Reflections on the Future of Pharmaceutical Public-Private Partnerships: From Input to Impact

Developing public-private R&D consortia to accelerate Alzheimer's disease drug development

Efforts to accelerate Alzheimer's disease (AD) drug development have been spurred on by the creation of open science, public-private R&D consortia. An R&D consortium provides an improved structure for generating and disseminating AD knowledge across a range of organizations while also aligning their interests. Drawing from archival and interview data collected on 46 public-private R&D consortia focused wholly or in part on AD, we uncover two important innovations: the creation of novel consortium types that facilitate coordination beyond the individual consortium, and the practice of organizations joining multiple consortia. Collectively these innovations provide member organizations with different pathways for advancing AD research. These findings have significant implications for how member organizations should approach collaboration in the AD drug development process.

Establishment of Advanced Regulatory Innovation for Clinical Trials Transformation (ARICTT): a multi-stakeholder public-private partnership-based organization to accelerate the transformation of clinical trials

Clinical trials have evolved with digital technologies and tend towards patient-centricity. A multi-stakeholder approach is needed to address the emerging complexities in clinical trials. In particular, the introduction of digital technologies and an emphasis on patient-centricity are the major trends in clinical trials. In response, we established a public-private partnership-based organization named Advanced Regulatory Innovation for Clinical Trials Transformation (ARICTT). Eleven organizations in total, from academia, industry, and regulatory agencies, participate in ARICTT. Based on multi-stakeholder collaboration from academia, industry, and government/regulatory bodies, we collected and prioritized current topics in clinical trials based on an internal survey. We established a three-year roadmap with axes that were termed trend, goal, structure, theme, topic, and method. In addition, we planned the development of recommendations based on real-world cases with feasibility studies. We developed appropriate organizational structure to fulfill the roadmap of ARICTT. The selected topics were decentralized clinical trials during the first year, followed by the three topics that were awarded the highest priority according to the internal survey: advances in the informed consent process, supporting sites using digital technology, and an effective recruitment strategy. We developed a case-based recommendation paper presenting an overview of the regulatory landscape and practical considerations with explanatory cases. We also designed and conducted fully decentralized trials to evaluate considerations in real-world settings for the selected topics. Overall engagement and communication were supported by the online platform and annual symposiums. In conclusion, we established a multi-stakeholder, public-private partnership-based organization to accelerate the transformation of clinical trials.

Adoption and use of immunotherapy in breast cancer management in Africa: barriers and prospect - a narrative review

Breast cancer (BC) is the world's most frequently diagnosed cancer in women, with 7.8 million women diagnosed with BC in the past 5 years. BC has the highest incidence rate of all cancers in women worldwide (1.67 million), accounting for over 500 000 deaths annually. In Africa, BC accounts for 28% of all cancers and 20% of all cancer deaths in women. The African continent has recorded an alarming increase in incidence, with the highest mortality rate globally. Despite BC being a major health concern in Africa, there is limited access to adequate healthcare services to combat the growing need. Immunotherapy, a promising treatment approach that harnesses the immune system's power to fight cancer, has shown great potential in BC management. However, in the face of the growing body of evidence supporting its effectiveness, the adoption and use of immunotherapy in BC management in Africa remain limited. Hence, this review aimed to explore the barriers and prospects of immunotherapy adoption and use in BC management in Africa. A comprehensive search across various databases and sources using specific keywords related to immunotherapy and BC to achieve the study aim was conducted. The criteria for including data in the study were based on relevance and availability in English, with no publication year restrictions. The collected data underwent narrative analysis, supplemented by information from sources like country reports, newsletters, commentaries, policy briefs, and direct Google searches. By identifying the challenges and opportunities, this review provided insights into how healthcare providers, policymakers, and other stakeholders can work together to improve the availability and accessibility of immunotherapy to BC patients in Africa.

