Public-Private Partnerships During Public Health Emergencies

Zera Ong and Dr. Antonio Gerbase

By Zera Ong and Dr. Antonio Gerbase

October 19, 2020

COVID-19 has been unprecedented in many ways, one of which has been the pandemic’s role as a seedbed and solidifier of public-private partnerships (PPPs). PPPs in public health have traditionally focused on the financing of healthcare infrastructure, contracting of discrete clinical services or a mix of the two. More recently, this model has evolved to include drug development and access, with GAVI and the Coalition for Epidemic Preparedness Interventions being two prime examples of funding the development of vaccines.

With COVID-19’s emergence and spread, PPPs have once again been brought to the fore, with the primary emphasis being on treatment. Whilst there are various key stakeholders in the public health arena (including academia, philanthropy and patient groups), the focus of this article will be on examining PPPs in the context of government-pharma industry relations during a pandemic. Specifically, we ask: What are the main drivers of pharmaceutical innovation and how can public-private partnerships achieve the twin aims of ensuring patient access and being commercially sound during a public health emergency?

Pharmaceutical Innovation: Patents as an Enabling Factor

Patients with unmet medical needs are at the core of every drug development effort. Living with a medical condition can severely impact one’s quality of life, from experiencing debilitating symptoms and complications of the condition to mental health challenges. At the core of what every drug development company does revolves around addressing an unmet need in the hope of ameliorating patients’ quality of life and possibly treating the condition with a transformative therapeutic.

Positive humanitarian intentions notwithstanding, drug development is fraught with challenges, not least because it is a complex, multi-stage undertaking involving research and development, preclinical testing, clinical trials in various phases and market launch. Recent estimates pin the cost of developing a single drug at a whopping $2.5 billion, notwithstanding the significant time and human capital investment into the entire development chain.

Drug development is also a risky business. From discovery phase projects in petri dishes to preclinical testing in animal models, a large majority of preclinical projects get culled even before reaching human trials. Even so, getting to Phase I of clinical testing in humans does not guarantee a successful drug – estimates from the Biotechnology Innovation Organisation, the largest trade association for pharma and biotech, pin the probability of success from Phase I trials to regulatory approval at a mere 9.6%. In other words, only 1 in 10 drugs which are tested in the clinical setting ever get approved and launched onto the market.

Given the high risk and capital outlay in developing drugs, what are the enabling factors behind therapeutic innovation?

Technological Inventions

Technological inventions are one of the enabling factors behind therapeutic innovation. Often, a new technology is born out of a plethora of other technologies. For instance, take the case of the Ebola vaccine. The vaccine, containing a modified virus, required the following enabling technologies:
A livestock viral delivery system called VSV; patented by Yale and licensed to Wyeth Pharmaceuticals
A method of engineering the viral delivery system to act as as “vector” for carrying a surface protein present in the Ebola virus (think of a trojan horse – the delivery system – which carries the cargo, i.e. the Ebola protein against which a patient’s bodily defences will mount an immune response)
A method for purifying the vaccine, i.e. removing contaminants
A method for scaling up the production of the vaccine to ensure that it meets market demand

The above is but a crude and simplified representation of various enabling technologies that go into creating a novel therapeutic. What, then, incentivizes science to continue progressing and innovating on these enabling technologies? The answer to that lies in intellectual property ownership, a legal mechanism of protecting the rights of inventors behind the creation of these technologies.

Patents & their Importance

Of the various intellectual property rights, the focus here will be on patents. Patents often cover the scope of the invention, the field in which they might be applicable (e.g. therapeutic / diagnostic use) as well as regional coverage, and are key to protecting inventors’ intellectual contribution and safeguarding commercial value.

