{"id":186284,"date":"2021-02-23T00:52:16","date_gmt":"2021-02-22T21:52:16","guid":{"rendered":"https:\/\/en.buradabiliyorum.com\/trudeau-and-big-pharma-not-a-love-story\/"},"modified":"2021-02-23T00:52:16","modified_gmt":"2021-02-22T21:52:16","slug":"trudeau-and-big-pharma-not-a-love-story","status":"publish","type":"post","link":"https:\/\/buradabiliyorum.com\/en\/trudeau-and-big-pharma-not-a-love-story\/","title":{"rendered":"#Trudeau and Big Pharma: Not a love story"},"content":{"rendered":"

“#Trudeau and Big Pharma: Not a love story<\/strong>”<\/p>\n

\n On the bright side, when it comes to vaccines, so far Canada is actually doing better than Australia.<\/p>\n

That country bet big on a thriving domestic bio-science<\/a>s sector. It was making good progress on a made-in-Australia vaccine until December, when it had to scrap its vaccine program<\/a> because while the candidate vaccine did well against COVID-19, it also produced weirdly high levels of false positives on HIV tests.<\/p>\n

Australia didn\u2019t app<\/a>rove Pfizer\u2019s vaccine until January. The country\u2019s prime minister became the first Australian to receive a vaccine dose<\/a> \u2014 yesterday<\/em>.<\/p>\n

So a domestic pharma industry is no guarantee of success against any given specific bug. Indeed, global dominance isn\u2019t even a guarantee. Three of the biggest vaccine makers in the world, GlaxoSmithKline, Merck and Sanofi, have seen their COVID-19 programs scrapped or badly delayed<\/a>. There are no guarantees in pharma. The work is too complex, too close to the cutting edge of science and manufacturing. It\u2019s one reason winning pays so well: because losing costs a lot.<\/p>\n

So it may be that even if Canada had a thriving pharma sector, it would still be scrambling to line up vaccine doses today amid a hotly competitive international feeding frenzy. And some of the attempts to explain the weakness of pharma in Canada approach Avro Arrow levels of quaint nostalgia, such as the notion that Brian Mulroney locked Canada into a generation of serfdom by privatizing a government lab<\/a> the year Patrick Swayze starred in Ghost<\/em>. As though subsequent governments had no ability to act.<\/p>\n

READ:\u00a0Is it possible to mix-and-match COVID-19 vaccines?<\/strong><\/p>\n<\/blockquote>\n

What I do know is that late last summer, as the Trudeau government scrambled to lock down agreements with manufacturers of several vaccine candidates, people in the Canadian pharmaceuticals industry were amazed, and grimly bemused, to find their phones ringing off the hook. Because for years before COVID-19, their attempts to interest Justin Trudeau\u2019s government and Stephen Harper\u2019s government before it, in building a robust pharmaceuticals sector for Canada had met consistent bland indifference.<\/p>\n

In the early days of the Trudeau government, it seemed that things might go better. If only for a while.<\/p>\n

In his 2017 budget, then-finance minister Bill Morneau introduced<\/a> an Innovation and Skills Plan, \u201can ambitious effort to make Canada a world-leading centre for innovation.\u201d Morneau was following the advice of an Advisory Council on Economic Growth led by one of the Trudeau Liberals\u2019 favourite people, McKinsey managing director Dominic Barton. Barton\u2019s final report<\/a> told the feds to \u201cunleash growth in six to eight high potential sectors\u201d like renewable energy, advanced manufacturing, and health care and life sciences. The approach in each sector should be \u201caspirational\u201d and \u201ccollaborative.\u201d<\/p>\n

The aspirational part came easily enough. Morneau said Canada should \u201cdouble the number of high-growth companies in Canada, particularly in the digital, clean technology<\/a> and health technology sectors, from 14,000 to 28,000 by 2025.\u201d Collaboration seemed, at first, to get off on the right foot as well. The government created a half-dozen Economic Strategy Tables, including one in the health and biosciences sector. That group of 16 industry leaders tabled its final report<\/a> in the fall of 2018.<\/p>\n

Canada\u2019s health and biosciences sector was on track to reach $17 billion in exports by 2025, the report said. But they said that wasn\u2019t good enough. By more than doubling growth in the sector, Canada could reach $26 billion in exports, from twice as many fast-growing firms, by 2025\u2014by adopting \u201cbold measures that eliminate barriers and drive growth.\u201d<\/p>\n

