The Price of Health

Brexit reforms may threaten medical innovation. 

Writer: Jenny Katsouli
Editor: Maria Stoica
Artist: Sophie Maho Chan

What is the medical research budget – and why should we care? A tiny fraction of the taxes we pay each year is channelled towards publicly funded institutions such as universities, multi-centre clinical trials and research institutes. So, you can pat yourself on the back for having some part in funding the Oxford COVID-19 vaccine and that promising new cancer nanotechnology therapy featured on the news.  

Understandably, scientists are dreading a potential medical budget cut that may accompany the inevitable reforms that a finalised Brexit would introduce. Research institutions, such as universities, have multiple revenue streams for research. However, governmental funds are often the most substantial. Cutting down governmental support of medical research is like cutting the blood supply to the heart.  

Globally, a third of all new approved medicines originate from publicly funded institutions. In the US alone, the 210 new medicines approved during 2010-2016 all benefited directly or indirectly from publicly funded research. When the public invests in research via taxes, better therapies and diagnostics become available and accessible. For example, the PROUD clinical trial, which aimed to test the efficacy of the drug Truvada-PrEP, was financially supported by the MRC Clinical Trials Unit at UCL and Public Health England. The trial demonstrated a 86% reduction in HIV infection in the participants using the drug. Because of these remarkable results, the drug is expected to drastically minimise expenses for the National Health Service (NHS), since each HIV patient faces disease-related costs upwards of £300,000 during their lifetime.  

As well as supporting research in universities, public funding drives innovation based-economic growth in research institutes. For example, the Dementia Research Institute strives to tackle the booming burden of dementia, which is expected to affect one million UK citizens by 2020 and cost the NHS more than £1 trillion over the next four decades. As health activist Mary Lasker cleverly stated, “If you think research is expensive, try disease.”

As publicly funded medical research is a massive undertaking, it is unlikely to be replaced by private initiative. Pharmaceutical companies closing down their research and development (R&D) facilities has become part of a wider global trend. Nine years ago, Pfizer closed down its largest UK R&D site in Kent, which employed 2,400 people. The company’s spokesman Andrew Widger stated: “Like all of our industry peers, Pfizer is challenged with insufficient productivity and an unsustainable model for innovation.” Since then, many companies have followed Pfizer’s example. Most recently, Eli Lilly announced the closure of the Erl Wood research centre in Surrey, which had been operating for more than 50 years.

Multinational companies that have decided to shut their innovation facilities are driven by financial considerations. Drug development ranges from £870 million to £1.9 billion and takes up to 12 years to complete. However, less than 12% of potential drugs that start Phase I trials will receive approval and launch on the market. Most for-profit corporations cannot bear such costs. Hence, publicly funded institutions often carry out preclinical research, which is then sold as intellectual property or entrepreneurial collaboration to pharmaceutical companies. This is considered a mutually beneficial transaction since they can reinvest their profits into research and innovation. A recent example is the AstraZeneca COVID-19 vaccine. University of Oxford, with taxpayer support, had been investigating a vaccine that could be readily developed during an outbreak, long before COVID-19 hit. In April 2020, AstraZeneca identified this innovative preclinical research and saw it through development, manufacturing and distribution. Overall, this demonstrates that it is essential that the public, who have the most to gain from medical research, funds the research that will improve their quality of life and mitigate the risk of disease. 

Medical research brings tremendous value to our lives, both metaphorically and literally. Research shows that population health and longevity, which stem from medical research, bring increased productivity. A recent study estimates that for every £1 invested by the public in cancer and cardiovascular medical research, 27 pence will be returned in interest every year. In fact, a unit of measurement called QALY assigns a monetary value to the health gain and standard of life improvement that research brings. An example of such cost-saving medical research was conducted by the UCL group led by Professor Jayant Vaidya at Royal Free Hospital. In the course of 20 years, the team developed TARGIT IORT, an innovative radiation therapy for breast cancer. With this technology, women can skip the usual postoperative daily radiotherapy sessions, usually lasting 3-6 weeks, and can resume their lives immediately. TARGIT IORT therapy offers financial value as well; it is estimated to save the NHS £9m per year as patients take fewer trips to the hospital, patient management becomes easier and fewer radiation sessions must be prescribed. 

In 2017, the UK invested 0.20% of its GDP in university research and development, ranking it 22^nd worldwide in funding as a share of GDP. However, chancellor Rishi Sunak’s new budget reforms, which are expected to be implemented within the next few years, may considerably shrink the budget allocated to medical research. The consequences of such a political decision would be alarming. The UK may lose its status as a global innovator and healthcare standards will decline as there will be little advancement in diagnostics, therapeutics and caregiving. As a consequence, the burden of disease, mortality and economic stagnation would grow. Ultimately, what seems to be a short-term national budget saving strategy will only result in long-term disease-related spending. Nevertheless, government officials may be pressured to reform their bills if the public intensely opposes them. Patient and public involvement has always empowered medical research. Expressing concern on social media, supporting research charities and signing petitions can make each one of us part of the conversation.