Public-private partnerships influencing the initiation and duration of clinical trials for neglected tropical diseases

Public-private partnerships (PPPs) for neglected tropical diseases (NTDs) are often studied as an organizational form that facilitates the management and control of the huge costs of drug research and development. Especially the later stages of drug development, including clinical trials, become very expensive. This present study investigates whether and how the type of PPPs influences the initiation and duration of NTD clinical trials. Using the ClinicalTrials.gov database, a dataset of 1175 NTD clinical studies that started between 2000 and 2021 is analyzed based on affiliation information and project duration. For the NTD clinical trials that resulted from PPPs, the collaborating types were determined and analyzed, including the public sector-, private sector-, governmental sector-, and nongovernmental organization-led collaborations. The determinants for the discontinuation of all stopped clinical trials were categorized into scientific-, funding-, political-, and logistic dimensions. The results reveal that public sector-led PPPs were the most common collaborative types, and logistic and scientific issues were the most frequent determinants of stopped clinical trials. Trial registration: ClinicalTrials.gov.

Pharmaceutical Scientists' Perspectives on Capacity Building in Pharmaceutical Sciences

With the anticipated health challenges brought by demographic and technological changes, ensuring capacity in underlying workforce in place is essential for addressing patients' needs. Therefore, a timely identification of important drivers facilitating capacity building is important for strategic decisions and workforce planning. In 2020, internationally renowned pharmaceutical scientists (N = 92), largely from the academia and pharmaceutical industry, with mostly pharmacy and pharmaceutical sciences educational background were approached (through a questionnaire) for their considerations on influencing drivers to facilitate meeting current capacity in pharmaceutical sciences research. From a global view, based on the results of the questionnaire, the top drivers were better alignment with patient needs as well as strengthening education - both through continuous learning and deeper specialisation. The study also showed that capacity building is more than simply increasing the influx of graduates. Pharmaceutical sciences are being influenced by other disciplines, and we can expect more diversity in scientific background and training. Capacity building of pharmaceutical scientists should allow flexibility for rapid change driven by the clinic and need for specialised science and it should be underpinned by lifelong learning.

Talking Ethics Early in Health Data Public Private Partnerships

Data access and data sharing are vital to advance medicine. A growing number of public private partnerships are set up to facilitate data access and sharing, as private and public actors possess highly complementary health data sets and treatment development resources. However, the priorities and incentives of public and private organizations are frequently in conflict. This has complicated partnerships and sparked public concerns around ethical issues such as trust, justice or privacy-in turn raising an important problem in business and data ethics: how can ethical theory inform the practice of public and private partners to mitigate misaligned incentives, and ensure that they can deliver societally beneficial innovation? In this paper, we report on the development of the Swiss Personalized Health Network's ethical guidelines for health data sharing in public private partnerships. We describe the process of identifying ethical issues and engaging core stakeholders to incorporate their practical reality on these issues. Our report highlights core ethical issues in health data public private partnerships and provides strategies for how to overcome these in the Swiss health data context. By agreeing on and formalizing ethical principles and practices at the beginning of a partnership, partners and society can benefit from a relationship built around a mutual commitment to ethical principles. We present this summary in the hope that it will contribute to the global data sharing dialogue.

Use of experimental medicine approaches for the development of novel psychiatric treatments based on orexin receptor modulation

Despite progress in understanding the pathological mechanisms underlying psychiatric disorders, translation from animal models into clinical use remains a significant bottleneck. Preclinical studies have implicated the orexin neuropeptide system as a potential target for psychiatric disorders through its role in regulating emotional, cognitive, and behavioral processes. Clinical studies are investigating orexin modulation in addiction and mood disorders. Here we review performance-outcome measures (POMs) arising from experimental medicine research methods which may show promise as markers of efficacy of orexin receptor modulators in humans. POMs provide objective measures of brain function, complementing patient-reported or clinician-observed symptom evaluation, and aid the translation from preclinical to clinical research. Significant challenges include the development, validation, and operationalization of these measures. We suggest that collaborative networks comprising clinical practitioners, academics, individuals working in the pharmaceutical industry, drug regulators, patients, patient advocacy groups, and other relevant stakeholders may provide infrastructure to facilitate validation of experimental medicine approaches in translational research and in the implementation of these approaches in real-world clinical practice.

