Abstract

Pension and state funds dominating biomedical R&D investment: Fiduciary duty and public health

Slavek Roller
Goethe University Frankfurt, Frankfurt, Germany

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

The article investigates public and quasi-public funding of biomedical research and development beyond direct allocations by governments. Adding investments by governmentally-mandated retirement schemes, central and promotional banks, and sovereign wealth funds around the world to traditional tax-derived public financing schemes shows that the majority of biomedical science funding is public in origin. As a result, public vs. private dichotomy of R&D funding becomes obsolete. It creates a false illusion that nearly two thirds of global biomedical R&D are discretionarily funded by the industry, whose characteristics - such as product performance, R&D priorities, and pricing strategies - can be explained, from an economist’s perspective, by consumer preferences. Instead, this study posits that this divergence in economic and public health performance of the drug development industry is resultant from its financial underwriting by enormously expanded pension schemes, governmentally mandated to represent the interests of ‘captive’ beneficiaries, as well as similar policymaker-designed funding flows, whose standards of transparency, accountability and representation are substantially lower than that of governments themselves. By constructing a direct connection from the output benefits to those directly providing the input capital I investigate how can a situation be explained in which savers’ retirement schemes are invested in companies whose medicines are not reimbursable in the jurisdictions where said savers reside, as is the case with eculizumab in the Netherlands and Canada and with bevacizumab in the United Kingdom and New Zealand - despite major public retirement schemes in those countries being directly invested into the respective drug producers.

Biostatistics, economics Other professions or practice related to public health Public health or related organizational policy, standards, or other guidelines Public health or related public policy Social and behavioral sciences Systems thinking models (conceptual and theoretical models), applications related to public health