The “pooled fund” is designed to reduce the high costs of developing new treatments. It would do so partly by increasing the number of experimental drugs being tested, raising the chances that some will succeed. It would also reduce the risks of unsuccessful new products by bringing in capital from non-profit backers who do not seek financial returns.

The plans were outlined in an article in a recent edition of the academic journal Nature Reviews Drug Discovery. The initiative would also offer equity stakes to investors, take on debt finance and seek “advanced reimbursement agreements” with healthcare systems. The agreements would guarantee revenues for new drugs meeting agreed outcomes.

The initiative reflects the renewed focus on innovation models in medical research against a backdrop of rising costs and falling productivity for pharmaceutical companies.

Sam Daems, lead author of the article and a portfolio manager at Waterland, a Dutch private equity group, said exploratory discussions were under way with potential backers. They included the foundations of several pharmaceutical companies, medical charities and private family offices.

“We have had orienting discussions with private investors,” Daems said. “There is a clear interest and appetite.”

The aim was to launch fundraising next year for €500mn, he added.

Traditional drug companies have relatively small interest in disease areas with limited revenues, including antibiotics and “neglected” or “orphan” diseases. Such diseases are concentrated in lower-income countries or affect only small numbers of patients.

The large disease burden and high pricing of drugs for cancer mean it already receives a large share of total pharmaceutical research and development funding. But paediatric cancers have been more neglected.

Andrew Lo, a professor at MIT Sloan who was consulted on the new project, proposed a $30bn cancer “megafund” a decade ago to combine drug testing projects to diversify risk.

The idea had already inspired smaller-scale applications at companies such as BridgeBio and Roivant, he said.

“If we can change the incentives and reduce risk, the increased reward will bring more money,” Lo said.

In one example of an innovative approach to drug development, the Cystic Fibrosis Foundation used a “venture philanthropy” model to fund research and development of the drug ivacaftor. It was then licensed to and launched by Vertex, the Boston-based pharmaceutical company.

The US Food and Drug Administration, meanwhile, has awarded a number of “priority review vouchers” to offer developers accelerated regulatory review of a relatively lucrative drug in return for developing another, less profitable one.

The AMR Action Fund has pooled funding from multiple drug companies and other backers to help cover the costs of testing of experimental antibiotics, although it has warned that it still needs greater efforts by governments to pay.

A number of public-private partnerships such as the Medicines for Malaria Venture have blended philanthropic support with prototype medicines tested in co-operation with drug companies. It recently gained approval in Brazil for use of a single-dose of tafenoquine to treat malaria.

Warning about the limits of potential new approaches, Evan Seigerman, an analyst at BMO Capital Markets, said that when the end-user market was “more limited”, it was harder to justify upfront investment.

“You need the experience of the biopharmaceutical industry to develop drugs,” he said. “The people who have that are within the pharmaceutical companies.”

One pharmaceutical industry veteran said he welcomed any new initiative to develop medicines.

But he added: “This approach looks remarkably complex.”

This story originally appeared on: Financial Times - Author:Andrew Jack

A review of 47 studies by researchers at the Center for Global Development, a Washington think-tank, suggests that more than 20 per cent of the gap in basic reading and mathematics can be attributed to elevated levels of lead in the blood, increasing concerns over the barriers to learning in the developing world.

It highlighted that children in low- and middle-income countries have average lead exposures that are 10 times higher than US levels, with only 40 per cent of children in those countries able to read and understand a simple story, compared with more than 90 per cent in the OECD club of mostly rich nations.

Some 600mn children had levels above 5 micrograms per decilitre, an amount that is considered worryingly high by the US Centers for Disease Control and Prevention.

Lee Crawfurd, lead author of the CGD paper, said children who have high levels of lead in their blood can have much lower IQ scores and test results than their healthier counterparts. “Lead poisoning is invisible — it has a huge impact on learning and productivity.”

To address the metal’s role as a leading cause of lower educational performance, health authorities are launching public awareness campaigns about lead contamination in paint, cosmetics and food. The CGD said lead exposure was particularly high in countries such as Afghanistan and India.

The study comes at a time of broader concern over poor educational outcomes for children in developing economies, with many children having suffered long periods of school closures during the Covid-19 pandemic.

Concern over lead will intensify a fierce debate among educationalists and policymakers over the most important priorities in children’s learning, from raising attendance in schools to improved achievement in basic literacy and numeracy, enhanced social and emotional learning, school feeding programmes and tackling violence.

While scientists have not discovered how high lead levels impair children’s ability to learn, the latest draft assessment issued this spring by the US Environmental Protection Agency describes causal relationships between lead exposure and reduced cognitive functions, hyperactivity and effects on cardiovascular health and development in children, as well as character traits such as aggression.

