IQVIA Executive Director Discusses Global Use of Medicines 2024 Report - Part 2

How do climate events impact medicine use?

One of the things that we've been thinking about in the context of all the discussion about climate change is to what extent is the life sciences industry ready to step up to the consequences of climate change, and those consequences come and will come in different ways. But one of the areas that we looked at and included in our report was the extent to which we saw climate change, and climate emergencies, if you like, or climate events; to what extent did they have an impact on the demand for medicines.

So, we looked at the Australian bushfires that occurred in late 2019, early 2020, we looked at the floods in Pakistan and Bangladesh. In the 2020 to 2022 period, we looked at the impact of the hurricanes in Puerto Rico and measure the impact that those climate precipitated events had on demand for medicines, whether it be respiratory inhalers in Australia, or anti effectives, in Pakistan, and Bangladesh, and so on. And what we caught out with some very significant impacts; we saw over 40% increase in the demand for respiratory inhalers. After the period of bushfires in Australia, we saw 20 to 25% increases in the anti-effectives that were being used and distributed in Pakistan and Bangladesh after their floods.

So, all of this speaks to the magnitude of the impact that climate events are already having in different parts of the world. And from that, you know, we're like wanting to see more modelling about what the longer-term impact will have, because that has implications for supply chains, that has implications for the mix of medicines that need to be produced. And of course, all of this is in addition to any new pandemics that may also be precipitated by climate change from population shift, populations shifting from animals shifting from mosquitoes, carrying malaria being becoming more prevalent in parts of the US, for example, right, all of these dynamics are playing out and do have an impact on demand for medicines, where that demand is going to be and what it will require from the health system manufacturers, also distributors and so on, to ensure that the medicines are available to the populations that will need them, where they need them and when they need them.

What kind of impact did COVID-19 have on spending?

COVID-19 has had multiple effects on the pharmaceutical market. If I step back, though, you know, overall were still impressed by the resilience of the both the demand for and the supply of medicines through the pandemic. Yes, there were absolutely disruptions and there were significant increases in demand in some areas and decreases and others and that played out over time. But overall, the pharmaceutical market remained remarkably resilient. Now, we also clearly have the COVID 19, vaccines and therapeutics that were remarkable outputs from the pharmaceutical industry and record-breaking time and with remarkable efficacy. And we've been watching those vaccines and therapeutics, you know, play out and their impact on the overall market. What we report on in our 2024 report is really the dramatic reduction in the use of COVID-19 vaccines and boosters, as well as therapeutics in 2023. We saw a very steep decline in the volumes.

We have also reduced our forecast for the next five years about the use of those medicines by something like $150 billion in in value on the back of how 2023 transpired. And sort of the signals if you like that were reading about, you know, the ongoing demand and use of COVID-19 vaccines and therapeutics. So, we had this amazing surge, of course, in demand in the wind when the vaccines initially became available, even though not everybody got vaccinated as we know. And around the world, we had very different levels of use. But what has surprised me is just how quickly the use of the vaccines has, has declined. And therefore, you know, when we look at the next five years, we see a very modest sort of impact from those vaccines and therapeutics over the next five years.

What of your findings do you think is most surprising?

The thing that we sort of marvel at, I would say, each year when we do this report is just how at how large and impactful this industry is. So, we do this big calculation, to try to count how many defined daily doses of medicines were consumed in the historical years, and then we forecast that out. So based on our calculations, they're not perfect, but we think we're the only ones that try to count up how many doses there are, we come up with 3.4 trillion doses globally, in 2023, we see that rising to 3.8 trillion doses in 2028. The numbers are somewhat, you know, mind boggling when you think about what it takes to not only discover and develop those drugs, but also manufacture them and then distribute them through a wide range of different distribution systems to reach patients around the world. They don't reach everyone, these numbers should actually be much higher, if everyone was getting access to the medicines they would benefit from. Yet still, it's remarkable just how big that that number is. And then on the flip side is how much is all this costing, on a list price basis? $2.3 trillion will be spent on medicines in 2028. That's a sobering number.

Again, it's a reflection of what payers are willing to pay for medicines, because that that's the amount that is being spent on them. Yes, there are rebates and discounts that affect the net amount received by manufacturers. But however, you look at it, this is a very large number. It's also not surprising that the amount being spent gets a lot of scrutiny that payers say, what value are we getting for the money? And I think, you know, the good news is the pharmaceutical sector recognizes those legitimate questions and has done a lot of work to create the evidence of the value that those medicines bring value to individual patients in terms of their outcomes, value to populations at a sort of national level and also how these medicines which include generics and biosimilars contribute to the sustainability of health systems as we see medicines work their way through the innovation cycle. That that does come to an end when exclusivity is lost and lower cost, you know, treatment options biosimilars and generics are able to enter the market. You know that that cycle is a beautiful thing to observe over time. But it's all part of this $2 trillion plus, that gets spent on medicines each year.