Notes from ISPE 2008: Hans Rosling on Ending Pharma Parochialism

End Pharma Parochialism: Think Globally, Act Globally

Anyone who still thinks of the term “third world” or uses “industrialized” vs. “developing” to describe world economies was duly chastised, in a most amusing and good-natured way, by Dr. Hans Rosling, Professor of International Health at the Karolinska Institute in Stockholm, Sweden.  (For a video of Dr. Rosling giving a similarly spirited presentation at an event two years ago, click here). 
Dr. Rosling, who cofounded Physicians Without Borders in Sweden, has worked around the world.  While in Mozambique, he discovered “konzo,” a paralytic disease caused by hunger/malnutrition (and badly processed cassava root). With family members, Dr. Rosling also established the Gapminder Foundation in Sweden three years ago, to continue development of Trendalyzer software, which brings statistical information to vivid life.  Google acquired the software last year, but the software can be seen (and played with) via http://www.gapminder.org/.  Its use should be required for anyone giving a presentation that involves statistics and trends.

This is the kind of keynote speaker one wants to hear at an event of this, or any, sort---someone with a keen intellect whose eye is very much focused on the big picture, and yet who manages to maintain a sense of humor.  At one point, he stopped to admire the technology behind the old-fashioned pointer he used for the talk (“it’s even recyclable”)

New economic models needed for drug development
The underlying theme of his talk was the industry’s urgent need to develop medicines for the world’s most ravaging diseases---without destroying the basic free market principles that drive the industry.

He discussed the preconceived notions that so many of us continue to have, convinced that we are operating on a “fact-based world view,” and dividing the world based on “long life with small family” vs. “short life with large family.”  The nations of the world could be neatly divided that way, he said, but that was back in 1950.

Rosling used Vietnam as an example.  Even though the country is more than a century behind the U.S. economically (its per capita GDP is now about 39, where the U.S. figure was about 50 back in 1900), it now has a higher life expectancy than the U.S. did after the Vietnam war, he said, so it is only one generation behind the “developed nations” as far as health care is concerned. 

Diligent Asians vs. Lazy Americans and Europeans?
He interspersed jokes throughout his talk, commenting, for example, on the work ethic of Asian students vs. Europeans, noting how he often works until midnight, and he and the Asian PhD students are the only ones waiting for the bus (“the Swedish graduate students had gone home hours earlier.”)  This theme was also found in some other presentations by U.S. professionals.

Although he acknowledged that 1.2 billion of the people on earth are now living below the poverty level, most people in the world are now “in between,” Rosling said, quoting the World Bank’s Yuri Dikhanov. (More on Dikhanov’s methods here. For a video program that Dikhanov participated in at MIT, discussing global drug pricing, click here. )

In Latin America, Rosling said, every income level can be found, with Mexico’s richest man outstripping Bill Gates on the Forbes wealth-o-meter last year.

In the 1970s, most of the world’s poverty was in China and India, he recalled, and many concluded at the time that “neither of them would succeed. ”

Three billion people are now coming into the global market economy, he said.  They may be viewed as a threat to pharma professionals in the U.S. and Europe, as they are highly trained and may snap up some industry jobs, but they also make up a huge market for new drug products as the pipeline moves from a focus on infectious diseases to cancer and the diseases of affluence.

He joked about how world views have changed, calling the Vikings the al Qaeda of their time, and sketching the following progression:

Dawn – barbarians vs. empires
1492 - colonies vs. empires
1948  - developing vs. industrialized.

Today, the world is instead divided into low, medium and high income regions (and, tragically, “collapsed nations” such as Afghanistan)

Middle income nations are showing economic growth….a quarter of world economy is already there, he said. The correlation between money and child survival is strong (0.8), he noted, but one can find wide variations within the same income levels. He pointed to Turkey, early in his presentation, as one example.

He also discussed “grandma-certified” statistics, a very nice, personalized way to illustrate the fact that we share more similarities than differences and that all nations are on a growth curve:  When his great great grandmother was born, Rosling said, Sweden’s economic situation was like that of Sierra Leone’s today, his grandmother was born at a time when it was like Egypt’s, he was born when it was like Mexico’s and his daughter was born when it was like Singapore’s today.

He then related income level to access to medical care and pharmaceuticals.

Low income 2 billion, $300 gdp per capita,  health expense $15 per year per capita, drug expense per capita, $10

Mid income 3 billion, $3,000 dollars gdp per capita, $200 per year health expenses per capita, drug expense per capita, $50 per year….

High income 1 billion,  $30,000 dollars gdp per capita, $3,000 per year health expenses per capita, drug expense per capita $300

Each region’s access to diagnosis and treatment (D&T) is different

Disease   Low Income  Mid Income  High Income
Iron deficiency  D&T in all
Pneumonia D   D&T   D&T
(lose millions of children each year)
Cancer    -   D   D&T
Depression   -   -   D&T
ALS    -   -   D


In 10-15 years, Rosling said, the world will likely have solved the problem of lack of treatments for low income areas….he had high praise for the Gates Foundation’s pioneering work in this area.

However, he noted the disparity in access to treatment and diagnosis, summarized above.  Depression, he noticed, was a key cause of death in some middle income nations and among some population groups, for example, women in China; diagnosis and treatment are needed, he said.

Dr. Rosling also discussed recent IMF growth outlooks:  Western Europe and the U.S. are expected to grow by 0.3%, Latin America by 3% and Asia, Africa and the rest of the world by 6%, with Africa growing by 6.3%.

“It really is a new world,” Rosling said, noting that we need to see the world based on new income levels, and discard the idea of “the West and the rest”.

He left the audience with this challenging question:  “How do we make innovations available without forcing people to wait 20 years AND without depriving companies of their profitability?  We need clever business models that will leave a legacy that will say, this was fair, there was return on investment.”

The past few years have seen some innovative ideas from Genzyme and we’re seeing others as well. (Click here for some discussion at BIO this past summer) More ideas, anyone?

-AMS