What did Canada need to overcome to reach this goal? The report included a handy \u201cWhat We Need To Overcome\u201d section. Among the obstacles: \u201cComplex regulatory, reimbursement and procurement processes impede the adoption of innovations\u201d\u2014which meant that the makers of new drugs, processes and technologies had a hard time getting their solutions approved, a long wait to get paid, and a long line to stand in if they wanted public health-care systems to buy their stuff. Canada\u2019s federal system added its own complexities: a product accepted for use in one province might not be available in the rest. That made it hard enough to sell new products into the Canadian market from outside. But it also made Canada a shaky base for anyone who might want to launch a new product into the global market, because the first question any country\u2019s regulators ask is, \u201cIs this new product approved in its country of origin?\u201d<\/p>\n

READ:\u00a0The tragic story of a Canadian vaccine trailblazer<\/strong><\/p>\n<\/blockquote>\n

The panel also noted the feds\u2019 plan to reform the\u00a0Patented Medicines Price Review Board (PMPRB), which was founded 35 years ago with a mandate to cap the prices on new drugs. Great, the panel said, but make sure that \u201cproposed drug pricing changes are not a barrier to growth.\u201d Setting prices low would save the government\u2014and taxpayers\u2014money. But it could be a false economy. At some point, manufacturers would become less interested in selling to Canada. And they sure wouldn\u2019t want Canada setting prices for the global market.<\/p>\n

So the Trudeau government\u2019s handpicked growth guy told them to work with industry on reaching ambitious goals. Morneau set the goals. The handpicked industry panel told him to reform procurement and be careful about pricing. Progress on both those fronts has been shaky at best. Last April, after the COVID-19 pandemic had shut down much of the world economy, Health Canada said<\/a> it was working on speeding up drug approvals\u2014and hoped to see results in 2021. That\u2019s halfway through the timeline Morneau laid out when he called in 2017 for reforms that would bear fruit by 2025.<\/p>\n

One report<\/a>\u2014commissioned by Innovative Medicines Canada and using data from 2018\u2014said Canada takes a lot longer than peer countries to reimburse companies launching new medicines. From first global approval to reimbursement takes 252 days in the United States, 317 days in the United Kingdom, and 926 days in Canada.<\/p>\n

\u201cThat doesn\u2019t create an environment that attracts business,\u201d says Pamela Fralick, CEO of Innovative Medicines Canada, the industry association for pharmaceuticals companies in Canada. (Some full disclosure is in order: I sometimes deliver paid speeches to various organizations. In 2018 I gave one speech to Fralick\u2019s group.)<\/p>\n

But if the process of bringing new medicines to market in Canada is glacial, at least the money promises to be bad. The government released its proposed changes to the PRPMB pricing regime<\/a>, which determines how much pharma firms get paid for their products, last year. The answer was, they\u2019d be paid less than before. For starters, the U.S. and Switzerland would be removed from an international basket of comparator countries that are used to determine prices for Canada, because both countries tend to pay drug manufacturers a lot of money. Since there\u2019s a global health crisis on, Health Canada has delayed implementation<\/a> of the regulations twice; they\u2019re now due to come into force on July 1 of this year.<\/p>\n

But if the process is slow and the money isn\u2019t great, at least the spirit of collaboration Dominic Barton called for was, until COVID-19 hit, in tatters.<\/p>\n

READ:\u00a0More COVID vaccines are coming to Canada. Who will get them first?<\/strong><\/p>\n<\/blockquote>\n

\u201cIt\u2019s definitely been an arms-length interaction with the government,\u201d Cole Pinnow, the CEO of Pfizer Canada, said in an interview. \u201cI would say that we\u2019ve always had a solid relationship with the regulatory part of Health Canada. But we certainly have not had a genuine engagement with the rest of Health Canada, despite several outreach attempts. And we\u2019ve had what I would call cursory engagement with Minister Bains [Trudeau\u2019s minister of industry, who resigned from cabinet in January], who seemed to be the most open to discussing a meaningful solution. But even that fell off his agenda late in 2019. There has been nothing but, frankly, draconian policy coming out of this government until the pandemic hit.\u201d<\/p>\n

Draconian\u2019s a big word. What does Pinnow mean by it? \u201cThere\u2019s not a willingness to collaborate or compromise or find a new path forward. It\u2019s really, \u2018This is our problem, this is how we want to solve this problem.\u2019 They welcome feedback, but that feedback is never iterated upon. It\u2019s merely, \u2018Thank you for your feedback, we will now proceed.’\u201d<\/p>\n

