May 2020

Perspective
EXPERT INSIGHTS ON A TIMELY POLICY ISSUE

SONJA MARJANOVIC AND CAROLINA FEIJAO

Pharmaceutical Innovation for

Infectious Disease Management
From Troubleshooting to Sustainable Models of Engagement

We need to ensure scalable and sustainable

approaches for pharmaceutical innovation in
response to infectious disease threats to public health
As key actors in the healthcare innovation landscape, pharmaceutical and life sci-
ences companies have been called on to develop medicines, vaccines and diagnostics
for pressing public health challenges. The COVID-19 crisis is one such challenge, but
there are many others. For example, MERS, SARS, Ebola, Zika and avian and swine
flu are also infectious diseases that represent public health threats. Infectious agents
such as anthrax, smallpox and tularemia could present threats in a bioterrorism con-
text.1 The general threat to public health that is posed by antimicrobial resistance is
also well-recognised as an area in need of pharmaceutical innovation.
Innovating in response to these challenges does not always align well with
pharmaceutical industry commercial models, shareholder expectations and compe-
tition within the industry. However, the expertise, networks and infrastructure that
This perspective argues for the need to establish
more sustainable and scalable ways of incentivising
pharmaceutical innovation in response to infectious
disease threats to public health.
industry has within its reach, as well as public expectations partners to see if they can be repurposed; accelerating tri-
and the moral imperative, make pharmaceutical companies als for potentially effective medicine or vaccine candidates;
and the wider life sciences sector an indispensable partner and in some cases rapidly accelerating in-house research
in the search for solutions that save lives. and development to discover new treatments or vaccine
This perspective argues for the need to establish more agents and develop diagnostics tests.3,4 Pharmaceutical
sustainable and scalable ways of incentivising pharmaceu- companies are collaborating with each other in some of
tical innovation in response to infectious disease threats to these efforts and participating in global R&D partnerships
public health. It considers both past and current examples (such as the Innovative Medicines Initiative effort to accel-
of efforts to mobilise pharmaceutical innovation in high erate the development of potential therapies for COVID-19)
commercial risk areas, including in the context of current and supporting national efforts to expand diagnosis and
efforts to respond to the COVID-19 pandemic. testing capacity and ensure affordable and ready access to
In global pandemic crises like COVID-19, the urgency potential solutions.3,5,6
and scale of the crisis – as well as the spotlight placed on The primary purpose of such innovation is to benefit
pharmaceutical companies – mean that contributing to the patients and wider population health. Although there are
search for effective medicines, vaccines or diagnostics is also reputational benefits from involvement that can be
essential for socially responsible companies in the sec- realised across the industry, there are likely to be rela-
tor.2 It is therefore unsurprising that we are seeing indus- tively few companies that are ‘commercial’ winners. Those
try-wide efforts unfold at unprecedented scale and pace. who might gain substantial revenues will be under pres-
Whereas there is always scope for more activity, industry sure not to be seen as profiting from the pandemic. In the
is currently contributing in a variety of ways. Examples United Kingdom for example, GSK has stated that it does
include pharmaceutical companies donating existing com- not expect to profit from its COVID-19 related activities
pounds to assess their utility in the fight against COVID- and that any gains will be invested in supporting research
19; screening existing compound libraries in-house or with and long-term pandemic preparedness, as well as in

2
developing products that would be affordable in the world’s with Ebola and Zika outbreaks.11 However, it has done so
poorest countries.7 Similarly, in the United States AbbVie to a lesser scale than for COVID-19 and with contribu-
has waived intellectual property rights for an existing com- tions from fewer companies. Similarly, levels of activity in
bination product that is being tested for therapeutic poten- response to the threat of antimicrobial resistance are still
tial against COVID-19, which would support affordability low.12 There are important policy questions as to whether
and allow for a supply of generics.8,9 Johnson & Johnson – and how – industry could engage with such public health
has stated that its potential vaccine – which is expected threats to an even greater extent under improved innova-
to begin trials – will be available on a not-for-profit basis tion conditions.
during the pandemic.10 The COVID-19 pandemic is a game-changer among
Pharma is mobilising substantial efforts to rise to global public health threats. The risk to human life (both in
the COVID-19 challenge at hand. However, we need to terms of morbidity and quality of life), the economic risks,
consider how pharmaceutical innovation for responding to the epidemiology of the disease and speed of escalation have
emerging infectious diseases can best be enabled beyond led to a crisis-response by many governments around the
the current crisis. Many public health threats (including world. This has in turn influenced the immediate indus-
those associated with other infectious diseases, bioterror- try efforts. Many other infectious disease threats may not
ism agents and antimicrobial resistance) are urgently in manifest as crises in the short term and in the same way as
need of pharmaceutical innovation, even if their impacts COVID-19, but they could nevertheless escalate. They are
are not as visible to society as COVID-19 is in the imme- not considered to be crises from a short term perspective
diate term. The pharmaceutical industry has responded to because they are contained to specific regions and affect
previous public health emergencies associated with infec- fewer people at present – or are re-emerging (e.g. Ebola) – or
tious disease in recent times – for example those associated their impacts have not yet materialised at a scale that would

