peak Pharma: Why the Pharmaceutical Industry has to change now".

Advocating for health equity everywhere

Susi is deeply passionate about healthcare and committed to promoting equality in access to medical services. Her primary goal is to ensure that everyone around the globe can receive the healthcare they need, whenever they need it—a vision that still feels far from realization. This mission drives her academic pursuits as well as her role as an expert member of the (opens in a new window)World Health Organization's Technical Advisory Group on Pharmaceutical Pricing Policies. Additionally, she is actively involved with (opens in a new window)Access To Medicines Ireland, an NGO that advocates for health equity both locally and internationally.

Market failures in healthcare

Susi has led the (opens in a new window)Misfires Project which has focused on examining market failures in healthcare and exploring potential solutions to improve these markets for those impacted. Two key examples of market failures she highlighted are:

First, during the pandemic, in January 2022, many people in high-income countries, including Ireland, were receiving their third booster vaccine, while healthcare workers in many lower- and middle-income countries had yet to receive their first vaccination and were going into COVID wards without any protection at all. This disparity stemmed from policymakers prioritizing advance purchases of COVID-19 vaccines, alongside the fact that manufacturers patented these vaccines, preventing widespread production by other companies. This created significant supply chain issues and highlighted global inequities.

The second example of a healthcare market failure impacts us all. In January of this year, the Irish government agreed to reimburse a drug called Libmeldy, essential for treating a rare disease, but it was priced at around €3 million per patient. The challenge isn’t just this drug; it follows a trend where several high-tech medications are being introduced at similar price points—often around €1 million per patient. Currently, there are 500 high-tech innovative medicines in development. The reality is that healthcare systems simply cannot sustain these escalating costs, and we need to find viable solutions.

Peak Pharma - Why we need a new political economy of pharmaceuticals

Susi’s new book to be published by Oxford University Press in early 2025 combines a historical perspective with a forward-looking analysis of the pharmaceutical industry over the past 40 years, highlighting the crises it has faced. In the final chapters, it presents two potential futures for global healthcare: a dystopian scenario characterized by a largely privatized system where high-tech drugs are accessible only to the wealthy, leading to significant inequalities both globally and within countries, and a utopian vision that promotes a vibrant and diverse innovation ecosystem. She believes that the utopian future should integrate various stakeholders—including not-for-profit organizations, public research entities, academic institutions, and university hospitals—rather than relying solely on the private sector. She emphasizes the importance of collaboration among these diverse actors, especially as we advance toward gene therapies. Ultimately, the book calls on policymakers to steer the healthcare system toward this inclusive, innovative future, ensuring that essential medicines remain accessible to all.

Challenges in Pharmaceutical Innovation Costs

Susi discussed the challenges surrounding the cost of pharmaceutical innovation, categorizing medicines into three tiers. The first tier focuses on generics, emphasizing the need for resilient supply chains to address current drug shortages, particularly for essential medications like cancer treatments and antibiotics. The second tier includes mass market innovative medicines, such as Ozempic and Wegovy, which are facing exorbitant price markups—Ozempic reportedly has a 40,000% markup in the USA. She advocates for stricter patent regulations to prevent manipulation and ensure fair pricing. Lastly, the third tier involves highly innovative medicines, which require a comprehensive re-evaluation of the pharmaceutical ecosystem to address their high costs effectively.

In order to address the escalating costs of pharmaceuticals, it is essential to monitor drug prices closely. Policymakers must ensure that patents are narrowly defined to prevent the practice of "evergreening," where companies extend patent protections unnecessarily. Additionally, there needs to be a concerted effort to focus on the pricing of highly innovative medicines, which often come with substantial costs. This calls for a comprehensive re-evaluation of the pharmaceutical ecosystem, as the industry has struggled to manage these high prices effectively.

Ensuring fair access while incentivizing innovation

While many assume that the pharmaceutical industry is the sole driver of innovation, a significant portion of research and development is actually funded by public institutions. For instance, the National Institutes of Health (NIH) in the United States directly or indirectly accounts for about 30% of all pharmaceutical R&D, demonstrating that even in a highly privatized system, public funding plays a critical role. This raises important questions about how to ensure that publicly funded research translates into accessible market-ready drugs. Policymakers must consider implementing conditions on this funding to ensure that new medications are affordable and meet market needs. A value chain perspective is essential, as relying solely on private entities for R&D is no longer a viable option.

For example, during the pandemic, Moderna and BioNTech received substantial support for research and development, totalling between $1.5 billion and $2.5 billion, both prior to and during the crisis. This funding highlights that the success of COVID-19 vaccines was not solely due to private investment. Once the vaccines reached the market, health systems were charged between €20 and €30 per dose, effectively resulting in a double payment for taxpayers. However, there is a looming concern that this could lead to a third round of payments. The broad issuance of mRNA patents has concentrated control over this technology in the hands of a few private companies, which poses risks for future innovations in areas like HIV and cancer vaccines.

The pharmaceutical industry has largely overlooked neglected tropical diseases, with only 1% to 4% of all pharmaceutical research and development (R&D) allocated to these critical health issues. However, organizations like the (opens in a new window)Drugs for Neglected Diseases Initiative (DNDi) have stepped in to fill this gap. For the past 20 years, DNDi has collaborated with affected countries to conduct research and development on the most neglected tropical diseases, ensuring that essential medications reach those in need. As high-income countries, it is crucial that we support these NGOs and their vital work in addressing these overlooked health challenges.

Right of access to healthcare

Access to healthcare is a fundamental right, as enshrined in the World Health Organization's constitution, and is considered a public good. It is important to recognize that many people don’t require much support to attain health—they need clean water, sanitation, and nutritious food. As we evaluate investments in the pharmaceutical industry, it is crucial to consider the broader healthcare system in which these companies operate. Taxpayer funding should prioritize addressing these socioeconomic needs in tandem with exploring other areas.

Moreover, significant advancements in medical science, including gene and cell therapies and personalized medicine, hold the potential to transform treatment for previously untreatable conditions, such as rare diseases, rare cancers, and HIV. "Let's make sure they're accessible to everybody who needs them - that's my mission in life."