Participating in innovative medicines initiative funded neurodegenerative disorder projects—An impact analysis conducted as part of the NEURONET project

The European Commission's Innovative Medicines Initiative (IMI) has funded many projects focusing on neurodegenerative disorders (ND) that aimed to improve the diagnosis, prevention, treatment and understanding of NDs. To facilitate collaboration across this project portfolio, the IMI funded the “NEURONET” project between March 2019 and August 2022 with the aim of connecting these projects and promoting synergies, enhancing the visibility of their findings, understanding the impact of the IMI funding and identifying research gaps that warrant more/new funding. The IMI ND portfolio currently includes 20 projects consisting of 270 partner organizations across 25 countries. The NEURONET project conducted an impact analysis to assess the scientific and socio-economic impact of the IMI ND portfolio. This was to better understand the perceived areas of impact from those directly involved in the projects. The impact analysis was conducted in two stages: an initial stage developed the scope of the project, defined the impact indicators and measures to be used. A second stage designed and administered the survey amongst partners from European Federation of Pharmaceutical Industries and Associations (EFPIA) organizations and other partners (hereafter, referred to as “non-EFPIA” organizations). Responses were analyzed according to areas of impact: organizational, economic, capacity building, collaborations and networking, individual, scientific, policy, patient, societal and public health impact. Involvement in the IMI ND projects led to organizational impact, and increased networking, collaboration and partnerships. The key perceived disadvantage to project participation was the administrative burden. These results were true for both EFPIA and non-EFPIA respondents. The impact for individual, policy, patients and public health was less clear with people reporting both high and low impact. Overall, there was broad alignment between EFPIA and non-EFPIA participants' responses apart from for awareness of project assets, as part of scientific impact, which appeared to be slightly higher among non-EFPIA respondents. These results identified clear areas of impact and those that require improvement. Areas to focus on include promoting asset awareness, establishing the impact of the IMI ND projects on research and development, ensuring meaningful patient involvement in these public-private partnership projects and reducing the administrative burden associated with participation in them.

The Innovative Medicines Initiative neurodegeneration portfolio: From individual projects to collaborative networks

The IMI public-private partnership between the European Commission and the European Federation of Pharmaceutical Industries and Associations (EFPIA) was launched in 2008 with an initial budget of €2 billion. Aiming to accelerate the development of innovative medicines for areas of unmet clinical need, the IMI has committed over €380 million to projects on neurodegenerative disorders (NDD), catalyzing public-private collaborations at scale and at all stages of the R&D pipeline. Because of this vast investment, research on neurodegenerative diseases has made enormous strides in recent decades. The challenge for the future however remains to utilize this newly found knowledge and generated assets to develop better tools and novel therapeutic strategies. Here, we report the results of an integrated programme analysis of the IMI NDD portfolio, performed by the Neuronet Coordination and Support Action. Neuronet was launched by the IMI in 2019 to boost synergies and collaboration between projects in the IMI NDD portfolio, to increase the impact and visibility of research, and to facilitate interactions with related initiatives worldwide. Our analysis assessed the characteristics, structure and assets of the project portfolio and identifies lessons from projects spanning preclinical research to applied clinical studies and beyond. Evaluation of project parameters and network analyses of project partners revealed a complex web of 236 partnering organizations, with EFPIA partners often acting as connecting nodes across projects, and with a great diversity of academic institutions. Organizations in the UK, Germany, France and the Netherlands were highly represented in the portfolio, which has a strong focus on clinical research in Alzheimer's and Parkinson's disease in particular. Based on surveys and unstructured interviews with NDD research leaders, we identified actions to enhance collaboration between project partners, by improving the structure and definition of in-kind contributions; reducing administrative burdens; and enhancing the exploitation of outcomes from research investments by EU taxpayers and EFPIA. These recommendations could help increase the efficiency and impact of future public-private partnerships on neurodegeneration.

