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BERN, Switzerland — What if reaching the United Nations Sustainable Development Goals on access to health for all depended on the willingness of all actors to see beyond outdated dichotomies? The concept may seem obvious, but is easier described than done. In an effort to break silos, the Swiss Federal Institute of Intellectual Property (IPI) brought together stakeholders of all sides last week to discuss how to harness political and economic will to achieve innovation leading to new medicines that are available and affordable for all in need.

The stakeholder discussions took place on 1 February at IPI’s offices in Bern. This is the first of a series of stories on ideas from the event.

Speakers last week, coming from a wide range of organisations such as public-private partnerships, academia, international organisations, industry, and civil society, shared their particular concerns and challenges, and pondered potential avenues forward.

Access to medicines has been a complicated subject for many years, and the conversation often polarised around intellectual property issues, one camp seeing patents essential to innovation, the other considering patents as creating high-priced monopolies, preventing access to medicines, in particular in developing countries.

Gilead’s treatment for hepatitis C (sofosbuvir), released in late 2013, with an initial price tag giving headaches to developed countries’ health systems and leading to rationing, marked a turn in the discussions as former firm defenders of the current innovation mechanism started to voice interest in alternative solutions.

The increasing threat of antimicrobial resistance where the current innovation model is hardly applicable since the new antibiotics will have to be sparingly used, and the escalating prices of new cancer drugs give an opportunity to address the issue in-depth.

The conversation last week was not limited to the role and/or impact of patents on the affordability and availability of medicines, but how to define the value of innovation, evaluate the costs involved in producing a new medicine, how to go beyond benefactors to conduct research and development for neglected diseases and antibiotics.

Ideas were advanced on reimbursement systems as a way to fund research, in particular in the quest of new antibiotics, on reforming national pricing policies to encourage breakthrough innovation, and on the importance of collaboration within governments.

Switzerland Sees Challenges, Finds Coherent Voice Across Agencies

“All of us are in the same boat, yet ultimately, it seems that no one is on board,” said Felix Addor. deputy director general, general counsel and director of the Legal and International Affairs Division at the IPI, opening the conversation. Later in closing remarks, he recounted the many ideas that had been shared during the day, and said encouragingly, “We are all in the same boat, so let’s sail together.”

Addor described perspectives from different actors on the value of innovation, and their own particular challenges with the current system, whether they are payers, originator or generic industry, or governments.

Switzerland too is experiencing a lack of innovation to fight a number of incurable diseases, such as dementia, while also facing sometimes “severe supply shortages” of existing medical products, and “ever-increasing health costs.” On shortages, he cited a patent-free vaccination against poliomyelitis and said that “in summer 2017, immunisations against hepatitis A and B, as well as against tetanus ran out.”

Today, CHF78 billion, a tenth of the country’s gross domestic product, is poured into the Swiss health care sector, he said.

If the United Nations Sustainable Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages) is to be reached, according to Addor, research needs to be carried out as efficiently as possible with as many competitors as possible; market authorisation procedures need to be harmonised and less complex, differential pricing should be allowed to provide affordable access to new medicinal products for all, and necessary financing and reimbursing schemes should be in place.

According to Addor, different Swiss agencies have been successfully collaborating over the last 10 years on the topic, and those agencies have the same opinion in different fora. He underlined the goals of the Swiss health foreign policy, including improved access to medicines, the strengthening of global health research, the protection of intellectual property, and the promotion of human rights.

Among those present at the event were representatives from the IP office, the Federal Department of Foreign Affairs, the Federal Office of Public Health, and the Swiss State Secretariat for Economic Affairs (SECO).

“Swiss delegates advocate building on voluntary and inclusive efforts instead of denouncing the IP system,” he said.

Margaret Kyle, professor at Ecole des Mines in Paris, underlined the lack of coordination between ministries in many governments, and the lack of long term strategy. Some participants suggested that the Swiss coherence could provide a model for other countries. It was also seen as possible that the meeting, which encouraged an open spirit on all sides, could eventually lead to a new compromise proposal in international negotiations, something for which the Swiss have become known.

Speaking about balance, Addor said the challenge of affordable access to needed medical products should not be reduced to intellectual property rights. The patent system is one incentive system that has provided new medicines.

But, he said, “We need to make sure that, wherever patent protection is no longer working as an incentive, other incentive systems or models” are promoted, such as public-private partnerships, innovation prizes, advanced purchase commitments, priority review vouchers, grants or tax breaks for companies.

One thing seems certain, if the Swiss put their minds to it, more ideas will follow.

William New contributed to this report.