Pharma is mobilising substantial efforts to rise to the

COVID-19 challenge at hand. However, we need to
consider how pharmaceutical innovation for responding
to emerging infectious diseases can best be enabled
beyond the current crisis.

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 what constitutes a pandemic phase does provide guidance
on national policy response options, but not specifically
The emerging threats raise as they relate to healthcare innovation activity.14 There are

important policy questions

also questions as to whether such policy initiatives and
incentives should only be applied in crisis situations, or

about how government

also as part of proactive government and industry efforts
to innovate in the areas of public health threats in order to

and the pharmaceutical prevent future global calamities. A crisis and ‘emergency
mode’ response may be inevitable for some diseases, but

industry can work more can be done to mitigate against the need for such a
response – especially in cases where emerging threats and
together. their consequences can be foreseen and are known to be
a risk. We need to anticipate and act now in terms of how
we plan and incentivise better for the future, and how we
qualify as an immediate crisis (e.g. growing risks of antimi- distinguish between different types of infectious disease
crobial resistance to some infectious pathogens). However, threats and phases in framing incentives and regulation.
such diseases and issues are recognised as global threats that
could become crises in the future.13
The emerging threats raise important policy questions Innovative financial instruments must
about how government and the pharmaceutical industry be integral to any sustainable and
can work together to ensure that pharmaceutical industry scalable approach to incentivising
innovation is incentivised sustainably and at scale. This is
pharmaceutical innovation for
important to help mitigate against current and emerging
threats becoming crises further down the line. At present,
tackling emerging threats to public
there are no clear and specific criteria to determine when health from infectious diseases
a disease can trigger the types of healthcare-innovation-re- The pharmaceutical industry has a responsibility to both its
lated policy actions that have been deployed in response to shareholders and to society at large.
the COVID-19 crisis. For example, this applies to criteria Incentivising the pharmaceutical industry to innovate
for securing financial resources for innovation-related solely on the grounds of being a socially responsible sector
activities, reforming regulation to accelerate trials and is unlikely to lead to a sustainable and scalable approach
regulatory approval processes, and securing reimburse- for innovating in response to emerging infectious disease
ment mechanisms that help enable industry engagement threats. There are also potential challenges to the types of
and the search for rapid solutions. The WHO guidance on innovation (i.e. how radical or incremental) a reliance on

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 challenges have been barriers to innovation in vaccine R&D
and in the antimicrobial space, for example. Developing
Various incentive vaccines can be a technically complex effort that influences

mechanisms for
success rates, and it can take a long time. The returns on
investment are not guaranteed for diverse reasons, such as

addressing the
unpredictable market size, the risk that by the time a product
is developed it may be obsolete (for example if medicines

commercial barriers to are developed in the meantime, or due to competition with

improved care standards), or uncertainty as to whether some

pharma innovation in the vaccines will be recommended by authorities for inclusion

in immunisation schedules.15,16 Antimicrobials also have an
infectious disease-related uncertain market due to the risk of the pathogens that they
target developing resistance, uncertain prescriber behaviours
public-health space are and risks of low volumes of use (meaning reserve of stock
for future use, which lowers prices).17
being considered, and Various incentive mechanisms for addressing the com-

have been for some time.