Digital Transformation in Medical Affairs Sparked by the Pandemic: Insights and Learnings from COVID-19 Era and Beyond

A number of developments, including increasing regulatory and compliance scrutiny, increased transparency expectations, an increasingly vocal patient, patient centricity and greater requirements for real-world evidence, have driven the growth and importance of medical affairs as a trusted, science-driven partner over the past decade. The healthcare environment is shifting towards a digital, data-driven and payor-focused model. Likewise, medical affairs as a function within the pharmaceutical industry has become more "patient-centric" with strategic engagements embracing payers and patients apart from clinicians. The pandemic has impacted the healthcare industry as well as the function of medical affairs in numerous ways and has brought new challenges and demands to tackle. There is indeed a silver lining due to intense digital transformation within this crisis. The emerging digital innovation and new technologies in healthcare, medical education and virtual communications are likely to stay and advance further. In this review, we discuss how the digital transformation sparked by the pandemic has impacted the medical affairs function in pharmaceuticals and provide further insights and learnings from the COVID-19 era and beyond. Based on the learning and insights, digital innovation in three key strategic imperatives of medical affairs-HCP engagement, external partnerships and data generation will enable medical affairs to become future-fit as a strategic leadership function.

Lessons learnt from implementing the Good Governance for Medicines Programme in Zimbabwe

WHO launched the Good Governance for Medicines (GGM) programme in 2004 with the aim of fighting the problem of corruption in the pharmaceutical sector. Zimbabwe adopted the GGM programme in 2015 and developed its own implementation framework (GGM-IF) in 2017 based on the WHO global guidelines and recommendations. Zimbabwe’s GGM-IF emerged from; (1) home-based expertise, (2) extensive local consultations and (3) effective incorporation into existing institutions. The GGM-IF committed to implementing a focused programme over a 5-year period from 2017 to 2022 with the expressed goal of improving transparency and accountability in the pharmaceutical sector as a key enabler to improve access to medicines. Midway through its projected lifespan, some notable achievements materialised attributed to key success drivers, including mutual collaboration with the Ministry of Health and Child Care’s existing Global Fund supported Quality Assurance Programme. Key challenges faced include limited funding for the programme, a shifting policy environment driven by a political transition and reorientation of priorities in the wake of the COVID-19 pandemic. This manuscript articulates 3-year operationalisation of Zimbabwe’s GGM-IF highlighting the success drivers, implementation challenges and lessons learnt.

Using the International Pandemic Instrument to Revitalize the Innovation Ecosystem for Antimicrobial R&D

The inclusion of antimicrobial resistance (AMR) and increased research and development (R&D) capabilities in the most recent outline of the World Health Organization's (WHO's) international pandemic instrument signals an opportunity to reshape pharmaceutical R&D system in favour of antimicrobial product development. This article explains why the current innovation ecosystem has disadvantaged the creation of antimicrobial products for human use. It also highlights how the COVID-19 pandemic experience can inform and stimulate international cooperation to implement innovative R&D incentives to bring new, life-saving antimicrobial products to the market.

Partnership agreements for regenerative medicines: a database analysis and implications for future innovation

Aim: Partnerships have been leveraged to advance the regenerative medicines (RMs) development. This study analyzed the evolution of partnership landscape for regenerative medicines (RMs). Methods: Partnership agreements publicly announced from January 2014 - June 2020 were described. Results: 1169 partnership agreements with total amount of US$63,496 million were identified. Most agreements concerned RMs that were for oncology (25.3%), in the discovery or preclinical phase (66.9%) and gene-based products (45.3%). The most common partnership type is collaborative agreements without licensing. The partnerships between 'biotechnology companies and not-for-profit organizations' represented the largest number (n = 416; 35.6%). 'Big Pharma' preferred collaboration and licensing agreements with a higher amount. Conclusion: Collaborations between highly specialized players with complementary expertise promote the successful translation of scientific discovery to RMs.

