Claudia Wild, former CEO of the Austrian Institute for Health Technology Assessment, on the part played by public institutions in medical innovations and why this is an argument in favour of cheaper therapies.
Interview: Dietmar Schobel
HEALTHY EUROPE
Dr Wild, how innovative are the major pharmaceutical companies?
Claudia Wild: These companies are not nearly as innovative as the public assumes. Currently, the majority of the research and development needed to produce active ingredients for medicinal products which actually lead to new or better therapeutic effects is conducted by universities and comparatively small start-ups. And the start-ups themselves are often spin-outs from universities. Therefore, it isn’t true that large pharmaceutical companies are almost exclusively responsible for researching and developing new treatments. Pharmaceutical innovation is a myth. It needs to be debunked in the interests of a solidarity-based public health system.
HEALTHY EUROPE
The final stages – culminating in the approval of these innovations for the medical sector, together with the production process and price negotiations – still remain the responsibility of the large pharmaceutical companies, though. Have their economic strategies changed over the past years and decades?
Claudia Wild: Yes, because instead of seeing the public and private sectors as partners, since the 1980s and 1990s the large pharmaceutical companies have always just been interested in profit. This goes hand in hand with a business strategy where professional scouts assess developments at these relatively small start-ups for their prospects of success. As a result, the ones that appear promising are then bought up. And there is a growing tendency for this to happen only after Phase I or even Phase II of clinical studies (see also box: “How do clinical studies work”), in other words when there is already confirmed evidence of the tolerance or efficacy of new therapeutics.
The large pharmaceutical companies have always just been interested in profit.
HEALTHY EUROPE
Minimising risk must surely be a sensible approach for a market-oriented company as well. What are the objections here?
Claudia Wild: The financial risk borne by pharmaceutical companies is much smaller than if they were to conduct all the research and development themselves. For instance, out of 30 medicines distributed by a well-known Swiss pharmaceutical company and approved by the European Medicines Agency between January 2014 and May 2024, two thirds were not researched and developed by that company from the very beginning. This is just one of numerous examples documented in research by the EU project “Health Innovation Next Generation Payment & Pricing Models” (HI-PRIX, see also box). But it is gradually becoming the rule, which needs to be taken into increasing consideration in price negotiations for the reimbursement of pharmaceuticals between the health insurance funds and hospitals on the one hand and the pharmaceutical companies on the other.
HEALTHY EUROPE
What advantages would that have from the perspective of public sector representatives, i.e. government and administration?
Claudia Wild: Pharmaceutical companies often argue that their major and high-risk investments before medical innovations reach market authorisation necessitate the high reimbursement prices. However, these amounts for research and development are frequently by no means as high as presumed. On the other hand, state subsidies are hardly taken into consideration during price negotiations, or indeed not at all. These subsidies range from financing for universities that conduct fundamental and applied research, as well as funding for technology transfer offices as an interface between scientists and the private sector, through to support via money and know-how for start-ups. In addition, there is research funding at European, natural and regional levels, as well as local state funding to attract new businesses and specifically pharmaceutical companies. Generally speaking, the overall infrastructure supplied by states naturally also plays a considerable role. All this financial support from the state for the development of medical innovations needs to be listed clearly and transparently.
The major pharmaceutical companies are not nearly as innovative as the public assumes.
HEALTHY EUROPE
This is also set to be part of the new pharmaceutical legislation planned by the European Union, which aims to achieve greater transparency for the future use of public funds for research and development in the pharmaceutical sector, among other things. Will that also contribute to better access to medical innovations for all, and to fair prices?
Claudia Wild: If the EU pharmaceutical legislation is passed as currently planned – and right now it looks like this will happen – then that is to be expected. Specifically, it is a complex challenge to present a transparent list of the public funds that have benefitted a certain new medicine. For this reason, the Austrian Institute for Health Technology Assessment in connection with the EU project “Health Innovation Next Generation Payment & Pricing Models” (HI-PRIX, see also box) have worked together with the Escuela Andaluza de Salud Pública in Spain to develop search strategies for the databases that contain this information. These strategies are now available to researchers and everybody else who wants to bring clarity to public and private contributions to investment in medical innovations. In any case, information that is as precise as possible about the state contribution to developing new active ingredients can be a good argument for representatives from the public sector during price negotiations. And this can help guide pharmaceutical research and development in a direction that is expected to bring the greatest possible benefit for the population, instead of just the greatest possible profits for the private sector.
HEALTHY EUROPE
Can you give some examples?
Claudia Wild: Currently, 42 percent of new drugs are oncology medicines. In addition, according to the AMNOG monitor in Germany that is used to evaluate the cost and benefit of new medicine, two thirds of the new cancer drugs do not bring any added value. But the profits are comparatively high for this type of medicine. For cardiovascular diseases, dementia and depression, as well as other conditions that also constitute a major part of the disease burden, there is relatively little research and development. It would therefore be a good idea to boost public and consequently private investment in these areas.
Claudia Wild was born in 1960 and studied communications & psychology at the University of Vienna. She was CEO of the Austrian Institute for Health Technology Assessment until March 2025.
HI-PRIX: AN EU PROJECT
The EU project “Health Innovation Next Generation Payment & Pricing Models” (HI-PRIX) aims to accelerate affordable access to medical innovations, many of which are now growing increasingly expensive. It is organised into ten “work packages” that predominantly explore the development of new pricing models. Work Package 2 focuses on how the public sector contributes towards developing new therapies. HI-PRIX is a three-year project running from January 2023 to December 2025.
HOW DO CLINICAL STUDIES WORK?
Interventional clinical studies examine the tolerance, efficacy and safety of new active ingredients for medical use. They are divided into four phases that build on one another. In Phase I, initial tests are conducted on a small group of healthy volunteers. The tolerance and safety of the new medicine are assessed to check it is suitable for human use. In Phase II, a medicine is tested for the first time on a group of approx. 100 to 300 patients. This focuses on the ideal dosage, and initial data on efficacy is also collected. In Phase III, details on the efficacy and safety of the new medicine are compiled using hundreds or thousands of patients, compared to a placebo or the standard therapy. In Phase IV, a medicine that has already been awarded authorisation is specifically tested once again, for instance with regard to its effect on patients from different age groups or those with certain underlying medical conditions. Gaining better awareness of rare side effects can be another objective here.
Source: German Federal Ministry of Research, Technology and Space: https://www.gesundheitsforschung-bmftr.de/de/wie-funktionieren-klinische-studien-6877.php, accessed on 30 June 2025