Andrew McCartor, executive director of Pure Earth, a charity focused on tackling toxic pollution, said lead was “by an order of magnitude the most damaging chemical to public health”. He estimated that up to one in three children around the world suffers from lead poisoning, which causes several million premature deaths each year.

While longstanding concerns over the effects on human health have led to a global ban on lead in petrol, campaigners have highlighted risks from sources including contamination from batteries, dust from paint, recycled metal cookware, adulterated spices and eyeliner used on infants in some cultures in a belief it wards off evil spirits.

The studies examined by the CGD, 18 of which focused on low- or middle-income countries, analysed lead levels in blood of children with a median age of four years old, and cognitive testing at eight years old. Most studies adjusted for parents’ IQ or education, other family background details or income levels.

USAID, the US development agency, said it was “expanding on our efforts to mitigate lead poisoning so that children can learn in safe and supportive environments” and planned to “monitor and mitigate toxic lead exposures for children”.

This story originally appeared on: Financial Times - Author:Andrew Jack

The Program for Monitoring Emerging Diseases (ProMED) was among the first to detect viral outbreaks including Sars, Mers and Covid-19, which it flagged in late 2019. But the system’s operators are considering selling its Brookline, Massachusetts office as they struggle to find fresh sources of funding to cover costs.

The free web and email-based notification service, which uses medical specialists to flag, interpret and share reports on infectious human, animal and plant diseases to aid mitigation efforts, has only raised $20,000 nearly a year after launching a $1mn fundraising campaign.

“ProMED is in dire financial straits,” its staff warned as they announced plans to introduce passwords and attract paying subscribers, limit web scraping of its data and restrict access to its archive.

Linda MacKinnon, executive director of the International Society for Infectious Diseases, itself a small non-profit organisation that has run ProMED since 1999, said: “We just cannot go on like this. We need sustainable funding. Right now it’s just keeping the lights on.”

The free service, which launched in 1994 and sends out 4mn emails a month to over 20,000 recipients, is widely consulted by medical researchers, public health officials and others in governments and international agencies, as well as many commercial organisations including pharmaceutical groups, insurers, banks and travel companies.

However, while ProMED continues to be respected for its expert analysis, widespread scraping of social media have led to the emergence of multiple competitors such as Bluedot and EpiTech Consultants, while sharing of data between countries has increased.

As well as tracking early signs of respiratory diseases such as Covid-19 and Mers, ProMED was among the first to alert health officials to mosquito-borne diseases Zika and Chikungunya.

ProMED has functioned on a budget of less than $1mn a year to pay employees and stipends to a network of expert contributors. It has received sporadic grants for particular projects such as nine non-English language versions of its services and has some core funding, notably from the Wellcome Trust up to 2025.

Its latest strategic plan aims to raise $3mn a year to support the modernisation of its website, collect additional data sets and integrate and automate different aspects of its operation, but it has failed to generate significant financial commitments from public sector funders or philanthropists.

Other surveillance systems have emerged that often integrate ProMED reports, including the World Health Organization’s Epidemic Intelligence from Open Sources. ProMED has complained that commercial companies also re-use its data for their own benefit or sale beyond the terms of their licences.

“After 30 years I still think it has a unique niche and has proven itself as an early warning mechanism repeatedly,” said Professor Lawrence Madoff at the University of Massachusetts Medical School and editor emeritus at ProMED. “It needs to be controlled by an organisation that has strong infrastructure and financial backing like a university.”

Prof Heidi Larson at the London School of Hygiene and Tropical Medicine, said: “ProMED has been a pioneer. Its global network of local reporters, investigators and contributors gives a different level of confidence to the real-time alerts and reports it delivers.”

This story originally appeared on: Financial Times - Author:Andrew Jack

The analysis, conducted by academics Jan-Emmanuel De Neve and George Ward at the University of Oxford, and Micah Kaats at Harvard University, suggests that companies with greater profitability and higher stock market performance tend to have staff who report greater happiness, purpose and job satisfaction as well as lower stress.

Diana Han, chief health and wellbeing officer at consumer goods group Unilever, said the study “adds to a growing body of research demonstrating the competitive advantages of a healthy and well workforce — if we look after our people, they will look after the business.”

De Neve and his co-authors’ work is based on 15mn wellbeing surveys by employees at 1,636 publicly listed companies on the Indeed recruitment website. The site combines the survey results on work happiness, purpose, job satisfaction and stress into a wellbeing index rating. Company performance was measured using return on assets as well as market value as a multiple of asset replacement value.