Public-Private Partnerships: Compound and Data Sharing in Drug Discovery and Development

Collaborative efforts between public and private entities such as academic institutions, governments, and pharmaceutical companies form an integral part of scientific research, and notable instances of such initiatives have been created within the life science community. Several examples of alliances exist with the broad goal of collaborating toward scientific advancement and improved public welfare. Such collaborations can be essential in catalyzing breaking areas of science within high-risk or global public health strategies that may have otherwise not progressed. A common term used to describe these alliances is public-private partnership (PPP). This review discusses different aspects of such partnerships in drug discovery/development and provides example applications as well as successful case studies. Specific areas that are covered include PPPs for sharing compounds at various phases of the drug discovery process-from compound collections for hit identification to sharing clinical candidates. Instances of PPPs to support better data integration and build better machine learning models are also discussed. The review also provides examples of PPPs that address the gap in knowledge or resources among involved parties and advance drug discovery, especially in disease areas with unfulfilled and/or social needs, like neurological disorders, cancer, and neglected and rare diseases.

The interface of multisectoral and multilateral dimensions of public health policy: what's new in the 21st century?

The article examines key developments unfolding in the 21st century in the intersection of multisectoral and multilateral dimensions of public health policy. Several processes and mechanisms, relatively new or rapidly evolving, are fuelling this dynamic interface. They include, in particular, expansion of the spectrum of sectors involved in the health domain, the upsurge of trans-border and commercial determinants of health, growing presence of health issues in multilateral instruments and processes that are outside of the health sector, and strengthening the legal base of intersectoral relations and responsibilities for health. They also encompass and reflect important transformations in health diplomacy and governance for health, some of the fundamentals of contemporary public and global health. The article argues that overall, multisectoral and multilateral dimensions tend to interact, inform and reinforce each other, and that such interaction would be one of important drivers of 21st century intersectoral policy-and international cooperation-for health.

Governing antimicrobial resistance: a narrative review of global governance mechanisms

Antimicrobial resistance (AMR), a central health challenge of the twenty first century, poses substantial population health risks, with deaths currently estimated to be around 700,000 per year globally. The international community has signaled its commitment to exploring and implementing effective policy responses to AMR, with a Global Action Plan on AMR approved by the World Health Assembly in 2015. Major governance challenges could thwart collective efforts to address AMR, along with limited knowledge about how to design effective global governance mechanisms. To identify common ground for more coordinated global actions we conducted a narrative review to map dominant ideas and academic debates about AMR governance. We found two categories of global governance mechanisms: binding and non-binding and discuss advantages and drawbacks of each. We suggest that a combination of non-binding and binding governance mechanisms supported by leading antimicrobial use countries and important AMR stakeholders, and informed by One Health principles, may be best suited to tackle AMR.

Patients with FLT3-mutant AML needed to enroll on FLT3-targeted therapeutic clinical trials

We sought to identify the total number of therapeutic trials targeting FLT3-mutant acute myeloid leukemia (AML) to estimate the number of patients needed to satisfy recruitment when compared with the incidence of this mutation in the US AML population. A systematic review of all therapeutic clinical trials focusing on adult FLT3-mutated AML was conducted from 2000 to 2017. An updated search was performed using ClinicalTrials.gov for trials added between October 2017 and December 2018. Analysis was performed for ClinicalTrials.gov search results from 2000 to 2017 to provide descriptive estimates of discrepancies between anticipated clinical trial enrollment using consistently cited rates of adult participation of 1%, 3%, and 5%, as well as 10% participation identified by the American Society of Clinical Oncology in 2008. Twenty-five pharmaceutical or biological agents aimed at treating FLT3-mutant AML were identified. Pharmaceutical vs cooperative group/nonprofit support was 2.3:1, with 30 different pharmaceutical collaborators and 13 cooperative group/nonprofit collaborators. The number of patients needed to satisfy study enrollment begins to surpass the upper bound of estimated participation in 2010, noticeably surpassing projected participation rates between 2015 and 2016. The number of patients needed to satisfy study enrollment surpasses 3% and 5% rates of historical participation for US-only trials in 2017. We estimate that 15% of all US patients with FLT3-mutant AML would have to enroll in US and internationally accruing trials to satisfy requirements in 2017, or approximately 3 times the upper level of historical participation rates in the United States. The current clinical trial agenda in this space requires high percentage enrollment for sustainability.

