Health Policy Problem Solver: Fumie Griego

Turning Ideological Challenges into Practical Solutions

The Geneva, Switzerland-based International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) represents research-based pharmaceutical companies and associations across the globe. It has consultative status with the United Nations and specialized agencies, including the World Health Organization (WHO), UNAIDS, the World Intellectual Property Organization (WIPO), and the United Nations Conference on Trade and Development, and has formal relationships with the World Bank and the World Trade Organization (WTO). IFPMA facilitates collaboration, dialogue, and understanding within the industry and with other global players in the health community, with the objective of bringing “the industry and broader health community together to foster innovation, promote resilient regulatory systems and high standards of quality, uphold ethical practices, and advocate sustainable health policies to meet global needs.”

IFPMA was established almost 50 years ago, but recent appointments to its leadership team indicate new efforts to expand its visibility both in Geneva and beyond. In February, Thomas B. Cueni-previously secretary general of Switzerland’s Interpharma and a former journalist and diplomat -was appointed IFPMA’s new director general; he told Intellectual Property Watch in May that he would like to see IFPMA’s ideas gain more exposure. Also in May, Cueni appointed Dr. Fumie Griego as assistant director

Dr. Fumie Griego

general for strategic planning, policy, and research. Citing Griego’s industry and policy-level experience-including tenures as head of global oncology policy and strategy, global government affairs and policy, at Merck KGaA, Darmstadt, Germany; as vice president for international health policy at Pharmaceutical Research and Manufacturers of America (PhRMA); and as a senior economist in the White House’s Office of Management and Budget-Cueni welcomed Griego as “a strong asset to help IFPMA bring thought leadership in addressing global health challenges.”

Soon after Griego’s appointment, she spoke to PharmExec  about how she sees her role with IFPMA as helping to shift the global healthcare debate from ideological concerns to a more pragmatic and solutions-oriented focus. 

PE: How have your roles as an economist and working for a big pharma company prepared you for your position at IFPMA?

Griego: I’ve always been interested in the intersection of science, policy, and economics. I started my career in environmental health regulation, but over time I became a little frustrated with the environmental field. We’re willing to spend so much of society’s resources regulating what are vanishingly small risks to health, but at the same time there are public health investments that are not being addressed in an adequate way. That dilemma drew me into the pharmaceutical space. There are policy drivers and a lot of evidence-based decision-making in this space that you don’t see in other sectors. Given my background and interests, I wanted to see what I could contribute to the policy discussion.

What I appreciate about my experience working within a company (Merck KGaA) is that it drew me closer into the product-level decisions that needed to be made, how policy influences those kinds of decisions, and meeting patients’ needs from the business side of things. Now that I have that company perspective, what I hope to bring to IFPMA is the ability to translate some of the policy dimensions into some of the commercial implications for companies, and vice versa.

PE: What are your chief areas of concern from an IFPMA perspective?

Griego: Part of the reason I was brought into IFPMA is because there is much more interest now in talking about drug pricing at a global level. We have seen across various countries a real concern about the potential cost of new therapies and how that might impact national budgets. But it’s becoming more of a global conversation now, and you see institutions like WHO and OECD (Organization for Economic Co-operation and Development) venturing into this space, which they haven’t done before. You also see developed

 markets raising issues related to their concerns about the high cost of medicines, which you didn’t see before. For me, the focus is about trying to unpack what the actual problems are, rather than just the perception of what the problems are.

PE: You’ve suggested that there is too much attention on the issue of drug pricing in the global industry. Can you elaborate?

Griego: There is a lot of focus on drug prices, but if you look at the proportion of healthcare spending devoted to pharmaceuticals, it’s fairly small, particularly in OECD and developed countries. But there’s the perception that the drug costs are driving the healthcare costs. There are a lot of misperceptions that need to be dispelled, particularly at the global level; it’s becoming a kind of negative feedback loop, where the conversation at the global level is impacting national level discussions, and vice versa. 

There is a lot of evidence and information that needs to be communicated, such as how the business actually works. At the national level, there are regular interactions between payers and companies to address some of these pricing and cost issues, but at the global level there isn’t that same experience. We’re having these conversations at these multilateral institutions, but there’s a lot of education that needs to happen about the differences across countries, across companies, and across different portfolios that get muddled during these conversations.

There are certainly concerns about cost of treatment and affordability that need to be addressed. But if you look at it more holistically and systematically, there are other things driving healthcare cost: aging populations and a growing incidence of chronic diseases, for example. In these areas, appropriate use of medicines is actually the solution to the projected healthcare-cost problem, not the problem itself. There needs to be that holistic view across the developed markets; there should be a focus more on broader health-system-improvement topics rather than a narrow focus on pricing.

If you look at the developing countries, there are so many other barriers to access and affordability. In many countries, even very cheap generics are often not accessible because the infrastructure is not there. There is no mechanism for pooling risk and avoiding the out-of-pocket costs of healthcare spending. Those things need to be addressed before we can even talk about pricing of innovative drugs. 

PE: How in this respect does IPFMA balance its focus on prioritizing the challenges of both the developed and developing pharma markets?

Griego: Pricing and reimbursement are very much national-level decisions and discussions. In terms of solutions, in the developed world we defer to sister associations such as PhRMA, EFPIA (European Federation of Pharmaceutical Industries and Associations), and JPMA (Japanese Pharmaceutical Manufacturers Association) so that they have the lead in developing the right policies for the right context. It’s much more of a collaborative, convening role than trying to focus our attention on solutions for those types of issues. 

That said, for developing markets, there is a much more active role that we need to play in influencing some of the policies being developed through and influence by the multilateral institutions. That’s where our core

mission is in terms of facilitating development. However, there are issues-for example, public health emergencies-that are more truly global in scope and don’t fit into a developing-versus-developed country template. 

Take, for example, the industry’s partnerships with the Union of International Cancer Control (UICC) through the Access Accelerated Initiative. The focus is on creating the infrastructure that’s necessary to deliver high-quality cancer care in low- and middle-income countries. What are the investments that need to be made? What needs to be in place in terms of specialists, diagnostics, surgeries, and radiation treatment? Then we can have a conversation about how specific treatments fit into the overall cancer control plan. 

There’s a lot of good work being done that is trying to address the root cause of the access barriers. A key component of what IFPMA is trying to do-along with our colleagues in PhRMA, EFPIA, JPMA, and all the other associations-is to reframe the debate and focus on the key issues that will address the problems at hand. 

PE: What do you hope to accomplish in your role?

Griego: During my short time in Geneva I have noticed, shall we say, a lot of trench warfare on ideological topics. Not that there isn’t ideology and politics involved in national-level discussions, but the nature of it is a bit different in Geneva. What I want to do is to move away from some of those ideological, no-win conversations to something much more pragmatic and solutions-oriented. 

For areas like global health, with respect to security and preparedness, there is a lot of common ground on the need for global-level solutions around issues like antimicrobial resistance. That is a space where there is a lot of clear understanding of the need for more cross-industry collaboration, not just in the research industry but also across the diagnostics and generics sectors, and a real partnership between the public and private sectors. An organization like IFPMA is very well placed to facilitate this, not only bringing the global perspective but also drawing on connections to the national and regional associations, where we can translate some of the global health conversations in to national actions. 

What I’m hoping to accomplish is to help to build that bridge, identifying common ground and offering a solutions-oriented action plan where the industry can contribute to the overall global health agenda.

Julian Upton is Pharm Exec’s European and Online Editor. He can be reached at julian.upton@ubm.com