That being said, a balance has to be struck between safeguarding private intellectual property rights and providing access to the technology on public interest grounds. To this end, many countries around the world have enacted legislation aiming to achieve this equipoise. For instance, the Patentgesetz in Germany states that “a patent shall have no effect should the Federal Government order that the invention is to be used in the interest of public welfare”, provided that the patentee shall have a claim against the Federal Republic for reasonable compensation. In Japan, “where the working of a patented invention is particularly necessary for the public interest, a person(s) intending to work on the patented invention may request the patentee or the exclusive licensee to hold consultations to discuss granting a non-exclusive license. Where no agreement is reached by consultations or no consultations are able to be held as provided in the preceding paragraph, the person intending to work the patented invention may request the Minister of Economy, Trade and Industry for an award.”

As seen above, fostering innovation is a delicate balancing act between safeguarding the innovation (especially if the invention might be in its infancy) and keeping the public interest in mind, with national level authorities and private companies being the key stakeholders. The question then turns to the following: in the case of public health emergencies which necessarily involve the public interest, how best might we achieve the twin aims of patient access and being commercially sound when developing such a therapeutic might require substantial resources?

Public Health Emergencies as a Compelling Opportunity for PPPs

What Might be Considered a Public Health Emergency?

First and foremost, it would be worth clarifying what a public health emergency might entail. Whilst there is no singular definition, Public Health Emergencies of International Concern are defined in the International Health Regulations (2005) as extraordinary events which are determined:

to constitute a public health risk to other states through the international spread of disease; and
to potentially require a coordinated international response.

Specifically, quantitative indicators can help health authorities decide whether the spread of an infectious disease qualifies as a public health emergency. Such indicators include:

Incidence and prevalence of the new disease, with incidence being the occurrence of new cases in a population over a specified period of time and prevalence being all cases, both new and pre-existing, in the population at the specified time; Mortality rate; and Geographical spread.

Taking a leaf from the influenza playbook, the World Health Organisation has described six phases of every influenza pandemic, with the highest phase being triggered when human-to-human transmission has resulted in sustained community level outbreaks (an incidence and prevalence measure) in at least two WHO geographical regions (geographical measure).

Taken together, public health emergencies are serious, unusual or unexpected and carry implications for public health beyond the affected State’s national border, such that immediate and co-ordinated international action may be required.

The Significance of PPPs During a Pandemic

Where pandemics such as COVID-19 are involved, the authors argue that there is a compelling case for public-private partnerships (PPPs), especially given the international scale and far-reaching consequences of such outbreaks. Through the looking glass of COVID-19, we will first dissect the competitive advantages that both the public sector and private companies possess, with a focus on therapeutic development against such outbreaks.

Thereafter, three contexts in which PPPs can be extremely meaningful will be considered: as a seedbed for scientific innovation, as an enabler of patient access to drugs, and finally, as a cornerstone for paving the way towards engendering goodwill amongst governments, drug development companies and patients.

Drug Development in Pandemics: Comparison Analysis of Competitive Advantages in the Public and Private Sector

PPPs as a Springboard for Drug Development During a Pandemic – Creating New Medicines & Repurposing Existent Therapies

When a novel threat such as COVID-19 emerges, two main routes can be taken: a) create new medicines, and / or b) repurpose existent therapies. A vaccine against COVID-19 belongs to the former category: vaccines aim to expose the body’s immune responses to the viral protein, and as COVID-19 has different viral proteins from that of other viruses, other extant vaccines such as influenza vaccines cannot be used to raise the body’s defences against COVID-19. As such, a new pandemic necessitates novel vaccine development. On the other hand, drug repurposing entails using already existing drugs used to treat other conditions and investigating if they might help ameliorate the symptoms or manifestations of a new pandemic. For instance, Gilead’s drug remdesivir had originally been targeted to Hepatitis C. Following evidence that it did not work as hoped, remdesivir was repurposed to be used against Ebola virus, before being currently investigated as a treatment against severe and moderate COVID-19.

As discussed above, how best can PPPs leverage the relative strengths of the public and private sector where it comes to therapeutic innovation and drug repurposing during a pandemic? The key might lie in: a) adequate patent protection, and b) closer interaction between drug developers and regulatory authorities in responding to the pandemic.

