Precision medicine needs financing to fight diseases like cancer - especially in poorer countries

Traditional financing approaches have held back the task of manufacturing and distributing COVID-19 mRNA vaccines, a process which required advanced facilities and new distribution pathways. As the pace of medical breakthroughs accelerates, it will become ever more important to bridge this gap in global health financing. Only by doing so can we deliver optimal care across the world.

Modernizing and strengthening healthcare systems for a post-pandemic world will require investments across many areas: workforce, infrastructure, technology and strategic planning. Solutions in any particular area will need to respond to the circumstances on the ground, taking into account patient populations, economics and political realities. Many healthcare systems are under-resourced or making a transition from prioritizing basic primary care to treating non-communicable diseases such as cancer and rare diseases. They will need new financing models in order to incentivize the adoption of new precision medicine.

Many poorer countries lack funding for precision medicine technologies. What's more, development assistance for health (DAH) groups and global innovative financing mechanisms have historically focused on infectious diseases such as HIV/AIDs, tuberculosis, and malaria. Non-communicable diseases (NCDs) such as cancers and cardiovascular disease – areas in which precision medicine is currently most applicable – remain underfunded through traditional global health channels.

Such financing flows reflect global health priorities – precision medicine approaches may lack attention because countries have other national health priorities. However, non-communicable diseases are an increasing problem for people in low- and middle-income countries, as recognized by the World Health Organisation. As this burden grows, we need to reassess the balance of health financing to support a greater mix of disease areas.

Despite these funding challenges, various applications of precision medicine in a global health context have emerged through unique funding methods and partnerships.

The Malaria Genomic Epidemiology Network (MalariaGEN) is a scientific consortium coordinated by the Wellcome Trust and further funded through the Grand Challenges in Global Health research initiative launched by the Gates Foundation. Its objective is to control malaria through more effective means developed through genomic research. MalariaGEN consists of 10 international projects studying how genetic variation in humans, Plasmodium parasites, and Anopheles mosquitoes affects the biology and epidemiology of malaria.

CMLPathtoCare, formerly known as the Glivec International Patient Assistance Program (GIPAP), first started in 2002. It is a patient access programme for oncology in low- and middle-income countries led by The Max Foundation. With funding and drug donation support from Novartis, the programme provides a targeted therapy, imatinib (Glivec), at no cost to eligible patients in low- and middle-income countries with chronic myelogenous leukemia or gastrointestinal stromal tumor.

Chile developed its Center for Excellence in Precision Medicine (CEPM), the first of its kind in Latin America. It is the result of a joint co-financing effort of $16.5 billion pesos (USD$21 million) between the Chilean Economic Development Agency and the pharmaceutical company Pfizer. Based on the incidence of various diseases in the Chilean regions, CEPM has focused its initial efforts on non-small cell lung cancer next-generation sequencing. Its technology partner, Thermo Fisher, invested USD$3 million in the collaborative project.

The appropriate funding sources and instruments will depend on country needs, the application for precision medicine and the project partners involved. There are various funding models available, which have their own merits. Our latest Financing and Implementing Innovation in Healthcare Systems report discusses these funding models in the lens of four key areas to consider: innovation governance; innovation financing; community and partnerships; and workforce and infrastructure.

The report discusses precision medicine financing based on different categories of health systems. “Exploring” health systems are early in their adoption of precision medicine approaches, potentially conducting some research studies or piloting programmes, but will generally not have precision medicine approaches accessible to members of the population. “Activating” health systems have some clinical use of precision medicine approaches with limited accessibility, while “implementing” systems have several precision medicine approaches accessible to a large number of people.

The focus of the report is on mechanisms that can be used today, case studies describing how different countries have implemented such precision medicine initiatives, and paths to innovation in healthcare. The goal is not to displace basic care, but to identify the best potential approaches to building precision medicine into budgeting and policy decisions. Continued investment can deliver the highest standards of health and healthcare to people around the globe.