Preferred Supplier: A Consensus Innovation Model for Health Equity

Abstract

[eng] Health areas with no commercial value are and will continue to be overlooked, while those that bring huge returns to the industry will not be sustainable for much longer. The current health innovation paradigm is pharma-led, profit-oriented, and does not always respond to social values and public health needs. Furthermore, the United Nations Sustainable Development Goals (UN SDGs) will not be achieved without innovation and the private sector doing its part. Our hypothesis is that the public sector, as a major investor and purchaser, can shape health innovation to deliver improved and equitable health care by aligning incentives with priority health needs. Companies that engage in socially desirable environmental and health equity practices would get credit as Preferred Suppliers in a new fair play, promoting competition among the the biomedical industry in its strive for excellence for the common good. The Preferred Supplier model (PSM) proposes a public health investment and procurement system prioritising business with companies that fulfill the “4 Share” (4S) principles during the life cycle of research and innovation (R&I) sharing: i) Needs, ii) Results, iii) Risks and Rewards, and iv) Outcomes, promoting equitable innovation in exchange for incentives for health priorities. This PhD research aims to reach consensus on the values (normative preferences) that define the problem with the current biomedical R&I model and its causes, to then co-create a new consensus model based on the PSM, identify its barriers and enablers and outline policy recommendations. The study considered early multi-stakeholder engagement with a constructive Health Technology Assessment (cHTA) to evaluate the different perspectives and reach consensus among twenty-seven global key informants. During in-depth interviews, experts’ interpretive frames were reconstructed applying an adaptation of the Richardson model to contested values. A modified Delphi consensus method was applied with two cohorts and three rounds of scoring surveys. The results showed the panel’s unanimous desire for health equity. The experts significantly agreed on the PSM 4S principles, aligning public health needs with incentives and conditioning public investment and procurement to accredited providers according to ESG, an Access to Medicine Index-like and financial and scientificdata sharing practices. The consensus co-created PSM would promote the hybrid risk-impact pricing model by balancing risk (involving disclosure of public R&I funds) and impact (revised value-based pricing) modulated by tier pricing according to the countries’ ability to pay (i.e. GDP per capita). The key PSM enablers are its balance of risks and rewards as an incremental change in the system and the growing responsible innovation by the industry (earning credit for them as Preferred Suppliers), likely driven by investors’ demands for disclosure. Overall, the co-created PSM reaches a multi-stakeholder consensus on the desirability (shared values) and plausibility (incentives and regulation) to accelerate equitable health innovation towards Planetary Health. It is recommended to further develop and pilot the PSM in the EU.