Open Access and Patent Protection In a Pandemic

In the past few months, patent protection for COVID-19 medicines has been an area of heated discussion. On the one hand, proponents for an open access platform have been calling for IP sharing, as “the existence of IP rights over those treatments and how they are exercised, will play an important role in determining how production is able to be scaled up.” On the other hand, others have argued that IP, as discussed in the opening section, is an enabling factor behind the risky therapeutic innovation necessary for finding COVID-19 treatments. As Thomas Cueni, the director-general of the International Federation of Pharmaceutical Manufacturers and Associations, writes, “patents, and IP more generally, are the main reason that there is such a strong innovation base to work from to find solutions…there is no guarantee of success as few treatments and even fewer vaccines may prove to be safe and effective. This level of risk-taking would be impossible without a flourishing innovation ecosystem built on strong IP incentives.”

The authors agree with Cueni for several reasons. First and foremost, as discussed above, patents are the bedrock of pharmaceutical innovation, especially since drug development is a risky undertaking. Furthermore, innovation in medicines is often driven by a bifocal emphasis on pipeline and platform. Pipeline refers to products that are being developed and are usually focused on a specific therapeutic area or indication (condition). On the contrary, platform refers to the technology which may not be relevant just to a specific drug or indication, but which acts as the spawning ground for future products or further improvements to current products. As evidenced by the Ebola vaccine, and as the case will likely be with its COVID-19 counterpart, development of any vaccine will likely entail improvement of predecessor technologies, and further inventions or discoveries being made on current technologies. Hence, in striking a balance between knowhow sharing and spurring innovation, the following are some questions worth considering:

How might one draw a distinction between patents relating to specific products (e.g. a COVID-19 treatment or vaccine), versus patents relating to platform technology (e.g. engineering techniques and isolation methods for vaccines)?

Even if a national patent office were to determine that a COVID-19 drug which would otherwise have been patented were to fall within a “public interest exemption” (and thus afforded no patent protection), would it still be possible to afford protection to the underlying platform technology or technological improvements?
Aside from patents which have been the topic of discussion, how else might the public and private sector work together? For instance, the sharing of data sets also represents a valuable intellectual property asset – might this be an alternative model which would strike a balance between valuing inventors’ rights whilst promoting open access in the public interest?

Furthermore, as alluded to above, patient access does not necessarily entail nullifying the concept of patents, for there are other means by which collaboration can take place. For instance, governments, academic institutions and pharma companies can share data, which can enable all parties to have a better understanding of the novel threat. One model worth considering would be the federated data access model propounded by the World Economic Forum. This model revolves around a “data superstructure” that can aggregate remote data sets (such as evidence related to COVID-19 trials), while allowing for localised data security. Each grouping is autonomous in terms of governance controls, yet, each party would be able to draw conclusions gathered from a much larger data set.

The federated data access model may be applied to the COVID-19 context and form the basis for PPPs. Often, drug development companies are the sponsor of COVID-19 trials – at the time of writing, there are more than 2,800 clinical trials globally, with 850 companies and institutions driving prophylactic and curative innovation. As every biopharma races towards the finish line for developing treatment options, might it be possible to consider sharing data sets? By pooling resources and knowhow, larger data sets might reveal more insights into clinical trial results and may aid in accelerating the time-to-clinic for potential treatment options.

Furthermore, if the question is one of access, there are other more productive ways of ensuring patient access. For instance, procurement agreements between pharma and government could be negotiated such that specific arrangements are agreed upon, such as pricing vaccines affordably or securing sufficient product liability protection from governments.

As with every partnership, PPPs should focus on creating win-win situations for the public and private sectors. Patents are not a zero-sum game in which the public sector loses and the private sector wins. It is in everyone’s interest to foster innovation especially during a global health pandemic, and given the alternative methods of ensuring open access, there is a strong case for safeguarding patent protection whilst exploring data sharing models and mutually beneficial drug procurement agreements.

