Docstoc

Considerations of public health and commercialism in

Document Sample
Considerations of public health and commercialism in Powered By Docstoc
					      Considerations of public health and
  commercialism in the Cuban biotech sector and
               vaccine industry.

                                         Lecture by Jens Plahte, cand. philol.,

                    Research Fellow,                               Visiting Researcher,
                 Centre for Technology,                            Centre for Health and
                 Innovation and Culture                              Welfare Studies
                   University of Oslo                              University of Havana

                 First Annual Latin America Research Conference:
 Contributing to a better future? The role of Norway based Latin America research
                             Oslo, 12–13 November 2009

Centre for Technology, Innovation and Culture                                         jens.plahte@tik.uio.no
 Outline of presentation


• Doctoral dissertation
• The Cuban biotech sector and vaccine industry
• Two paradoxes




Centre for Technology, Innovation and Culture
   Ph.D. dissertation
• “Vaccine innovation for public health or profits – The
  Cuban vaccine industry in a national and global
  context ”
• Funded by the Research Council of Norway
• Papers:
        – A decision centered vaccine innovation model (with Lisbeth Meyer
          Næss, NIPH)
        – Tiered prices of vaccines: not a subsidy, but a win-win-win
          situation (Lancet Inf Dis 5(1), 2005)
        – The pneumococcal vaccine Advance Market Commitment may
          create a market, but seems to fail as ‘market-pull’
        – Strategic evaluations and techno-economic networks. Vaccine
          innovation in the Cuban biotech sector: for public health – or
          profits?
        – Development, organization and management of techno-economic
          networks: the Cuban biotech sector and vaccine industry
Centre for Technology, Innovation and Culture
 The Cuban biotech sector

 • An industrial district of western Havana
 • ≈ 20 000 workers
 • ≈ 10 research and production centres
 • Biopharmaceuticals are the second most important
   foreign currency earner of Cuba
 • Diagnostics, therapeutics, vaccines
 • Massive investments since 1981
 • Long term focus on science, education and health
   since 1959

Centre for Technology, Innovation and Culture
 The Cuban vaccine industry
 • Main centres
         – Centro de Ingeniería Genética y Biotechnología
         – Centro de Inmunología Molecular
         – Instituto Finlay
 • Main products
         –    Meningococcal group B vaccine
         –    Hepatitis B vaccine (hepB)
         –    Haemophilus B vaccine (HiB), synthetic
         –    Pentavalent DTP-HiB-hepB
 • Vaccines are important in the total biotech product
   portfolio

Centre for Technology, Innovation and Culture
                                         Two paradoxes

        The initial rationale of the               High priorities of the Castro
        biotech initiative was to                  Government are public
        target ’modern’ diseases                   health, medical diplomacy,
        (cancer, cardiov. and                      as well as export revenues


                                            Why?
        cong. dis.)                                generation


                … but …                               … but …


        … vaccines target                          … Cuban vaccines are not
        ’traditional’ infectious                   sold on the global public
        diseases                                   sector markets

Centre for Technology, Innovation and Culture
 Strategic and techno-economic
 evaluations




    Health transition required ’modern’ measures (products)


Centre for Technology, Innovation and Culture         Adapted from Callon (1992)
  Economic revenues as
  rationale: Two sides of the same coin




          Use domestic                              Finance
      supplies to legitimate                    domestic supply
       creating an export                        by commercial
         oriented sector                             exports




Centre for Technology, Innovation and Culture
Late 1970s: Morbidity and
mortality transition
        Patterns:                                             Interventions:
                                                Traditional
        – Infectious diseases                                 –   Immunization
        – Malnutrition                                        –   Sanitation
        – Neonatal and maternal mortality                     –   Primary health care
                                                              –   Essential drugs

                                                  Modern
        – Cardiovascular conditions                           – Secondary and tertiary health
                                                                care
        – Congenital disorders
                                                              – Prenatal diagnosis
        – Cancer
                                                              – Advanced biopharmaceuticals


Depletion of traditional measures  Need for modern measures
Centre for Technology, Innovation and Culture
  The meningococcal epidemic 1976-91

   •     National emergency
   •     No vaccine available
   •     Domestic vaccine innovation project 1983 
   •     Group B meningococal disease eliminated in 1991
   •     Finlay Institute founded in 1991
           – Vaccine innovation capabilities
           – Based on traditional bacteria fermentation technologies




Centre for Technology, Innovation and Culture
 Endemic hepatitis B

 • Recombinant vaccine developed by Merck in 1986
 • Creation of a platform technology: Yeast based
   expression system
 • CIGB founded in 1986
         – Vaccine innovation capabilities
         – Based on single cell organism recombinant technologies
 • Cuban recombinant hepatitis B vaccine licensed in
   1992



Centre for Technology, Innovation and Culture
Altered strategic evaluations

 Vaccine innovation capabilities were developed
         – National meningococcal epidemic
         – Endemic hepatitis B
         – Platform technology development, technological window of
           opportunity
  Vaccine innovation became important because
   capabilities had been developed




Centre for Technology, Innovation and Culture
 Strategic and techno-economic
 evaluations




    Health transition required ’modern’further vaccine innovation
    Established capabilities facilitated measures hepB vaccines)
    Strategic evaluations were altered (menB and(products)


Centre for Technology, Innovation and Culture         Adapted from Callon (1992)
                                         Two paradoxes

       The initial rationale of the                The Castro Government
       biotech initiative was to                   has public health and
       target ’modern’ diseases                    medical diplomacy as a
       (cancer, cardiov. and                       high priority, as well as a
       cong. dis.)                                 commercial motivation


              … but …                                 … but …


       … vaccines target                           … Cuban vaccines are
       ’traditional’ infectious                    not sold on the global
       diseases                                    public sector markets

Centre for Technology, Innovation and Culture
   Markets for Cuban vaccines

       Middle income countries: Argentina, Venezuela,
       China, Russia, South Africa, South Korea


   Global public sector markets
   • Least developed countries in Africa, Asia and Latin-
     America
   • Procurement services by UNICEF and PAHO


Centre for Technology, Innovation and Culture
   Price discrimination
    Plahte 2005, Lancet Inf. Dis., Vol. 5, No. 1:
    Tiered prices of vaccines: not a subsidy, but a win-win-win situation




         Single market                          Low price market   High price market
Centre for Technology, Innovation and Culture
    The Cuban health system

 • Top national priority (with education and science)
 • Medical diplomacy: Medicine as an instrument of
   foreign policies
 • Foreign currency generation by exportation
         – of medical services
         – of biopharmaceuticals




Centre for Technology, Innovation and Culture
 Possible explanations
 • The Cubans are unaware of the price discrimination
   mechanism????
 • Political considerations????
 • Lack of commercial motivation?????
 • Cost ????
         – Embargo raises production costs



  Explanation: Philanthropy sometimes
  requires a competitive edge!

Centre for Technology, Innovation and Culture
Conclusions
   1) Despite the transition towards ’modern’ public health
      challenges, ’traditional’ products became important.
      One important reason is that vaccine innovation
      capabilities were established because
           – a national emergency had to be countered
           – of the need and opportunity for technology platform creation


         Once established, these capabilities opened windows of
         opportunity for further vaccine innovation




Centre for Technology, Innovation and Culture
Conclusions
   2) Despite it being profitable to do so,
      … and despite its focus on public health and medical
     diplomacy,
      … and despite being a self declared socialist state,
      … Cuba does not sells vaccines on the global public
     sector markets

         Most probable reason: Uncompetitive production costs




Centre for Technology, Innovation and Culture

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:12/6/2012
language:English
pages:20