Description: A proposal to delink R&D costs from drug and vaccine prices in the case of cancer.
Start date: Proposed in 2017, dates back to 2008.
The Cancer Innovation Fund is a label for a series of proposals to demonopolise cancer treatments, and remunerate innovators instead through a fund.1
Proposals to this effect have taken various forms (for more information, see below), including:
A fund for the EU only
A fund for like minded countries
Funding from national budgets for cancer treatments
Funding from national budgets for the purchase of cancer drugs
Funding from national budgets for healthcare
Rewards in proportion to health impact
Such proposals have been discussed at the WHO and in 2017 a resolution was passed which mandated a feasibility study into pricing approaches for cancer treatments.2
In 2008 Barbados and Bolivia made a proposal on cancer delinkage to the WHO.3
In 2009 Bangladesh, Bolivia and Suriname made a proposal on cancer delinkage to the WHO.4
In 2014 a proposal was discussed by actors in Europe for an EU wide cancer fund.5
In January 2017, the WHO Executive Board discussed a proposed resolution on a cancer fund. References to delinkage were apparently removed at this point due to their controversial nature.6
A draft resolution was proposed to the WHO in May by Brazil, Canada, Colombia, Costa Rica, France, Netherlands, Nigeria, Panama, Peru, Russia, Thailand and Zambia.7
In May, WHO members agreed to this resolution.
Scope: The proposals focus on cancer treatments. The proposals would affect all stages of R&D in the field of cancer.
Access: As the proposals would delink completely, competition would increase, drug prices decrease, and access increase. If rewards were linked to health impact, this would provide a distribution incentive.
Innovation: Some versions of this proposal suggest explicitly linking incentives to health impact. Removing all monopoly rights would create incentives for generic competition, and if a sufficiently large remuneration fund were established, this would incentivise new research.
Efficiency: This would be an expensive proposal. The 2014 EU proposal suggested a fund of 15.7 billion (currency unstated, presumed dollars).8 The fund would be market-based, as it would create demand-side competition.
Governability: Such a fund would require a multinational governance structure. Little work seems to have been done in developing proposals in this area. If remuneration were based on impact, this would require complex measurement. The selection system would need to be robust against political interference.
Political Feasibility: The US opposed any reference to delinkage in the WHO resolutions.9 James Love commented that there is growing interest in Europe and the developing world for such a proposal.10 As it entirely does away with monopoly rights, it is unlikely to receive support from pharmaceutical companies.
Another fund that entirely does away with monopoly rights is Medical Innovation Prize Fund (MIPF). MIPF only concerns the US, unlike CIF, and affects all drugs, rather than just cancer.
The Health Impact Fund (HIF) and the Australian Democrats Prize Fund are comprehensive and optional versions of CIF.11
The proposals from the WHO health R&D discussions envisage a comprehensive international fund which does not replace monopoly rights.12
The Fund for research in Neglected Tropical Diseases (FRiND) and the PDP+ Fund fund R&D upfront rather than via remuneration, and coexist with the patenting system. Like CIF, FRiND is an international and disease specific research fund.13
Developing Economies\’ Fund for Essential New Drugs’ (DEFEND) annual payments proportionate to social value and burden of disease are reminiscent of remuneration rights. The difference is that remuneration rights replace patent rights completely, while these license payments only compensate for the drug licenses in developing countries, leaving the patents in developed countries intact.
Stakeholders on board:
Union for Affordable Cancer Treatment (UACT)
Bangladesh, Bolivia, Barbados and Suriname
“Geneva Technical Workshop on Proposals for a Cancer Innovation Fund (CIF) – Union for Affordable Cancer Treatment,” 2017. https://cancerunion.org/2017/02/01/101/.
Members, W. H. O., and Easily Adopted In Committee-WebLegal says. “Resolution On Cancer Hailed By WHO Members, Easily Adopted In Committee.” Intellectual Property Watch, May 31, 2017. https://www.ip-watch.org/2017/05/31/resolution-cancer-hailed-members-easily-adopted-committee/.
2008 proposal: Barbados and Bolivia. “Cancer Medicines and Vaccines in Developing Countries Prizes as a Reward Mechanism for New Cancer Treatments.” Working Document, 2008. https://www.keionline.org/misc-docs/b_b_igwg/prop4_cancer_prizes.pdf.
2009 proposal: “Prizes as a Reward Mechanism for New Cancer Treatments and Vaccines in Developing Countries.” PROPOSAL by Bolivia, Suriname and Bangladesh, 2009. http://www.who.int/phi/Bangladesh_Bolivia_Suriname_CancerPrize.pdf.
2017 draft proposal: Brazil, Canada, Colombia, Costa Rica, France, Netherlands, Nigeria, Panama, Peru, Russian Federation, and Thailand and Zambia. “Cancer Prevention and Control in the Context of an Integrated Approach.” Draft Resolution, 2017. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_ACONF9-en.pdf.
2017 report: The Secretariat. “Cancer Prevention and Control in the Context of an Integrated Approach.” WHO, 2017. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_32-en.pdf.
2017 resolution: “WHA70.12: Cancer Prevention and Control in the Context of an Integrated Approach.” WHO, 2017. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R12-en.pdf.
News coverage: Cassedy, Claire. “Civil Society Groups Urge EU to Support WHO Cancer Resolution.” Delinkage, March 31, 2017. http://delinkage.org/civil-society-groups-urge-eu-support-cancer-resolution/.
“KEI Statements on World Health Assembly Committee Passage of Cancer Resolution | May 30, 2017 | Knowledge Ecology International.” Accessed July 13, 2017. https://www.keionline.org/node/2794.
“WHO Members Urged To Support Resolution Delinking Cancer Drug Prices From R&D Costs.” Intellectual Property Watch, 2017. https://www.ip-watch.org/2017/05/04/members-urged-support-resolution-delinking-cancer-drug-prices-rd-costs/.