mercial barriers to pharma innovation in the infectious
disease-related public-health space are being consid-
ered, and have been for some time. The focus has been
on identifying financial instruments that can do good as
incentives rooted solely in a social responsibility argument
well as facilitate returns. Existing incentive mechanisms
can lead to. Donating existing compounds for testing is
have helped with many global health challenges, but there
important, but it is different to at-scale, industry-wide
are issues with their scalability and questions about the
intensive investment in R&D geared at developing highly
timeliness with which they can mobilise industry involve-
innovative diagnostics, medicines and vaccines. Even in
ment. Examples of incentives include various push incen-
the case of COVID-19, there are significant differences in
tives (for example R&D tax credits, public investment in
the scale of innovative activity that focuses on repurposing
clinical trials infrastructure, provisions for exceptional
existing products and technologies – for example, through
depreciation of manufacturing equipment, patent exclu-
testing existing antiviral compounds for potential thera-
sivity extensions for qualified infectious disease products)
peutic value – and more radically innovative R&D efforts
and pull incentives (mainly revolving around securing a
aimed at developing something that acts on the COVID-19
guaranteed market through guaranteed purchase funds,
virus in fundamentally novel ways.
advanced market commitments or prize funds, and accel-
Commercial incentives are needed, alongside those
erating approvals and product uptake through fast-track
rooted in the pursuit of health as a public good. Commercial

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Innovative financial instruments have gained attention
in more recent times, including the subscription-based
‘Netflix model’ and the use of vaccine bonds.
approval mechanisms). These incentives seek to reduce the upfront investment is intended to incentivise innovation
risks associated with the costs of R&D and market risks.17 because the payment received by industry is independent
The pooling of intellectual property– a mechanism where of the future volume of sales and of prescribing behaviours,
two or more patent owners license one or more of their which de-risks R&D and trials for pharma.21
patents to each other or third parties – can also help enable For example, in the United Kingdom, the National
innovation (although they are not an incentive per se). IP Institute for Health and Care Excellence (NICE), NHS
pools can apply to both new and mature technologies and England and NHS Improvement government agencies are
help remove some of the barriers to further downstream testing a subscription-based model in which they intend to
innovation, as well as enable better access to new medi- pay pharmaceutical companies upfront for access to antibi-
cines, for example in developing countries.18–20 otics that meet their criteria (with payment depending on
Innovative financial instruments have gained attention the value of the antibiotics to the NHS)23. However, antimi-
in more recent times, including the subscription-based crobial resistance is not a UK challenge only, it is a global
‘Netflix model’ and the use of vaccine bonds. While these one – thus models such as this only make sense as an
hold promise in terms of facilitating timely innovation incentive if they are adopted globally. A further challenge
activity within industry, they require global-level engage- is that the model is more aligned with single-payer systems
ment and buy-in, ex-ante robust estimates on likely degree like the NHS, unless there is involvement and commitment
of need (i.e. volume) of specific products, and transparent from multiple payers in multiple-payer systems.21
resource allocation processes and criteria, in order to In the United States, this Netflix model has also been
realise their full potential as financial instruments. In the used to negotiate access to Hepatitis C antivirals, with
‘Netflix subscription model’, pharmaceutical companies some US states paying a fixed monthly cost for access to
are paid a monthly fee (usually by healthcare authorities) in direct-acting antivirals from pharmaceutical companies, as
exchange for health authorities securing access to specific opposed to paying on a volume-based prescription basis.24
innovations upfront.21,22 The effectiveness of this model Given the large cost that these subscriptions can impose
depends in part on securing sufficient monthly fees, which on government authorities, one of the challenges asso-
may require investments at an international scale. The ciated with the ‘Netflix model’ is to achieve as accurate

6
as possible an estimate of the degree of need on which to
base subscription fees; another revolves around negotiat-
ing industry commitment to appropriate treatment rates.25 In considering innovative
financial incentives
Subscription-based models also raise questions about
how to ensure clear, open and transparent processes for