The analysis showed that the wellbeing index not only correlates with gains in company performance, but is also predictive: investing $1,000 in companies with higher staff wellbeing scores in January 2021 would have generated a return of about $1,300 by the start of March 2023, compared with a return of roughly $1,100 from the S&P 500 stock index.

[A] possible interpretation of this result is that employee wellbeing may be especially important for business success in consumer-facing industries

The authors found that company happiness scores are especially predictive of performance in the service sector and said that a “possible interpretation of this result is that employee wellbeing may be especially important for business success in consumer-facing industries”.

This story originally appeared on: Financial Times - Author:Andrew Jack

The large majority of patients in Africa seek medicines and healthcare in private pharmacies and hospitals because state-backed systems are dysfunctional. Rockson had started his company, mPharma, as an alternative to ineffective official supply chains, offering political leaders a model for how to shake up the provision of public services and essential goods.

If Rockson’s hunch was right, a contract could tap into strong demand by delivering healthcare to those most in need, providing important social impact alongside sustainable profit growth. It offered scope for future ownership of the service and a model with applicability to many other countries.

Carruthers adds: “You want to power up the state if they are benign because your reach goes exponential. But, often, there are very dysfunctional politics inside ministries. We felt a lot of diligence was needed. If you get the right contract with the right government and properly de-risk, it’s great. If they don’t pay, it can kill you. It’s binary.”

Many African countries use state-owned central medical stores such as Gabon’s OPN. But opacity, corruption, bureaucracy and cash flow constraints have led to high prices, expired medicines and “stock outs”, leaving patients without life-saving drugs — and driving those who can afford them to costlier private pharmacies, instead.

As Rockson laid out the terms of the prospective arrangement to his board in 2021, he was tempted by the potential of the new adventure, while mindful of the limitations — including the essential role of his relationships with key decision makers led by Daouda. Now, he had to convince his directors.

To proceed would mean operating in a complex francophone country with which, as a Ghanaian, he was unfamiliar, in an inefficient sector he had avoided because of fierce vested interests that resist reform, with uncertainties over politics and patronage. It would also mean diverting scarce expert staff and resources from mPharma’s burgeoning activities elsewhere.

What would you do in his situation?

For a teaching note to accompany this case study, contact prashant.yadav@insead.edu

Andrew Jack is the FT’s global education editor

Prashant Yadav is a senior fellow at the Center for Global Development, affiliate professor at Insead and a lecturer at Harvard Medical School

This story originally appeared on: Financial Times - Author:Andrew Jack

The study, founded by Vitality and backed by the Financial Times along with Rand Europe, the University of Cambridge and Aon, will explore the effects of the pandemic and broader factors influencing the health of employees.

Participation is free, and will help employers and employees alike to improve wellbeing and boost staff retention. Any organisation in the UK with 20 or more employees can take part through a simple registration process, and winners in different categories, based on size, will be announced in November 2023.

Previous rounds of the study have highlighted the disproportionate burden of physical and mental ill-health on young people, on women and on those on low incomes; and the stress connected to financial worries, poor diets and insufficient sleep.

The most recent survey findings from last year identified growing mental health concerns, the importance of quality as well as quantity of sleep, and the value of hybrid working.

Winners of the Healthiest Workplace awards in 2022 included Nomura, Novo Nordisk and OpenCredo, as well as public sector groups led by Derbyshire Community Health Services NHS Trust.

Employers wishing to take part this year can register on the survey website, and will then receive a customisable questionnaire link to send to their employees for completion by September 30.

Participants will receive a report on their health and tips on how to improve it, while employers will receive an anonymised analysis of their workforce’s health, engagement, and performance.

This story originally appeared on: Financial Times - Author:Andrew Jack

As health and safety manager for the UK operations of the Japanese bank, he has seen a notable jump in stress linked to caring for family members during and since the outbreak of Covid-19, as well as growing financial worries and fear about climate change.

“We saw social anxiety increase,” he says. “There are also a whole series of financial and environmental concerns affecting our employees. They are worrying about where their fish [in their diet] are coming from, whether the house will flood.”

It shows a surge in mental ill health and anxiety compared with previous years, and a rise in sickness absences and “presenteeism” or unproductive working. It also highlights the effects of recent trends, including the sharp increase in remote working sparked by lockdowns and infection-control measures in response to Covid-19.

The survey suggests that employees who are able to adopt hybrid working patterns — balancing their time between office and home — have the highest levels of job satisfaction and the lowest levels of presenteeism and absenteeism. The least productive were those required to be away from home in workplaces other than an office — such as a factory or retail outlet.

