Healthcare for the many; not only the few

A Q&A with Melanie Nallicheri, CEO of EQRx, on a mission to remake medicine.

In June 2021, Abdul Latif Jameel Health and EQRx, a company committed to developing and delivering break-through medicines at lower prices, signed a strategic collaboration for the distribution of two affordable new lung cancer drugs – once these have been fully approved by all relevant authorities – to a potential 1.5 billion people across the Middle East, Africa and Turkey.

The two oncology programs, aumolertinib, an epidermal growth factor receptor (EGFR) inhibitor and sugemalimab, an anti-PD-L1 antibody, have shown promising Phase 3 data for the treatment of patients with advanced non-small cell lung cancer (NSCLC).   These therapies have the potential to offer treatment at a fraction of the cost of existing approaches.

This collaboration will see Abdul Latif Jameel Health commercialize the drugs to selected markets throughout the Middle East region, as well as in Turkey and all of Africa, providing access to affordable, safe, effective treatment for thousands of lung cancer patients.

We spoke to Melanie Nallicheri, Chief Executive Officer, EQRx, and Akram Bouchenaki, CEO, Abdul Latif Jameel Health, about the partnership and what it could mean for cancer patients in the target markets.  

Melanie, can you tell us about your mission at EQRx?

MN: Our mission is to improve health for all through great innovative, affordable medicines:

• so that people around the world can access these medicines for chronic or life-threatening diseases or conditions without any barriers;
• so prescribers around the world can offer them to their patients without unnecessary administrative challenges; and,
• so payers and health systems around the world can make these medicines available to patients in a financially sustainable way.

What we are basically saying is, we want to make innovative, life-enhancing medicines available and accessible to patients all over the world.

Why are the issues of accessibility and affordability such big problems in the pharmaceutical industry?

MN: Our understanding of medicine, biology and data science has developed enormously in recent years.  Things we can do today would have been seen as science fiction a decade or two ago.  What usually happens  as technology moves forward, costs – or at least consumer prices – come down.  But in healthcare, costs have actually gone up.  This means our understanding and our capabilities have increased, but the accessibility and affordability of these new solutions has decreased.  We could see this was wrong, and we saw an opportunity to do things differently by building a successful business at scale to change this dynamic.

AB: To add to Melanie’s point, there is an incredible unmet medical need for these drugs.  If you look at the Gulf region, which generally has a good level of healthcare, lung cancer is the second most common cancer in men, and it is the leading cause of death by cancer in men.  Up to 80 percent of cases are diagnosed at advanced stages, and the five-year survival is as low as 10 to 20 percent. 

This is why it is absolutely critical to massively expand access to these therapies.  That’s the vision that we’re trying to implement.

This isn’t a new problem, so what is different about EQRx’s approach to addressing it?

MN: We recognized that to make a real difference, you need a significant portfolio, or catalog, of medicines.  This allows you to offer many choices for treating chronic or life-threatening diseases and enables you to make the greatest impact.  Instead of starting with one or two drugs, we wanted to start with 10, 20, 30, focusing on critical areas like oncology and immune-inflammatory diseases.

We are also coming at the problem from a different perspective, from the basis of a shared objective with prescribers and payers.  Normally a manufacturer will launch a great new drug, but they keep the price high to maximize their profits and keep their shareholders happy.  Prescribers want to offer this drug to their patients, while payers – like health insurers or national health schemes – want to make it available to their members and communities.  The problem is, the cost is so high they can only afford to prescribe to a certain number of people, otherwise it would blow their budget.  This means they have to restrict who can benefit from these drugs.  In effect, the objectives of the manufacturers, the prescribers/payers and the patients are at odds with each other.

Our approach is to work towards a shared objective of making these medicines as widely available as possible.  To do this, we intend to make our pricing  transparent, simple and radically lower.  We will benefit from selling more of our medicines, prescribers and payers benefit from offering these treatments to more people without breaking their budgets, and patients benefit from having access to life-enhancing healthcare.

How big a difference could this make for health systems as well as for patients?

MN: The potential benefits are enormous.  Our mission is to offer life-changing medicines at radically lower prices.  By radically lower, we’re talking a quarter, a third, a half lower.  That makes a significant difference.  For example, say there is a total global spend for a specific drug of US$ 10 billion, which isn’t inconceivable for many immune-inflammatory diseases.  Our drug might be priced at a third of the price of the current drug, so in a market of US$ 10 billion, there is immediately a potential saving of over US$ 6.6 billion.  Of course, we’re never going to own 100% of a market, but even if we only had 15% of the market – US$ 1.5 billion – by offering our drug at one-third of the price, that’s still US$500 million in revenue for us and a saving of US$ 1 billion for the health system.  So you can see how we can potentially build a great business yet also generate significant value for all of the other stakeholders in our ecosystem, not least the patients, who will have access to treatments that may have been previously unavailable to them.

How has EQRx been able to overcome the barriers that have stopped someone doing this before?