for tackling emerging

awarding contracts to specific pharmaceutical companies –
given that many may be operating in the same competitive
space – and how to agree on an appropriate duration of a
subscription. There are also questions as to whether there infectious disease threats
is an appropriate cap that can be set on maximum volume
commitments from industry for specific products.
to public health, decision
The ‘vaccine bond model’ is another finance instrument
that mobilises long-term pledges from governments and
makers also need to reflect
other stakeholders to a finance facility (i.e. the International
Finance Facility for Immunisation), which in turn allows
on where the resources
the facility to raise funding on the capital market in the for their implementation
should come from.
form of investments (bonds) and with a competitive rate of
return for investors. The investments are then channelled to
GAVI (Global Alliance for Vaccines and Immunizations) to
support childhood immunisation efforts in the developing
COVID-19 as well. Organisations such as the Coalition
world. In this model, future pledges from governments (or
for Epidemic Preparedness Innovations (CEPI) – which
other stakeholders) to vaccine manufacturers to guarantee
focuses on the development of epidemic vaccines and on
purchase for their products could help to ensure access and
access – could represent a potential global mechanism
affordability, and translate into an ability to raise funds and
through which funding is channelled.28 Whereas the model
ensure cash flow for industry to engage with suppling vac-
shows great promise, it has not been evaluated for scalabil-
cines for immunisation efforts today.26,27
ity and sustainability.
Although the ‘vaccine bond model’ has been applied
In considering innovative financial incentives for
mainly to secure access to existing innovations, it could
tackling emerging infectious disease threats to public
in principle be applied to incentivise R&D and innova-
health, decision makers also need to reflect on where the
tion development. However, such a model requires trust
resources for their implementation should come from (for
in the institutions who coordinate funding flows – GAVI
example to what extent government funding alone should
is one such trusted institution. There is increasing inter-
be expected to contribute to R&D in a subscription-based
est to apply this financing instrument to the fight against
model, or whether this should be extended to other actors).

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Decisions on who the appropriate investors should be – for
example, in order to achieve scale – are likely to influence
how various incentive mechanisms are structured and Access to large amounts
of linked healthcare data
governed.

A range of other issues – extending at a particularly rapid

beyond financial considerations –
need to be tackled in a global and
pace can only be made
coordinated manner, to ensure possible through innovative
pharmaceutical innovations for
emerging infectious disease threats governance mechanisms.
have the intended impact. We need
a systems view on the innovation need access to large amounts of linked healthcare data
challenge at hand, and on critical at a particularly rapid pace (when compared to ‘business
success factors as usual’).30 This can only be made possible through
innovative governance mechanisms that can ensure data
One such issue relates to access to data and data shar- quality, interoperability, public support and appropriate
ing. Industry needs access to healthcare data to better and trusted safeguards for privacy, security and ethical
understand the disease threats and to improve the speed, practice. Alongside technical and operational challenges,
efficiency and effectiveness by which it can identify this raises questions about who the most appropriate and
potentially effective candidate therapies, to inform clini- most trusted custodians for such data may be, especially
cal trial design, create appropriate approaches to patient in a global and coordinated (as opposed to only national)
stratification and trial recruitment, and to access the latest effort. Identifying such custodians and building the infra-
research evidence.29 Diverse data types are needed, span- structure needed to support their delivery is a major policy
ning genomic, proteomic, cellular and molecular level data, challenge, but also a critical success factor for innovation
epidemiological data, patient-level data from electronic efforts. Complexities in governing data use by industry in
healthcare records (e.g. on symptoms, test results, prescrip- a publicly acceptable way may be further accentuated by
tions and patient outcomes) and population-level data. a landscape where a very large number of companies are
In the context of urgent infectious disease threats and working on the challenges in parallel, and together with
global pandemics such as COVID-19, or in cases where public sector actors. To address this, we need to acceler-
innovation is urgently needed to prevent a crisis in the ate learning from prior efforts to build effective health
future, both public and private sector actors are likely to

8
data ecosystems.29,31 The experiences of the European
Medical Information Framework (EMIF), which sought
to enable secure and coordinated access to patient-level Ensuring timely access to
the requisite clinical trial
data for research purposes across a federated context, may
offer particularly fertile ground for practical and action-

infrastructure for industry

able learning.32 The European Commission has recently
launched a COVID-19 data platform, although the extent
to which it considers industry access to data, and the types
of data it proposes to collect, are not yet entirely clear (in contributions is also a
the public domain). For example, would such a data sharing
platform be confined to epidemiological and pre-clinical
critical success factor in
research, clinical trial and basic science data alone, or
would it extend to health services and patient level data
tackling infectious disease
contained in electronic health records?33,34
Of course, the pharmaceutical industry will not only
threats.
need access to data – it will also need to share data with
other actors. Occasionally, this can involve commercially further consideration of not only technical requirements
sensitive data. Platforms supported by artificial intelli- but also of data standards and the governance of such
gence and blockchain technologies could help support such collaborations in terms of benefit distribution. The need for
data sharing. For example, in 2019 ten large pharma com- global-scale action and global-scale data sharing to tackle
panies and other partners joined forces to bring together emerging infectious disease threats also implies a likely
data on small molecules into an Artificial Intelligence- need for different pharmaceutical companies (who gener-
based platform to accelerate drug discovery. The plat- ally might be competing with each other) to share data with
form, known as MELLODDY (Machine Learning Ledger each other, as part of innovation efforts. This challenges
Orchestration for Drug Discovery), will use a blockchain the historical – although gradually changing – competitive
architecture where the algorithm searches company data- dynamics and commercial sensitivities within the industry,
sets on annotated chemical libraries with full traceability, which are also changing in the context of COVID-19.10
without disclosing commercial secrets.35 Such technol- Beyond data issues, ensuring timely access to the
ogies could potentially also support collaboration in the requisite clinical trial infrastructure for industry contribu-
area of COVID-19 innovation and in innovation for other tions is also a critical success factor in tackling infectious
infectious disease threats, given appropriate data quality disease threats. The public sector has a big role to play
and interoperability standards. However, if this type of in this regard – both in relation to resource investment
collaboration is to be scaled, there is likely to be a need for and in relation to coordinating available clinical trial

