Ending Ireland’s cancer patient paradox

Ireland is a world leader in making and producing cancer therapies, so why do Irish patients have to wait so long to access innovative medicines?

It is a paradox of the Irish pharma success story our manufacturing plants make and produce innovative medicines for use in healthcare settings across the world, but Irish patients wait longer than most Europeans to access the latest approved therapies.1 This is particularly pointed when it comes to patients in Ireland trying to access cancer medicines.

The production of modern cancer medicines, as well as decisions on their reimbursement, may be complex. But, the simple reality is that every week, trucks loaded with cancer therapies bypass our patients on their way to the port. For example, while Ireland produces Keytruda® (pembrolizumab), its availability is limited here compared with other European countries.2 It is approved in Europe for 12 indications across six tumour types.3 However, it is reimbursed in the public system in Ireland for four indications. Patients with a certain type of health insurance cover may have access to a wider variety of indications, further exacerbating the inequity within the Irish system

Global demand

This contradiction came to mind as I reflected on the decision to begin producing cancer medicines at our Carlow site five years ago. It has, by any measure, become a stand-out success story in the global pharmaceutical industry.

When MSD Carlow first opened it was the company’s first vaccines facility outside of the US. That may not mean much to people in other lines of business but it’s a big deal in the pharma world – helping set Ireland apart as a leader in the sector.

Such is the MSD’s confidence in the skills and experience that drive our operations in Ireland, that it has continued to ask our sites in Ireland to do more to support our critical operations. This has translated into significant growth and expansion, with over 2,500 employees currently working across our five sites in Cork, Dublin, Tipperary and Carlow.

Last year it was announced that a new 13,000 square metre facility will be constructed at the existing Carlow plant with the addition of 170 jobs to its current 450 staff to expand production of vaccines and biologics, as well as warehouse and laboratory capacity. New manufacturing capacity is needed by 2023 to meet global demand for cancer treatment and vaccines.

I focus on MSD as it’s the company I know best. But I know we are not the only company playing a strong role in Ireland’s thriving pharmaceutical manufacturing industry, as well as delivering high end jobs and playing a positive, active and supporting role in the communities where we operate. All of the world’s top 10 pharmaceutical companies now have substantial operations in Ireland, with over 30,000 people directly employed in the industry and a similar number employed indirectly.

Pandemic response

Our industry’s collective response to the pandemic highlighted another role we play in supporting Ireland’s health system. From donating PPE equipment and expertise to the urgent fight against Covid-19, to maintaining the supply of vital medicines and pivoting our research power to find vaccines and treatments that the world needs, our sector has played a significant part in supporting public health authority efforts to tackle this outbreak.

The pandemic is, nonetheless, a major challenge to businesses and to the wider health system. For Irish cancer patients, it has meant disruption and delays to clinical trials, screening, radiotherapy, surgery and medical consultations, as well as development of a longer waiting lists. We also experienced a pause in decisions on reimbursement of new medicines as funding was diverted to address the emerging pandemic.

While no-one can question the need to address the outbreak urgently, the knock-on impact on patients with other conditions is stark. This has been a deeply distressing time for Irish patients and their families. It has been difficult too for doctors who have seen patients deteriorate in the absence of treatment.

Even prior to the pandemic and despite Ireland’s record in medicines manufacture, patients here were already at a disadvantage compared to European neighbours. An EU-wide survey4 published in May showed Ireland below the European average when it comes to waiting for access to innovative therapies. The Comparator Report on cancer, published earlier this year by EFPIA, a trade association, showed particular delays in oncology.

Remember, we are not talking here about experimental medicines. These therapies are given the green light by the European Medicines Agency as they have completed large clinical trials. They are the result of heavy investments of time, funding and expertise.

Reimbursement decisions

So, what now? After a disruptive six months and with further uncertainty ahead, the 2021 budget is a moment for Ireland to send a new signal to its patients and the wider world and address the backlog of reimbursement decisions that were put on hold during the worst of the Covid-19 crisis.
In July, the four-year agreement between the government and Irish Pharmaceutical Healthcare Association (IPHA) on the supply of medicines was extended to the end of 2020. In the context of a pandemic, this short extension was essential, but a detailed new deal is sorely needed. It should be ambitious and include a commitment on funding new medicines.

Budget 2021 is a chance to join the dots: Ireland’s fast-moving, ever-growing pharma manufacturing capacity contrasts unfavourably with our slow-moving system for bringing life-improving medicines to those who need them.

We are a world leader in making medicines and barely mid-table in bringing them to our patients. Action and investment are needed to address this imbalance. Its time Irish oncologists had access to every available tool when they treat people with cancer.

Health Minister Stephen Donnelly has said he looks forward to working with the pharmaceutical industry in “seeking innovative solutions to funding new medicines”. We welcome this and stand ready and willing to identify and implement innovative solutions in Ireland. Let’s start today. Because, for people in Ireland with cancer, every day counts.

References

1. https://www.efpia.eu/media/554526/patients-wait-indicator-2019.pdf slide 26
2. 2.https://www.efpia.eu/media/554526/patients-wait-indicator-2019.pdf slides 24 and 25
3. KEYTRUDA SPC
4. https://efpia.eu/media/554526/patients-wait-indicator-2019.pdf