MN: There are three core pillars in our business model that we believe will enable us to do this.  The first is that, right from day one, we have had a laser-sharp focus on creating a completely different cost structure.  We are a new business, so we’ve been able to create that structure from the ground up right across the organization.  Second, we are creating operational processes that leverage everything we have at our disposal as an industry to lower the cost of developing the medicine.  For instance, you can use remote approaches to monitor patients during a clinical trial, which means you can conduct trials much faster and more efficiently, which reduces costs.  Lastly, because of this unique business model, we don’t need the typical salesforce-driven, high-promotion approach to selling drugs.  Our partners should be creating the pull-through and the access to our medicines, as opposed to us sending hundreds of salespeople to persuade people to buy them.  This kind of market-driven model has not existed before in the global healthcare sector.

Akram, what was it about EQRx that convinced you they would be good partners for Abdul Latif Jameel Health?

AB: As we were looking to become an investor in EQRx, we found a great alignment with the vision, the values and the overall purpose of EQRx.  Abdul Latif Jameel Health aims to be a bridge to accelerate access to innovative therapies in the global south.   The two key words there are ‘accelerate’ and ‘access’.  We want to get vital medicines  to people faster and make them accessible to more people.  Affordability is a key part of that, but price is not the only factor preventing medicines reaching those who need them.  I’ve been in situations in my career where we have donated tons of drugs to treat infectious disease to countries where prevalence rates were very high, but unfortunately the drugs never made it to the patients who needed them.  So, there is more than just an affordability issue to address.

The other thing we really liked with the EQRx approach is that we saw a great alignment with the innovative business model they are building, the way they’re focusing on the right stakeholders for the future.  It is a vision and a strategy that we very much support and look forward to implementing in our part of the world.

Melanie, your first two products are both cancer drugs – aumolertinib and sugemalimab. Why did you choose to start with these two?

MN: When we first started, we said we wanted to have our first drug available to patients within five years.  That was part of our thinking when we were scanning the market for medicines to bring into our portfolio.  Both aumolertinib and sugemalimab are for non-small-cell lung cancer, as well as other cancers.  Aumolertinib is a targeted therapy in oncology for patients with EFGR-driven mutations.  Sugemalimab is an immunotherapy.  In cancer, it’s the largest drug class that we know today.  

We were very excited about these drugs, both of which have been shown to have excellent efficacy and a strong tolerability profile. 

Not only that, these two medicines could be available as early as 2023, which is much sooner than our original five-year target.  This means we can start having conversations with regulatory agencies around the world, and with our partners around the world, to start the process of getting these drugs to the people that need them.  It’s the ideal scenario: a great medicine with a great tolerability profile, much sooner than we had originally anticipated.  That’s why we were so excited about these two therapeutics.

Akram, how do you plan to leverage Abul Latif Jameel’s global footprint to get these drugs to those who need them?

AB:  This is the kind of challenge for which Abdul Latif Jameel Health was designed.  It was the vision of Mohammed Jameel that we become a critical part of the innovation chain, because innovation is not just what happens in the lab.  That’s the starting point, of course, but innovation is also about finding new ways, faster and more effective ways, to deliver those therapies to patients.  We see ourselves as the deliverers of that promise of innovation.  These drugs are going to be absolutely central in transforming patient care, in prolonging life, in making cancer treatment better tolerated.  The promise is there, and we see delivery as an integral part of that innovation journey.

What do you see as the biggest challenges for EQRx in achieving your ambitions?

MN:  Our first challenge is to develop our catalogue of medicines and build up our organization at scale.  To do that you need to be able to do two things.  One, you need to attract some of the best talent in the entire industry.  Two, you need to be able to mobilize significant capital to build an enterprise rapidly at scale.  We’ve been working really diligently from the get-go on both.  On the people front, we have established a talent brand that’s really unique, both because of our social mission, which is really exciting to people, and also because of the culture at EQRx that rewards enterprise and innovation.  People are encouraged and empowered to try to do things differently, even if we know that some of the ideas might not work.

AB:  For us, the challenge is to implement this uniquely innovative and disruptive model.  We need to go out and change people’s perceptions about how the drug market works.  We don’t want to have armies of sales reps hovering around corridors in hospitals, which is a huge waste of productive time, but rather focus on service, education, distribution.  Partnering with healthcare authorities, regulators, and healthcare providers in general is going to be a key success factor for us as we build a new model of medicine where patients are actors in their own health.

Finally, what’s next for you both?

MN:  We’ll be focusing on building our catalogue and our organization.  We have over 10 programs in our portfolio right now.  Of these, five are clinical-stage programs, including aumolertinib and sugemalimab.  We also have another immunotherapy option in our portfolio.  We have a breast cancer drug, and we have a drug for major immuno-inflammatory diseases, like rheumatoid arthritis and atopic dermatitis.  After those, we have several earlier-stage programs that we’re developing.  These include both oncology and immuno-inflammatory diseases, and then most recently, we’ve announced several drug engineering collaborations with companies.  By 2025 or 2026, we expect to be addressing more than 20% of the spend of a trillion-dollar global branded drug market.  And that’s a hugely exciting prospect.

AB:  We can’t wait to be part of that journey.  We’re looking forward to working with Melanie and the team at EQRx and really starting to put our strategy into practice.  That’s when the work really starts.  We’re super-excited.  We would love to see patients get access to these exciting new drugs as soon as we possibly can, and we’ll do all we can to achieve that over the next few years, and hopefully beyond.