Cause and effect

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If Pfizer CEO Jeffrey Kindler were up against Microsoft magnate Bill Gates in a ranking of the world’s most influential people, which one would finish higher? Unless you are frequently stumped by the $100 questions on Millionaire, you would, of course, predict Gates to be near the top, if not at the top, with Kindler languishing any number of fathoms below.

But what if the list were to rank instead the world’s most influential people in pharmaceuticals? Now the situation reverses, with Kindler moving ahead, right? Wrong. At least, according to World Pharmaceutical Frontiers’ “Pharma 40” list of most influential people for 2007, which is decided by a (somewhat limited) panel of industry “experts.” Nevertheless, Kindler crawled to an unspectacular 19th place, while Gates gravitated to top spot, which he shared with his wife and partner in philanthropy, Melinda.

So is the Bill and Melinda Gates Foundation really the world’s most powerful pharma force? With coffers bulging to the tune of around $32 billion, its spending power is unquestioned.

But does throwing billions of dollars at global health issues translate into the kind of power that can break price structures and patents, improve patient access to medicines and force shifts in corporate mindsets?

Absolutely it can. In fact, some industry watchers believe that it’s a case of “when,” rather than “if.”

Last month, for example, IMS Health warned drug manufacturers to be prepared for the threat posed by this emerging billion-dollar philanthropy “phenomenon.” However, the firm also spoke of an opportunity for collaboration with The Gates’s: “It benefits pharma companies to work synergistically with the Foundation,” said the report. “The alternative is for pharma to allow itself to be perceived as indifferent to global health concerns—or to be unseated in the pursuit of advances in world health.” In other words, get with the giving or get back in the firing line. It may sound like a kind of reputation blackmail, and I suppose it is. However, on the up side, it’s quite possible that for a large pharma company the long-term benefits of becoming a philanthropic partner to the Gates Foundation could go way off the charts.

An important part of the Foundation’s offensive is the already close ties with nonprofit pharma companies. Institute for OneWorld Health is one such company (see Warren Ross’ article, “Conscientious Objectives"). OneWorld Health, a.k.a. Victoria Hale, PhD, had resurrected an old, shelved antibiotic, paromomycin, which had the potential to wipe out leishmaniasis (black fever), a disease killing 60,000 people a year in the developing world. But Hale was struggling to raise the funds required to complete clinical trials in India. When a copy of her business plan landed on the desk of Bill Gates, he immediately wrote a check for the first installment of what eventually amassed to a grant of more than $100 million.

Needless to say, the trials were completed and the drug received Indian approval. And while this particular example is unlikely to threaten worldwide patents, the approach used to develop and fund it could potentially change the global pharma landscape and raise some awkward issues about intellectual property to boot.

A pharma company that chooses not to make any money could become a very powerful entity when it’s backed with lots of somebody else’s.

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