Pamela Fralick, President, Innovative Medicines Canada
*This article originally appeared in The Hill Times’ Innovation Policy Briefing on October 17, 2022.
In 2016, Blair Price was diagnosed with a bladder cancer that, over time, metastasized into his lungs. Thanks to his oncologist, Blair had access to innovative immunotherapy and chemotherapy treatments that have proven effective for those living with cancers like his.
As Canadians, we likely read this without any surprise. We assume that yes, of course our health care systems ensure that people like Blair have access to the newest, most innovative life-saving treatments available to patients and health care professionals. For most of my career I have worked on behalf of patients with organizations like the Canadian Cancer Society, the Centre for Addictions and Mental Health (CAMH), and the Health Charities Coalition of Canada, to name a few, and I can tell you that, unfortunately, timely access to innovative medicines is not the case for many patients in Canada.
Consider Biba Tinga’s son Ismael, for example. Not long after he was born in Niger, Ismael was diagnosed with Sickle Cell type SS (SCD), which was a death sentence for close to 50 per cent of children born with SCD in that part of the world. Biba and her son Ismael came to Canada when he was 16. Since then, he has had access to treatment options that have contributed to a better quality of life. However, like many other drugs, after prolonged use the primary treatment for SCD can lose its effectiveness while serious side effects increase, leaving patients with few treatment options. As a result, quality of life declines and the life expectancy of patients is much lower than the rest of the population.
Biba, who is the President and Executive Director of the Sickle Cell Disease Association of Canada, notes that the situation is different in the U.S. where, in 2019, the Food and Drug Administration (FDA) approved three new drugs specifically targeted for people with SCD. Even as of today, none of these drugs are available in Canada. As she points out in an interview for our Meet the Patients series, any regulation or delay that prevents SCD patients from accessing these life-changing medicines risks exposing patients to significant health complications and possibly death. Canadians expect and deserve better from our health care system.
According to one recent analysis of IQVIA data, less than 20 per cent of new medicines launched globally are available to Canadian patients on public plans. Of those that are available, patients are waiting on average as much as eight times as long as a US patient, over three times as long as a patient in Germany, and approximately twice as long as a Japanese patient. Overall, Canada ranks last in the G7 and 19th out of 20 peer OECD countries for access to new medicines on our public plans.
As the examples of Blair and Ismael demonstrate, this is more than an abstract regulatory or policy challenge – it has a tangible impact on the health, well-being, and quality of life of patients and their loved ones. The impact is felt beyond the individuals and their families too. Delayed access to life-changing new medicines has possible implications for overall health care costs, economic productivity, and Canada’s ability to attract investment and much-needed labour talent.
There’s no denying that science and innovation play a critical role in overcoming serious disease and in enhancing our quality of life. But it requires hard work and significant investment. While patient access to a new drug can take nearly two years in Canada, the path from a drug’s discovery to clinical trials and regulatory approval takes much longer. For example, a new drug can take more than a decade and up to $2.6 billion to develop and then deliver to patients. Of the 5,000 to 10,000 compounds that are screened for their potential, only five will ultimately make it to the clinical trials phase.
Given the human, social, and economic cost of disease, the tremendous financial and intellectual effort required to develop new medicines, and the power of the innovation underpinning them to improve quality of life and help drive economic growth, we owe it to Canadians to do what is necessary to improve availability and access to new drugs.
To improve access for Canadians, governments should take a holistic view of delays across the entire approval process at both the federal and provincial level, as delays in any part of the process negate efficiencies gained elsewhere. For example, while pending improvements to Health Canada’s drug approval process are likely to be beneficial, their impact will be undermined by adverse Patented Medicine Prices Review Board (PMPRB) Guidelines changes, health technology assessment recommendations, and finally by prolonged drug negotiation and listing processes. Canadian governments need to work collaboratively with industry and other stakeholders to accelerate patient access to new medicines and vaccines.
In Canada, it takes an average 732 days from the time a new medicine is approved by Health Canada to it being covered on a public plan. If we were able even to cut that time in half, it would bring us in line with the G7 average and peer OECD median. More important, though, is the tremendous impact it would have on the lives of patients like Blair and Ismael, and their families. Let’s commit to working together to ensure more Canadians enjoy the benefits access to these life-saving medicines offers, while doing more to support the innovation and investment in the pharmaceutical sector that fuels their discovery.