Last week, researchers James Allison and Tasuku Honjo were awarded this year's Nobel Prize in medicine for their work on cancer immunotherapies, heralded by the Nobel committee as "seminal discoveries" that "constitute a landmark in our fight against cancer."
Immunotherapies like those developed on the basis of Allison and Honjo's work are indeed an important step towards a whole new way to treat cancer, as well as a host of other chronic diseases. However, this Nobel award should remind us that these innovative therapies are out of reach for so many patients in the United States due to the exorbitant prices drug companies charge for them.
Just weeks before the Nobel announcement, oncologist Ezekiel Emmanuel wrote in a Wall Street Journal essay, "We Can't Afford the Drugs That Could Cure Cancer," that "a cure for cancer has become possible, even probable" with immunotherapies, but that our health system cannot afford their price tag. Just after the Nobel announcement, Vox reporter Julia Belluz reminded us that "the average cost of cancer drugs today is four times the median household income" (emphasis added).
Immunotherapies constitute a part of the class of drugs called biologics (as opposed to chemical pharmaceuticals) that have shown very promising results in treating many previously intractable conditions, such as multiple sclerosis, asthma, chronic pain, and Crohn's disease, due to their ability to more precisely target individual diseased cells. Therefore it's no surprise that currently most of the top 10 best-selling drugs worldwide are biologics.
Though the public has helped pay to develop every single new drug approved by the Food and Drug Administration in recent years—including several immunotherapies for cancer and other diseases—we pay again, and pay dearly, when we want to access such treatments.
Though the public has helped pay to develop every single new drug approved by the Food and Drug Administration in recent years—including several immunotherapies for cancer and other diseases—we pay again, and pay dearly, when we want to access such treatments. As we have written before, one way around this sort of double taxation would be to invest in the creation of public pharmaceutical companies that could produce and distribute medications at cost, or even below cost when deemed a public health necessity.
Cuba has, perhaps, the most developed public pharmaceutical sector in the world and is actually known for its achievements in biologics. With its success at vaccine development and production, and the development of drugs to treat chronic kidney disease, reduce the risk of diabetes-related amputations and treat HIV/AIDS, Cuba's biopharmaceutical industry is booming.
Cuba nationalized the pharmaceutical sector in 1960 and consolidated a number of pharmaceutical manufacturing companies under the auspices of the Ministry of Health (later transferred to function under the Ministry of Basic Industry). In the 1980s, Cuba began to develop its biotechnology capacity, investing $1 billion into that sector between 1990 and 1996 alone. By 2013, the Cuban biotechnology industry held around 1,200 international patents and was marketing pharmaceutical products and vaccines in more than 50 countries.
Among the pharmaceutical innovations to come out of this fully public pharmaceutical system is the lung cancer immunotherapy vaccine CimaVax. It garnered worldwide acclaim as the first vaccine for an illness the World Health Organization says was responsible in 2016 for an estimated 1.7 million deaths globally. CimaVax is so promising that clinical trials are being run in the US, UK, Canada, Japan and some European countries. Moreover, a four-shot dose of CimaVax is reported to cost Cuba only "up to $100."
The US and Cuba have even formed a joint biotech venture, the Innovative Immunotherapy Alliance, providing the US's Roswell Park Comprehensive Cancer Center access to CimaVax and other cancer therapies. Roswell Park is already running clinical studies with CimaVax in order to obtain FDA approval for the medication's use in the US, and the joint venture plans to develop the other cancer drugs currently in the pipeline in order to gain FDA approval to market those in the US as well.
At the same time, though, President Trump's recent renegotiation of the North American Free Trade Agreement has extended patent protection on biologics in the region to 10 years. Biologics already enjoy 12 years of market exclusivity in the United States, but the 10-year patent protections now applicable to Canada and Mexico is much longer than previous terms, unnecessarily adding costs to the health systems of those countries and restricting patient access to these lines of treatment.
Furthermore, the extension of patent protections on biologics may drive up prices on those medications both at home and abroad by restricting the market for biosimilars (essentially, generics for biologics), according to Peter Maybarduk, the Director of Public Citizen's Access to Medicines Program.
If biologics really are the future of medicine, we must change the way prescription drugs are priced in the United States, or millions of patients will be left behind. One way to do that is to invest in public pharmaceuticals that can assure an adequate supply of and equitable access to essential medications.