9
infrastructure within a particular geography. The avail-
ability of good trials infrastructure is an incentive for phar-
maceutical companies – not least in relation to the quest There is a need to
consider success criteria
for speed and efficiency. To this effect, and in the context
of COVID-19, in the United Kingdom the Department of

extending beyond the

Health and Social Care and UK Research and Innovation
have sponsored the ACCORD (Accelerating COVID-
19 Research & Development) clinical trial platform to
fast-track COVID-related trials. This was enabled by innovation-intensive
collaborative working between various government
agencies and government funded initiatives, including the
product development
Government Scientific Office, the National Institute for
Health Research’s biomedical research centres and clini-
phase alone.
cal research facilities – as well as centres of expertise in
Northern Ireland, Scotland and Wales – and collaboration Finally, there is a need to consider success criteria
with the private sector (namely clinical research company extending beyond the innovation-intensive product devel-
IQVIA and the pharmaceutical company AstraZeneca).36 opment phase alone. Many of these criteria represent
Rapid regulatory approval and a focus on prompt patient important industrial and healthcare policy concerns,
enrolment have been central to this effort and to the role it and will require coordination between public and private
aims to play in accelerating COVID-19 related R&D. sector actors. This applies to areas such as ensuring an
However, questions remain as to the extent to which appropriate approval process for innovations that are in
the public sector and policy actions can sustain attrac- the pipeline and carefully considered procurement prac-
tive and timely support for a coordinated clinical trial tices, so that accelerated access does not compromise safe
infrastructure that can be rapidly mobilised for infectious access and bear other unintended, global consequences.
disease and public health innovation efforts outside of a Recent RAND research examined the potential unintended
crisis context. There is also a risk that if some trial needs consequences of innovation in this space. Amongst other
are pushed to the front of the queue, other areas in need of potential unintended impacts, the research identified a
clinical trials are pushed back. Avoiding this risk requires need to ensure that appropriate testing is aligned with
innovating in how the clinical trials infrastructure is rapid access to treatments so that products are not inap-
coordinated and in how trials operate across the spectrum. propriately channelled to those who may not benefit or
There may be transferrable learning to be gained from how who may experience undesirable side effects. The research
this is happening in the COVID-19 response context. also underlined the need to ensure a sufficient supply of
drugs that may be used for multiple clinical indications

10
when resources are diverted to a pandemic, and to ensure
ethical practices when considering supply to populations
across the world, including in the world’s poorest coun- Industry and government
actors will also need to
tries.37 To tackle some of these issues, policymakers and
industry will also need to focus on securing appropriate