Closer Co-operation Between Biopharma and Regulatory Authorities

Most therapeutics which are on the market have been subject to a rigorous regulatory procedure – health authorities in each country usually examine a dossier of information related to the drug to determine whether clinical trials may proceed. Such a suite of information often comprises data related to the toxicity, immunogenicity, potency and therapeutic efficacy of the drug, which have been determined by in vivo testing in animal models.

Whilst the sponsor of the clinical trials (usually a biotech or pharmaceutical company) has to make a formal regulatory submission, there has been an increasing degree of public-private interaction in this sphere. For instance, the FDA in the USA runs an INTERACT program, which enables trial sponsors to obtain preliminary informal consultation on investigational therapeutics at an early stage of development. Such interactions are helpful as they facilitate conversations about the drug development process (e.g. animal study design, process development and manufacturing). This promotes a mutually beneficial situation – biopharma is empowered to make more informed decisions related to drug development, and the regulatory authorities gain a deeper understanding of cutting-edge technologies possibly years before they are formally submitted for approval. Upon being given the go-ahead, clinical trials evaluating the drug in humans may begin – it is only after the drug has met defined endpoints after successive trial phases that the therapeutic may become available for patient use more widely.

During a pandemic, there is an even stronger case for closer co-operation between biopharma and regulatory authorities. Often, our understanding of the biology underlying an emerging health threat may not be clear in the early days of a pandemic. In such cases, PPPs are one of the key ways in which public and private actors can evaluate the highest level of scientific evidence available and make well thought through decisions together. Take the case of remdesivir in COVID-19 as an example. Originally targeted towards Hepatitis C and then Ebola, early trials revealed its potential in accelerating the recovery time for patients with severe COVID-19. Based on these topline results, Gilead submitted a request for emergency use authorization (EUA) of the drug. Whilst remdesivir was still an investigational drug and was not yet approved for any indication, the FDA decided to grant it EUA based on:

The severity of SARS-CoV-2, which can cause a serious or life-threatening disease or condition;
The totality of scientific evidence available to the FDA, which suggested that it was reasonable to believe that remdesivir may be effective in treating COVID-19, and that the known and potential benefits of remdesivir when used to treat COVID-19 outweighed the known and potential risks of such products; and
The lack of adequate, approved, and available alternative to the emergency use of remdesivir for the treatment of COVID-19

Since its authorization, remdesivir has been used in patients who would otherwise have had limited treatment options, potentially acting as a lifeline for some of them.

Case in point, in the throes of a pandemic with limited and constantly evolving scientific evidence, PPPs can be a formidable tool in fostering productive interactions that enable all actors to make enlightened decisions about the best next step to take based on available information.

PPPs as a Driver of Patient Access

In this multifaceted discussion, it is important to remember that therapeutic development is ultimately patient-focused, and at the crux of PPPs lies their potential to act as a driver of patient access. Here, PPPs will be examined within three contexts: i) Pricing and procurement, ii) Risk allocation and risk sharing between public and private stakeholders, and iii) Distribution and infrastructure

I) Pricing and Procurement

Fair and equitable access to medicines is one of the most pressing issues of our time, especially during a pandemic which affects all, albeit to different degrees. Whilst developed nations have been hard hit by the ensuing economic crisis, developing nations face an additional challenge of overcrowded populations and often poor living conditions, which increases the risk of COVID-19 transmission.

One of the ways in which PPPs have the most transformative power would be to implement measures promoting equitable distribution of therapeutics via pricing mechanisms. For pricing measures to achieve the highest efficacy, both private and public actors have a role to play.

On the biopharma end, where generics are concerned, pricing at cost may be an option. A trailblazer in this respect is Novartis, which has announced a portfolio of 15 generic and over-the-counter medicines which will be sold at zero-profit to governments in up to 79 low and middle-income countries. This is a laudable effort and paves the way for stable pricing for a basket of medicines essential to treating COVID-19.

