Article: Advanced and accessible therapies in public health

We are currently entering a new frontier of knowledge, in which tackling chronic-degenerative diseases, associated with increased life expectancy, has become an undeniable priority. Many current cancer drugs, for example, are subject to failures, relapses and unwanted side effects such as cardiotoxicity and nephrotoxicity. However, with the advent of biological therapies and, more recently, advanced therapies, we are witnessing a real revolution: medicine is becoming increasingly personalized, smaller in scale but highly complex and specialized.

The transformative potential of advanced therapies is undeniable. Current clinical research explores the use of these therapies in a variety of conditions, ranging from solid tumors to diseases such as diabetes, cardiovascular diseases and Alzheimer's disease. But who has access to this medical revolution?

Currently, these technologies are extremely expensive and only a few people have access to them. In Brazil, a study commissioned by Fiocruz revealed that over the next five years, the costs of products related to gene and CAR-T therapies could vary between R$19 billion and R$72 billion. The figure represents a significant commitment to SUS' (Unified Health System) annual pharmaceutical budget, especially given the prospect of an increase in lawsuits related to access to these therapies.

However, Brazil is one of the few countries in the world with the potential to take advantage of this medical revolution for the population free of charge, through SUS. This is because the country has the advantage of having public institutions, such as Fiocruz and the Butantan Institute, which already have the scientific-technological and production bases needed to make advanced therapies available, especially those of a genetic and cellular nature.

Another crucial point for the advancement of these therapies in the country would be to have highly specialized health services, like our National Cancer Institute (INCA). Fiocruz, the Butantan Institute and INCA have already established partnerships to produce these therapies and conduct clinical trials. The scenario also looks promising with the National Strategy for the Development of the Economic-Industrial Health Complex (CEIS), launched by the Federal Government in 2023. But it is time to retrain public institutions to meet this challenge.

We need other partners, whether public or private, to be incorporated into the country's strategy throughout the process, contributing to the formation of a strong and diversified collaboration network.

We are talking about a strategic approach that includes investments in infrastructure, incentives for research and technological development, infrastructure and external partnerships; implementation of training programs in the field, as well as the establishment of local production partnerships.

In addition to the political and regulatory frameworks, it is crucial to promote dialogue between government bodies and collaborate with the private sector, encouraging investment in innovation and facilitating access to the market through public-private partnerships and technology orders.

The future of public health is being shaped today at a speed never seen before, and we, the managers of the leading institutions in this country, must be engaged and committed to ensuring that it is a future of hope for all.

*Mario Moreira is the president of Fiocruz; Camile Giaretta Sachetti is a special advisor to the Presidency of Fiocruz

**This article was originally published in O Globo newspaper on September 20th, 2024