Since the start of Covid-19 especially, employers have shown increased interest in staff wellbeing as they seek to support continued growth in their organisations. They have explored new approaches and tools, from mindfulness apps to restructuring roles and responsibilities. That has sparked a thriving wellness industry offering programmes that claim to improve health.

But experts who study the topic warn that there is a lack of rigorous research on cause and effect, and which interventions really work. Jan-Emmanuel De Neve, an economist at the Saïd Business School at Oxford university, says: “There is little ‘gold standard’ evidence with randomised control trials. There are lots of small pilots which are often not well evaluated or reported on.

“There is one piece of really good evidence: you can’t yoga your way out of these more structural issues underpinning mental and physical health. That’s not to say mindfulness is a bad thing, but it’s not addressing the main structural causes.”

Report suggests that employees who are able to adopt hybrid working patterns have the highest levels of job satisfaction

He points to a rigorous analysis published in 2019 called the Illinois Workplace Wellness Study, which explored the effects over two years of a comprehensive workplace wellness programme called iThrive in Urbana-Champaign in the US.

Bob Chapman, Barry-Wehmiller’s chair and chief executive, has argued for the importance of empathetic management in contrast to what he described earlier this year as a more typical trend: “Traditional leadership or management conditions us to view people as functions, to get them to do what we want so we can be successful, not because we care about them.”

For Sir Cary Cooper, professor of organisational psychology at Alliance Manchester Business School and co-founder of the National Forum for Health and Wellbeing at Work, the most effective measures to improve employee wellbeing would be to give equal weight to “people skills” and emotional intelligence alongside technical skills when recruiting or promoting line managers.

He also says employers should appoint a non-executive director and a senior executive responsible for health and wellbeing; and to introduce regular surveys and reporting to measure the effects on the workforce.

Even for companies such as Nomura that have the resources and commitment to wellbeing, identifying the right policies and overcoming external pressures beyond their control remain significant constraints.

Nomura’s Edwards points out that even while remote and hybrid working has simplified efforts to train its line managers, it has reduced the benefits of human contact in the office. “It is giving people more flexibility but they are not getting the health benefit from it yet.”

And however much the bank does to support staff, it has limited ability to influence external factors that weigh on staff wellbeing. “You think employees are healthier and then you get Brexit or the war in Ukraine and it totally changes the playing field.”

This story originally appeared on: Financial Times - Author:Andrew Jack

Wellbeing in the workplace was, for many years, an incidental add-on, involving one-off interventions to encourage greater physical activity or healthy eating — such as the provision of fruit in the canteen or subsidised gym membership. But there are now more wide-ranging approaches to address mental wellbeing that tackle the underlying structural causes of workplace stress, rooted in how organisations are managed.

There is a clear economic case for action: reduced physical and mental health is associated with lower performance, due to absenteeism as well as presenteeism, where staff come to work but underperform. And other worrying trends have been intensified by the pandemic — not least the high proportion of working-age people withdrawing from the workforce entirely, raising concerns for the economy and individual employers.

However, while there is enhanced interest in programmes to support employee wellness, and no shortage of consultants and services, the evidence on what works remains thin. Cary Cooper, a professor of organisational psychology at Manchester university, says rigorous studies are rare and difficult to conduct. “Organisational researchers feel they can’t get work on them published and employers don’t want to waste time doing them,” he says. His own research, backed by discussions with the National Forum for Health and Wellbeing at Work, a network of senior UK executives that he oversees, points to the need to tackle the underlying structural reasons for employee stress, frequently rooted in poor management practices.

Cooper argues that reduced workplace stress and improved productivity is linked to factors including autonomy, a sense of purpose among staff and empathetic management. “It’s all about the line manager — from the shop floor to the top floor,” he says. “They need to have interpersonal, social and empathetic skills. But we promote them today based on technical expertise.”

The Britain’s Healthiest Workplace awards at least point in the direction of trends and best practices that merit greater attention in future.

This story originally appeared on: Financial Times - Author:Andrew Jack

That is the snapshot of the workforce provided by this year’s Britain’s Healthiest Workplace survey, as the nation emerges from two years of pandemic in worse shape. It offers worrying findings for individuals, employers, and the country overall.

The results, based on responses from more than 8,500 workers in 251 private and public sector organisations between March and September this year, offer insights into habits, feelings and practices — with lessons for the health of the nation and the prospects for the economy. The survey and associated awards are funded by Vitality, in partnership with Aeon, Rand Europe, Cambridge university and the Financial Times, which jointly help to oversee the analysis.