Another example is Gilead, which has signed voluntary licensing agreements with generic pharmaceutical manufacturers to manufacture remdesivir for distribution in 127 countries. Circling back to the discussion above on patent retention by private inventors, this is a prime example of achieving the twin aims of securing patient access and safeguarding commercial value – whilst Gilead still owns the underlying patents which it may leverage in the commercialisation of future products, this has not hindered access to remdesivir generics which can now be made available to patients in an affordable manner.

This being said, where novel medicines such as a COVID-19 vaccine are involved, pricing at cost may not be an option. This is because the notion of the “cost price” in itself may be difficult to define – which vial / tablet would be the foundation for the cost-based approach, the first or second produced? Whereas the cost of innovation is high, the cost of production decreases for the second unit, third unit and so forth. Here, PPPs may be valuable in helping to reduce the cost of production per unit of drugs, thus enabling cost savings to be passed onto patients in the form of lower pricing. For instance, safe yet efficient and accelerated trials may reduce the total fixed cost of producing a new therapeutic. This is a mutually beneficial situation for both private and public stakeholders – pharma companies can achieve similar marginal return on investment at lower total average cost per drug, and where cost savings are translated into lower prices, these enable governments to fund access to therapeutics that may have the potential to halt or slow a pandemic in its tracks.

On the end of public actors, policymakers also have a role in determining how to allocate resources, such as the amount of investment to dedicate to the pre-emptive manufacture of vaccines and how to distribute successful vaccines. One model might be to form a coalition amongst nations to promote economies of scale amongst participating countries in negotiating procurement agreements for infectious disease treatments.

An international initiative, COVAX, has recently been jointly set up by CEPI, GAVI and the WHO. Recent estimates state that investment of around $18.1 billion will secure the development of and equitable global access of up to 2 billion vaccine doses. Early efforts have been encouraging, with 92 low and middle income countries and 77 high income countries which have expressed interest. As Dr. Ngozi Okonjo-Iweala, the GAVI Chair, expressed in a podcast interview by The Economist, “by bringing them (the countries) all together, we will have an affordably priced vaccine for all, we will have risk sharing in the facility for all, and this will ensure that so many more people in the world who would not have had access will have access.”

II) Risk Allocation and Risk Sharing Between Public and Private Stakeholders

Aside from pricing mechanisms, risk allocation and sharing is also a key element shaping PPPs during a public health emergency. As discussed in the opening section of this article, therapeutic development is a highly risky undertaking given the significant capital outlay and human resource investment. At present, approximately 4 billion doses of COVID-19 vaccines have been ordered by governments around the world, such that vaccine manufacturing has already commenced even prior to obtaining a full picture of their therapeutic efficacy. In doing so, pharma companies are manufacturing at risk. An example of a significant risk involves exposure to product liability claims in the event of side effects of a vaccine.

How, then, can governments and pharma companies collaborate to ensure that adequate risk-sharing is achieved such that the burden is not unduly borne by drug developers? One example involves risk allocation in manufacturing and supply agreements. In the case of AstraZeneca, reports suggest that the company has been granted protection from future product liability claims in most of the countries with whom it has struck supply agreements.

The protection that such indemnification provides is salient in a public health emergency – due to the time-sensitive nature of controlling a pandemic, the balance tips in favour of getting a drug to patients quickly. This might mean that longitudinal studies on potential side effects which would otherwise have been carried out may not have been able to proceed ahead of the therapeutic being used in patients. As such, there is an inherent risk that patients may experience side effects a few months or even years down the line. In a pandemic of global proportions, it would not be viable for drug developers to expose themselves to undefined financial obligations were they found to be liable for monetary compensation due to previously unknown side effects.