reflect on the distribution

manufacturing capacity within industry; this too is likely in
some instances to require collaboration between different
pharmaceutical companies to ensure sufficient production
capacity.10 Although many pharmaceutical companies have of benefits from highly
said that they will focus resources on manufacturing a
COVID-19 vaccine if and once developed, there will only
collaborative efforts.
be some vaccine candidates that achieve success and reach
the manufacture stage. It is difficult to predict which these on a price. For example, there is a role for the pharma-
will be and to plan for manufacturing capacity within a ceutical industry to play in ensuring fair and equitable
specific company or amongst collaborators behind a suc- distribution of innovative products, in helping support
cessful collaboration.38 Industry and governments will also compliance with treatment regimes, in raising awareness
need to work together to revisit and reform pharmaceutical and in education efforts geared at healthcare service
supply chains to avoid overly relying on a few countries, providers, patients and the public. The patient and public
and to strengthen distribution and delivery systems and voice and patient and public concerns must not be forgot-
delivery capacity for potentially successful products within ten in innovation conversations on infectious diseases and
national health systems.39 public health – not least as public trust and buy-in will
The ultimate impact from pharmaceutical industry determine many of the critical success criteria for innova-
innovation efforts will depend on the ability of many tion development (e.g. access to data) and for downstream
actors to work together to address both upstream bot- public health impact (e.g. uptake of testing, medicines or
tlenecks to the pharmaceutical industry’s commitment vaccines).
to innovate, as well as downstream challenges on which Industry and government actors will also need to
effective, equitable and affordable access to innovations reflect on the distribution of benefits from highly collabo-
depend. The pharmaceutical industry will need to deliver rative efforts, in which pharmaceutical industry pipelines
on commitments made in response to any financial and development efforts are supported by both academic
and regulatory incentive systems that are put in place. research and by the breadth of scientific and technological
Ensuring such delivery will require industry to engage innovation taking place more widely in the biotech and
with society in ways that extend beyond coming up with small and medium enterprise sectors, which also need
and manufacturing the pill, test or vaccine and agreeing

11
 industry commitment and global collaboration across
sectors, professions and disciplines are unleashed. Building
Innovation in response to on this momentum to ensure sustainable and scalable

the COVID-19 pandemic

approaches to pharmaceutical innovation will prepare
for other pressing, emerging and re-emerging infectious

is showing what can be

disease and public health threats of our time – now and in
the future.

pursued – and hopefully

achieved – when the
political will, policy and
regulatory momentum,
industry commitment and
global collaboration across
sectors, professions and
disciplines are unleashed.
incentives for working on emerging infectious disease
threats.
The areas in need of policy attention are more straight-
forward to identify than finding solutions to them. But
as we have shown, there is fertile ground from which to
learn, and based on which to design solutions in many – if
not all – of the areas highlighted in this reflective paper.
Innovation in response to the COVID-19 pandemic is
showing what can be pursued – and hopefully achieved –
when the political will, policy and regulatory momentum,

12
Notes: https://sloanreview.mit.edu/article/in-the-face-of-a-pandemic-can-
pharma-shift-gears/
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14
About This Perspective About the Authors
In this Perspective, the authors discuss the need for more sustainable Sonja Marjanovic directs RAND Europe’s portfolio of research in the
and scalable ways of incentivising pharmaceutical industry innovation field of healthcare innovation, industry and policy. Her work provides
in response to infectious disease threats to public health. The authors decision makers with evidence and insights to support innovation in
consider incentives for innovation both in the current context of the healthcare systems, and to support the translation of innovation into
COVID-19 crisis, and in the context of preventing other emerging or societal benefits for healthcare services and population health. She
re-emerging infectious disease threats from becoming crises further has over fifteen years of experience working at the interface of policy
down the line. The paper discusses the potential for innovative financial challenges in healthcare innovation and healthcare service improve-
instruments, such as subscription-based models and bond-based ment, for public, private and third-sector decision makers. Sonja has
approaches, to act as incentives. The authors also highlight the need also worked for the UK Economic and Social Research Council’s
to tackle a range of critical success factors beyond financial consid- Centre for Business Research, and has both consulting and commercial
erations. This includes tackling issues related to data access and experience of business development and founding and managing a
the governance of data sharing, securing appropriate clinical trials start-up. She received a PhD from Judge Business School (University of
infrastructure, ensuring suitable approval processes and procurement Cambridge).
practices, and planning for manufacturing and supply chain capacity to
Carolina Feijao is an analyst working in the field of innovation, health
mitigate against unintended consequences in affordability and access.
and science policy at RAND Europe. She brings interdisciplinary and
Finally, the authors observe that the pharmaceutical industry will need
cross-sector perspectives to bear on healthcare innovation policy
to engage with society in ways that extend beyond producing a pill,
challenges, including from consulting engagements in other sectors
diagnostic test or vaccine, in order to deliver on commitments made in
(such as the agri-food sector). Previously, Carolina worked in scientific
response to any incentive systems that are put in place.
publishing. She holds a PhD from the Department of Biochemistry
(University of Cambridge) and an MSc in Quantitative Biology (Imperial
Funding College London).
This Perspective was made possible through internal funding provided
by RAND Europe. Acknowledgements
The authors would like to thank Jon Sussex, Kevin Dean and Tom
Saylor for their helpful comments and advice.

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