This affects employers and the wider economy, as staff prove less productive, with some dropping out of work entirely. “We’re in a situation for the first time, probably, since the industrial revolution, where health and wellbeing are in retreat,” said Andy Haldane, former Bank of England chief economist, in a speech last month. “Having been an accelerator of wellbeing for the last 200 years, health is now serving as a brake in the rise of growth and wellbeing of our citizens.”

Poor sleep and musculoskeletal problems featured in the survey — both are linked with mental ill health and stress. Thirty per cent of respondents said they slept less than seven hours a night, and more than four-fifths reported at least one musculoskeletal condition.

The good news — insofar as cause and effect can be teased out — is that those who were able to work in a hybrid fashion between workplace and home had the lowest overall number of unproductive days, at 47.

People who worked from home believed they had a better work-life balance than other workers and had less burnout — although they also had a higher rate of long Covid symptoms and were less satisfied with their jobs than hybrid workers or those based in offices.

Worryingly, productive time lost to sickness or presenteeism — when people are at work but not doing much actual work — was far higher for younger staff (aged below 30), at more than 61 days. These groups reported higher levels of depression, financial insecurity, burnout and job dissatisfaction than their elders. They also drank less alcohol.

Women had higher absence rates than men, and respondents who declared as neither male nor female reported far greater loss of productive days, more problems with sleep, depression and chronic health conditions, more dissatisfaction with their jobs, and a poorer work-life balance.

One surprise was that the level of financial insecurity — a driver of ill-health — was just 10 per cent on average. “Most people came out ahead during the pandemic”, given government support schemes, says Chris van Stolk, executive vice-president at research company Rand Europe and an adviser to Britain’s Healthiest Workplace. But, now that the UK appears to be leaving the worst of the pandemic behind and heading into a period of sluggish growth and austerity, the situation is likely to worsen.

“We know this next period will be even tougher. It’s a burning platform,” van Stolk says.

Most people came out ahead during the pandemic. This next period will be tougher

Some 78 per cent of respondents said their manager cared about the health and wellbeing of staff, but just a third believed their employer should play a more active role in helping them to maintain their health and wellbeing.

This story originally appeared on: Financial Times - Author:Andrew Jack

Its product is just the latest in a series of antibiotics that have struggled to take off, alongside an even longer list of potential drugs that have not made it beyond the laboratory bench. A public health need for innovative treatments is increasingly being confronted by a reluctance to back products for fear they will be lossmaking.

“The market is fundamentally broken,” says Aleks Engels, a partner in Novo Holdings, a Danish life-sciences investor that has ploughed €130mn into potential treatments. “With the prospect of low volumes and low price, you end up not succeeding. We need to start rewarding companies that provide new drugs. We have to change the model.”

This story originally appeared on: Financial Times - Author:Andrew Jack

That hesitancy — by Italy and the UK — to provide more money to the Global Fund to Fight Aids, TB and Malaria, which supports prevention, diagnosis and treatment in poorer countries, was a signal of the difficulties ahead in tackling existing and emerging communicable diseases.

The coronavirus pandemic is estimated to have killed at least 16mn people globally, left millions more with debilitating illness, and wreaked lasting economic damage. It continues to claim lives every day, and should be a sobering reminder of the resurgent risks of infection alongside the underlying — and interrelated — growth in non-communicable diseases.

“It’s remarkable that we went through Covid and didn’t come out with better data systems or better access to preventive healthcare,” she says. “I don’t get a sense from what we’re seeing from polio or monkeypox that we’ve really learned any lessons.”

There is, however, still willingness to provide financial support. Peter Sands, head of the Global Fund, says that, in spite of hesitancy from a few large donors, the $14bn pledged in September suggests “there is clear recognition in both a moral priority to save lives and a self-interested priority to contain infectious diseases and preserve socio-economic stability”. He adds: “It’s very difficult for countries and communities to prosper and thrive if they are under a very heavy disease burden.”

Technological advances have been made since the start of the Covid-19 pandemic, with implications for other less severe infections. There is fresh investment in vaccines, and the application of mRNA technology provides scope for a range of more effective, targeted and rapid ways to shield against illness and death.

Like many of his peers, Sands stresses the prime importance of strengthening existing health systems to tackle communicable and non-communicable diseases alike.

“The priority should be to fight existing big disease threats — and do it in a smarter way that explicitly builds in multi-pathogen capability and surge capacity,” he says.

Kluge agrees. One of his greatest concerns is the current stress on healthcare systems around the world, as workers retire or burn out and quit, while the pipeline of replacements is thin.

“The health and care workforce is a ticking time-bomb,” he says. “There is a medical desert. But we have to invest in the health workforce and reserve capacity. We see the battle is not won in hospitals, it’s won in primary healthcare.”

This story originally appeared on: Financial Times - Author:Andrew Jack