The chilly relationship doesn\u2019t date from Trudeau\u2019s election, Pinnow said. Stephen Harper\u2019s Conservative government was also reluctant to seem too close to an industry whose products are produced by multinational firms and sell for high prices. The political benefit of siding with generic drug manufacturers, whose products are usually cheap and easily available but which aren\u2019t renowned for developing new products for new circumstances, is obvious.<\/p>\n

\u201cWe\u2019re in a situation in Canada that is a result of decades of a poor relationship between government and this industry,\u201d Fralick of Innovative Medicines Canada said. \u201cAnd we\u2019re kind of paying the price for that now.\u201d<\/p>\n

It\u2019s not as though there were no consultations on the patent-drug price regulations. The review board held hearings across the country and accepted written submissions; a summary report<\/a> says they received 123 of those. But Fralick and Pinnow described a sensation familiar to many people who\u2019ve shown up to government consultations in recent years: it was clear that they were free to speak, but less clear that anyone was listening.<\/p>\n

Fralick said an international group of more than two dozen CEOs from big pharma wrote to Trudeau four times asking for a meeting. The first letter was sent in February 2018, the second in May 2018, the third in April 2019, and the fourth in February 2020. The letters \u201cwere very high level in nature, respectful in tone, expressing an interest in working more collaboratively with Canada, and referencing concerns with the changes being considered for the regulatory regime,\u201d Fralick said. The first letter received an unsigned response from Health Canada\u2019s strategic policy branch. The others received no answer. Pharma bosses do occasionally meet leaders in other countries, she said, including French president Emmanuel Macron and British prime minister Boris Johnson. And Trudeau\u2019s dance card does include the occasional CEO in other sectors, such as Mary Barra from General<\/a> Motors, Satyah Nadella from Microsoft, and former GE Canada CEO Elyse Allan. Global pharma had much less luck getting a look-in.<\/p>\n

Pinnow insists that long-term chilly relationship hasn\u2019t affected the COVID-19 vaccine emergency procurement effort. \u201cA\u00a0government that has not wanted to interact in a sincere and meaningful way\u201d has \u201cquickly realized that we now have a common desire to work together on a hot topic,\u201d he said. \u201cI want to make it perfectly clear: we have never talked about the policies and the vaccines at the same time.\u201d In fact, he said Canada\u2019s procurement effort will soon be seen as \u201cworld-class compared to everyone else out there.\u201d By late summer, when the Belgian factory retooling effort that slowed Pfizer\u2019s deliveries is well in the past, and vaccine candidates that weren\u2019t yet approved in February join Pfizer and Moderna, \u201cCanada\u2019s going to be swimming in vaccine.\u201d<\/p>\n

Fralick agrees. \u201cNo company that I\u2019ve spoken with, no member company of IMC, is in any way connecting the dots between the regulatory environment and the supply of vaccine,\u201d she said. \u201cBut the bottom line is, where you have more anchor companies, where you have more activity, where you have a relationship with industry, it\u2019s probably going to have an impact on where you sit in the pecking order.\u201d<\/p>\n

(I should also note that the weary note sounded by Pinnow and Fralick isn\u2019t the only one I heard. Patricia Gauthier, CEO of Moderna for Canada, was more upbeat in an interview. \u201cMy experience has been extremely positive,\u201d she said. It\u2019s also brief: she became Moderna\u2019s first employee in Canada at the end of 2020. \u201cIt\u2019s hard for me to comment on the past,\u201d she said when I asked about pharma policy before the current crisis.)<\/p>\n

For Gauthier\u2019s colleagues, complaining about long-term trends during a pandemic is a delicate rhetorical path to tread: the Harper and Trudeau governments put up successively larger DON\u2019T BOTHER signs to the local representatives of a fabulously lucrative global industry, but bygones became bygones just as soon as everyone found themselves in a global crisis where big pharma was suddenly needed. If that\u2019s so, what lasting harm was done?<\/p>\n

Maybe only this. Canada remains, for this sector as for others, a place where the status quo is timidity, snail\u2019s-pace progress and a weird disconnect from the action in the rest of the world. Canada has no effect on moderating global drug prices, but is usually pretty good at ensuring new medicines don\u2019t get here first. It brags about its intentions to change all of the above, then doesn\u2019t follow through. The crises aren\u2019t the main problem. It\u2019s what happens between crises: not much.
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