On such occasions where there is an ill-defined risk potentially of overwhelming proportions, PPPs can act as a stabilising force to spread the risk amongst public and private actors. As an AstraZeneca senior executive aptly stated, “in the contracts we have in place, we are asking for indemnification. For most countries, it is acceptable to take that risk on their shoulders because it is in their national interest”. Governments are often best placed to make assessments in relation to the public interest, and risk sharing with private actors in the context of achieving the national interest will likely continue to mould PPPs during public health emergencies.

III) Transport and Care Infrastructure

Whilst the focus of this article is on the strategic decisions underpinning healthcare PPPs, logistical aspects also play an important role. From the time of release of a batch of drugs to the point at which the patient receives it, several key steps are involved.

First and foremost, transportation logistics are a salient factor. From a contracting standpoint, it is important to clarify the point at which title and risk in the drugs passes from the manufacturer to the buyer. The transfer of title and risk are also usually interwoven with the legal concept of “delivery”, and so what constitutes delivery of the goods should also be made explicit.

Once the legalities have been ironed out, public and private actors should seek to co-manage practical details of distribution. For instance, governments should have well-defined plans as to the clinical settings in which patients can access the drugs. As an example, would generics to manage COVID-19 symptoms be available only via GP clinics, or might they be available over-the-counter? Who would administer the vaccines – community hospitals, pharmacy chains, or GPs?

Furthermore, what are the transportation routes to be used when transporting the drugs, and what storage conditions must be adhered to? Vaccines for instance usually need to be refrigerated, and so it is crucial that critical storage conditions are maintained throughout the process from transport to storage (possibly at a government facility) to promote product integrity.

On the other end, pharmaceutical companies can assist governments by leveraging existing local distribution networks to ensure that drugs including vaccines can reach patients in an efficient manner.

PPPs as a Foundation for Educating the Public

In the longer term, PPPs have the potential to lay the foundation for an improved understanding of healthcare amongst the everyday layperson. Both public and private actors have a role to play as public health is, after all, a multipronged matter involving political, societal and medical dimensions.

In a health pandemic, governments are often citizens’ first port of call for guidance on behavioural interventions, whereas private companies are often the drivers of medical innovation in response to the health threat. When the pathology of a newly discovered disease remains shrouded in mystery, it is ever more important that governments and drug developers join forces in educating the public. It is contingent upon both public and private actors to manage the public’s expectations and to promote transparency in the state of clinical progress. Questions to address might include:

What do we know about the public health threat, and what are the areas that we lack clarity on?

What are the current treatment options being researched, and how far are we from the clinic?
Pharmaceutical development is a complex undertaking that necessitates rigorous testing of therapeutics’ toxicity, clinical safety and efficacy. During a pandemic, public perception may be that timelines for a vaccine seem overly protracted. The onus would be on both governments and biopharma to ensure that the importance of adequate testing is highlighted as it would be in everyone’s interest to have a safe and effective drug.

What is appropriate scientific advice based on the highest level of evidence available?
In a public health emergency, there are often temptations for politicians to demonstrate publicly that action is being taken. The American and Brazilian presidents are two unfortunate examples of leaders who have made poorly substantiated health claims. For instance, Bolsonaro has on several occasions touted the benefits of hydroxychloroquinine against COVID-19. This was despite the fact that the FDA had previously cautioned against use of the drug for COVID-19 outside of hospital or clinical trial settings due to a risk of heart rhythm problems.

Such political bravado must stop for it puts lives at risk. A study found that as a result of the popular myth that highly concentrated alcohol could disinfect the body and kill the virus, approximately 6,000 people have been hospitalised and 800 individuals have died. Governments and pharma are in a position to set the record straight where it comes to doling out advice based on available scientific evidence. As such, both stakeholders ought to take on the joint mantle of delivering consistent messaging about claims that are substantiated versus others which are poorly evidenced.