The Economic Impacts of Open Science: A Rapid Evidence Assessment

A common motivation for increasing open access to research findings and data is the potential to create economic benefits—but evidence is patchy and diverse. This study systematically reviewed the evidence on what kinds of economic impacts (positive and negative) open science can have, how these comes about, and how benefits could be maximized. Use of open science outputs often leaves no obvious trace, so most evidence of impacts is based on interviews, surveys, inference based on existing costs, and modelling approaches. There is indicative evidence that open access to findings/data can lead to savings in access costs, labour costs and transaction costs. There are examples of open science enabling new products, services, companies, research and collaborations. Modelling studies suggest higher returns to R&D if open access permits greater accessibility and efficiency of use of findings. Barriers include lack of skills capacity in search, interpretation and text mining, and lack of clarity around where benefits accrue. There are also contextual considerations around who benefits most from open science (e.g., sectors, small vs. larger companies, types of dataset). Recommendations captured in the review include more research, monitoring and evaluation (including developing metrics), promoting benefits, capacity building and making outputs more audience-friendly.

Role of Academic Biobanks in Public-Private Partnerships in the European Biobanking and BioMolecular Resources Research Infrastructure Community

Public-private partnerships (PPP) are an efficient means to advance scientific discoveries and boost the medical innovations needed to improve precision medicine. The increasing number and novel nature of such collaborations is keeping the biomedical field in constant flux. Here we provide an update on PPP development involving academic biobanks in the BBMRI community (the European Biobanking and BioMolecular Resources Research Infrastructure) and report the views on PPP of 20 key players from this field. The interviewed academic representants broadly show interest for their institution to establish PPP and initiate or partner with BBMRI expert centers. The results indicate that PPP has gained foothold in this area of biomedical research, with great promise to facilitate access to samples and data and to improve data interoperability and reproducibility.

Measuring the Efficiency of U.S. Pharmaceutical Companies Based on Open Innovation Types

The pharmaceutical industry, where research and development (R&D) efficiency is central to company survival, has recently faced significant challenges. To increase efficiency, companies must implement strategies such as open innovation (OI), wherein they sell their intellectual property, maximize their use of external resources, adjust their structures, and implement new business models. In this study, we divided 701 U.S. pharmaceutical companies according to their OI strategies to measure and compare their R&D efficiencies between 2001 and 2016. We analyzed the deal data of companies by first dividing them into four groups (inside-out, outside-in, coupled, and closed) to calculate R&D efficiency using stochastic and meta-frontier analyses. In the first group analysis, the coupled group shows high technical efficiency, but in an overall comparison, the inside-out group achieves the highest efficiency values. These values increased between 2005 and 2010, when the R&D crisis in the industry was great at its highest. We thus identified the characteristics of each group based on our results, and presented extensive analyses using a time-series comparison and enterprise-level analysis. We claim that pharmaceutical companies can still cope with the current R&D crisis by implementing different OI strategies.

Rational Drug Design Using Integrative Structural Biology

Modern drug discovery and design approaches rely heavily on high-throughput methods and state-of-the-art infrastructures with robotic facilities and sophisticated platforms. However, the anticipated research output that would eventually lead to new drugs with minimal or no side effects to the market has not been achieved. Despite the vast amount of information generated, very little is converted to knowledge and even less is capitalized for cross-discipline research actions. Therefore, the need for re-launching rational approaches has become apparent. Here we present an overview of the new trends in rational drug design using integrative structural biology with emphasis on X-ray protein crystallography and small molecules as ligands. With the aim to increase researchers' awareness on the available possibilities to perform front line research, we also underline the benefits and enhanced prospects offered to the scientific community, through access to research infrastructures.

Innovative Approaches to Increase Access to Medicines in Developing Countries

Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions.

Innovative Approaches to Increase Access to Medicines in Developing Countries

Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions.