Talk: "Affordable Medicine by Design? Evidence from Alternative R&D Models for National and Global Public Health"
On 5 March 2025, Professor Suerie Moon, a Visiting Professor at the Center for Outbreak Preparedness (COP) and the SingHealth Duke-NUS Global Health Institute (SDGHI); Professor of Practice in International Relations & Political Science at the Geneva Graduate Institute, delivered a talk titled "Affordable Medicine by Design? Evidence from Alternative R&D Models for National and Global Public Health." A total of 65 participants from the region and beyond registered for the event, with approximately 40 attending in person.
The event, co-hosted by COP and the Centre of Regulatory Excellence (CoRE), included a panel discussion examining both the challenges and opportunities in pharmaceutical innovation. It specifically addressed the limitations of the current market-driven approach and explored alternative models that could better serve global public health needs. Moderated by Assistant Professor Tan-Koi Wei Chuen, Lead of Regulatory Systems Strengthening at CoRE, the following Q&A session featured keynote insights from Professor John CW Lim, Executive Director of CoRE and Lead of Policy at SDGHI. The panel underscored the value of these new models while acknowledging the practical challenges of implementation. They emphasised the need for openness to regional collaboration, stressing the importance of an upstream approach—addressing affordability and other access considerations early in the research and development (R&D) process rather than after regulatory approval.
From left: Sun Yimei - Research Associate, Centre for Outbreak Preparedness (COP); Tan-Koi Wei Chuen - Lead (Regulatory Systems Strengthening), Centre of Regulatory Excellence (CoRE); Prof John CW Lim - Executive Director, (CoRE) and Lead (Policy), SingHealth Duke-NUS Global Health Institute (SDGHI); Prof Suerie Moon - Visiting Professor, SDGHI and Professor of Practice in International Relations & Political Science, Graduate Institute Geneva; Elyssa Liu - Lead (Legal Frameworks), COP
Key issues with the current system
The presentation highlighted four major criticisms of the mainstream pharmaceutical model:
- Lack of innovation in areas of market failure – Research in essential areas such as antibiotics, rare diseases, and pandemic preparedness suffers due to weak commercial incentives
- Slow progress in critical areas – The competitive logic of a market-driven model inhibits open science approaches that could accelerate the development of medicines and vaccines
- Risk of harm – A perennial challenge that must be governed for all pharmaceutical R&D
- Restricted access – A system that relies on high prices and monopolies will lead to limited supply and prevent equitable access, particularly in low- and middle-income countries (LMICs)
These inequities were especially evident in past outbreaks when LMICs faced challenges accessing vaccines despite actively contributing to research by sharing data and pathogen samples. For special areas such as rare diseases, this model will usually lead to high-cost treatments that are inaccessible to the public. Policymakers are now increasingly aware that access can be built early into the R&D process, not just at the pricing and distribution stages. This shift in understanding, along with growing public concern over affordability and accessibility, has fueled interest in alternative innovation models that prioritise the public interest.
What are alternative innovation models?
The traditional mainstream pharmaceutical innovation model is profit-driven, primarily focusing on at least the later-stages of R&D, commercialisation and manufacturing, and historically based in high-income countries. In contrast, alternative models introduce key differences, such as:
- Mission-driven approaches (e.g. public health-first models)
- Non-traditional organisational structures (e.g. public-private partnerships, non-profits)
- Different financing mechanisms (e.g. government-supported R&D, pooled resources, push funding)
- Distinct intellectual property (IP) frameworks (e.g. open science, no patenting, non-exclusive licensing, participating in patent pools)
- Affordable and equitable pricing models
- Manufacturing based in LMICs
Drawing from her 5-year study, Professor Moon identified three archetypal alternative models: national publicly focused model, public private partnership (PPP) and collaborative network — vividly describing them as “Soup, Sandwich and Salad” respectively. These alternative models are particularly important in areas such as:
- Rare diseases – Low patient numbers can limit private-sector investment
- Antibiotics – Relatively low-priced drugs whose use should be reserved limits profit potential
- Neglected tropical diseases – Affected populations lack purchasing power
- Pandemic preparedness – Highly uncertain demand means the benefits of investment may not be immediately apparent
Case studies: Alternative R&D in action
A prime example of the PPP model is the Oxford-AstraZeneca COVID-19 vaccine, which illustrates how the “sandwich” approach operates in practice. The vaccine’s technology, invented at Oxford University, was licensed to AstraZeneca with global access as a priority.
Key elements that made this model different include:
- Public and philanthropic funding from organisations like CEPI and the British government supported the R&D process
- Technology transfer agreements enabled large-scale production in India and other LMICs
- LMICs benefited from equitable access through bilateral purchase agreements and pooled funding mechanisms such as COVAX
This approach accelerated the availability of vaccines and made them more affordable and accessible compared to traditional commercial models.
Less well-known but also highly relevant is the collaborative network – or “salad” model – in which a network of smaller actors conducts various stages of the R&D process to successfully bring a product through regulatory approval. Such networks often include academic labs, non-profit organizations, public and philanthropic funders, and LMIC-based manufacturers. One example is the organic evolution of a network of collaborators who over 30 years sustained the development of continuously improved oral cholera vaccines, with affordable pricing and technology transfer to LMIC producers built into the innovation process from the start (learn more here). The collaborative network model may be particularly well-suited for countries with emerging R&D systems, including small advanced economies and larger middle-income countries, as it does not rely on the willingness of large established multinational firms to partner in the public interest (as the PPP model often does).
Looking ahead: The future of pharmaceutical innovation
There is an urgent need to rethink how medicines are developed and distributed considering today’s evolving global landscape on R&D. Key priorities include:
- Strengthening public funding for high-need areas
- Expanding open-access R&D initiatives
- Creating regulatory pathways that support non-traditional innovation models
- Ensuring equitable access is built into R&D from the outset
Further research is needed on how these alternative models can continue to develop and thrive within the existing pharmaceutical innovation system. Identifying ways to support these models through policy, funding and regulatory frameworks will be crucial to ensuring affordable, accessible and effective medicine for all.