Down the line, even when a vaccine has made it into the clinic, educating the public does not stop there. A vaccine is not necessarily a panacea, and it would still be contingent upon public and private stakeholders to duly inform the public. A positive example would be the way in which Professor Sarah Gilbert has communicated about the Oxford COVID-19 vaccine candidate. In an interview with The Economist, she carefully managed expectations about what the vaccine might achieve. Specifically, she articulated that a vaccine may not guarantee that patients would not contract the virus. Instead, she communicated that should a vaccine reduce the likelihood of developing severe COVID-19 complications, such a treatment option might be considered good enough as a first generation vaccine.

In the final analysis, PPPs can act as a bulwark against false and potentially health-threatening medical claims which may be circulating in a time of uncertainty. Indeed, well-coordinated and consistent advice doled out by public and private actors would enable the public to be more informed about the state of clinical research and promote greater coherence in tackling public health threats.

Beyond COVID-19: Broader Considerations

As we reflect on happenings thus far in today’s COVID-19 world, how can we translate COVID-specific learnings into forging stronger PPPs more broadly?

One of the biggest topics for discussion revolves around drug availability on a global scale. For instance, arrangements such as exclusive supply agreements between pharma and national governments might come into focus. This is because public health emergencies are global events, and so such agreements jeopardise the integrity of international efforts such as COVAX to ensure fair and equitable distribution. Of course, from a commercial standpoint, it would be impractical and undesirable to strictly regulate the boundaries within which commercial agreements can be struck. How, then, might we encourage global cooperation instead of insular nationalism?

Firstly, biopharma companies could consider entering into an industry code of conduct specific to public health emergencies. Such a code could specify “best practice” guidelines on how industry players might act during a pandemic, such as whether non-exclusive licensing and supply agreements should be prioritised to prevent a single country from laying claim to the entire supply of a drug. Whilst dissidents might argue that such consensus might be difficult to achieve, similar feats have been achieved before. For instance, in the realm of mergers and acquisitions, the UK has developed a City Code on Takeovers and Mergers which is administered by an independent body. The code seeks to reflect the collective opinion of those professionally involved in the field of takeovers as to appropriate business standards and as to how fairness to shareholders can be achieved. In a similar vein, might drug developers consider developing a framework to uphold core industry values, especially during a public health emergency?

Furthermore, can multilateral organisations play a part in securing equitable access to therapeutics during a public health emergency? For instance, could the World Health Organisation work with national health offices to put pressure on governments seeking to monopolise drug supplies? On a governmental level, could bodies such as ASEAN, the G7 and the G20 co-operate to ensure that no one country monopolises drug supplies?

Ultimately, the COVID-19 pandemic has brought with it an onslaught of challenges that are multifaceted, ranging from the dimension of therapeutic innovation to issues of equitable access. Whilst a long road remains ahead of us, herein lies a prime opportunity for public and private actors to explore potentially new ways of working together, thus setting the stage for even closer public-private collaboration in the future.


In totality, we have come a long way since COVID-19 first surfaced. Whilst this has been an unprecedented period of uncertainty, COVID-19 has also propelled an unparalleled level of public-private partnerships. Governments and pharmaceuticals have undoubtedly made coordinated efforts in fostering research and development, conducting regulatory testing, and promoting fair access to therapeutics to a degree perhaps never seen before. This is a significant achievement in itself which should be duly recognised.

Looking to the future, even after vaccines become available and after a semblance of normality has returned to our lives, we must not forget the principal role that PPPs have played in enabling such progress. Establishing close relations between public and private actors engenders greater trust, and continuing on this trajectory will only foster positive outcomes for all.

NB: Zera Ong is an Oxford graduate and multiple sclerosis charity trustee who currently works in a legal and commercial role within the biotech industry. Dr. Antonio Gerbase is a public health professional with more than 30 years’ experience working in the infectious disease space and previously led the HIV/AIDS response within the World Health Organisation. All opinions expressed here are held by their authors in their personal capacity, and do not reflect the views of any affiliated organisations.