Public-private partnerships: To infinity and beyond!

By Margaret Anderson, managing director, and Kimberly Myers, principal, Deloitte Consulting LLP

Ten months. People searching for proof that public-private partnerships work—and hold infinite promise—have merely to look at 10 extraordinary months in 2020, when the United States government, biopharmaceutical companies, and academia teamed up to develop breakthrough vaccine innovations in response to COVID-19. Within 10 months, the public-private biomedical ecosystem produced the first mRNA vaccine—and gained emergency use authorization—to fend off severe disease and death during the most devastating pandemic since 1918.¹

Government has been a disruptive force for innovation across many sectors, from the Defense Advanced Research Projects Agency² (DARPA) laying the foundation for the internet in the 1960s, to the US Department of Energy and National Institutes of Health’s (NIH) role in the Human Genome Project,³ to the President’s Emergency Plan for AIDS Relief (PEPFAR) initiative that has saved more than 25 million lives from HIV/AIDS across the globe.⁴ There is a growing interest in making more investments in the federal health infrastructure to accelerate biomedical innovation. Two federal health agencies have been tasked with advancing later-stage research: The National Center for Advancing Translational Science (NCATS), and the Advanced Research Projects Agency for Health (ARPA-H). Both were formed in 2022.^5,6

The scale and speed of COVID-19 vaccine development provides a model for how government can work with non-government partners to advance care and treatment for all diseases. A challenge may be in leveraging lessons learned from COVID-19 in future collaborations, crisis or not.

Partnering may be the best way forward

Deloitte recently interviewed leaders in government, biopharma, nonprofits, academia, and philanthropy for their perspectives on key drivers of innovation, partnership challenges and opportunities, and the role of government in discovery and development. Our new publication, Unlocking the potential of biomedical innovation: The crucial role of government and partnerships in accelerating progress, proposes three ways government can work with partners to help foster disruptive biomedical innovation:

• Leverage the full continuum of collaboration to help foster innovation.
• Prioritize patients and communities in the innovation pipeline.
• Implement last-mile infrastructure to support high-risk research endeavors.

Leverage the full continuum of collaboration to help foster innovation

COVID-19 vaccine development elevated shared public-private collaboration to a new level. Pharmaceutical companies, government agencies, and regulators came together and agreed that a COVID-19 vaccine was needed to save lives. But they had to determine the best path to get there quickly and safely. Developing a vaccine that prevented COVID-19 might have been possible, but it likely would have taken a substantial amount of time. The chosen path? Developing a vaccine that helps diminish and decrease the severity of the disease and its symptoms—a much faster process. This collaboration, along with the design of development rules, produced a tightly focused and competitive environment. It also helped to bring the innovation closer to the regulation by which a new vaccine would likely be measured and evaluated. And—importantly—it helped to create a vaccine at a faster pace.

Even before COVID-19, federal health partnerships that fostered innovation by sharing assets, expertise, and knowledge, and reducing administrative red tape were gaining ground. Examples include the National Cancer Institute (NCI) Formulary; the NIH Pragmatic Trials Collaboratory, and several NCATS programs. An important element in these and other partnerships is understanding and appreciating what each player brings to the table. Oftentimes, a company, agency, or group opts to go it alone. But it is unlikely any single entity has all of the necessary scientific, business, and market expertise. Going into the process with an equal voice for each organization that can offer expertise, or a different perspective, will likely make program implementation easier and more successful.

Prioritize patients and communities in the innovation pipeline

Recent years have seen a growing recognition of the importance of patient and community perspectives to improve the efficiency and effectiveness of the clinical research process. However, it appears much work remains.⁷ Typically, a scientific hypothesis is determined by a small group of people in a lab setting or with their doors closed. The ideal path might be for researchers to go to the community and ask, “What do you want?” “What do you focus on?” “What bothers you?” “What are some things that you need as a community?” That input might then be used to inform the research question being developed.

A number of recent federal health efforts have combined patient voices with COVID-related community engagement work. The NIH Community Engagement Alliance (CEAL) enlists patients to address the disproportionate impact of COVID-19 on underserved communities. The program collaborates with local community organizations to develop deeply tailored messaging and interventions suited to different cultural contexts.⁸ By directly partnering with communities and patients, agency leaders can work to rebuild trust and improve the quality and relevance of innovation.

This is the point of ARPA-H: To be an innovation engine that helps address market-related health issues. It could be used for massive challenges like finding cures for cancer, or for solving day-to-day problems such as improving access to care for people in underserved communities. Some health innovators need research partners and individuals who know the community, who belong to the community, and who interact with the community. It could behoove every part of the health ecosystem to engage with every part of the audience—no one should be an afterthought.

Implement last-mile infrastructure to support high-risk research

We are in an environment where venture capital funding is generally not plentiful, and NIH’s dollars have a purpose that is not necessarily the last mile. How can stakeholders organize infrastructure in a way that helps to move clinical advancements through the pipeline and gets therapies and programs to people more quickly?

Part of the challenge is that taking things to the last mile can be fragmented, and there may not be a clear vision. Also, the incentives might not be great, or they could be misaligned—incentivized organizations might be focused on making a profit. And while ARPA-H may be able to help fill the funding gap, the jury may be out until we start to see successes and failures from its initiatives.

Optimal examples of success don’t yet exist in the health space, but there is opportunity to draw on leading practices from other industries and markets. For example, DARPA, a central research development organization for the Department of Defense, collaborates with businesses and educational institutions to make pivotal investments in breakthrough technologies for national security.⁹

Implementing the last mile of translational research—the delivery of therapeutics and devices to the patient bedside—might be one of the hardest steps for any innovative idea. But it is often an important step, especially as private sector funding declines for commercialization. Private-public partnerships could be the future.

Acknowledgement: Nina Gonzalez

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Endnotes: 

¹ Pfizer, "Pfizer and BioNTech Celebrate Historic First Authorization in the U.S. of Vaccine to Prevent COVID-19," press release, December 11, 2020.

² About DARPA.

³ Genome.gov. “Human Genome Project Fact Sheet,” last modified August 24, 2022.

⁴ The United States President's Emergency Plan for AIDS Relief - United States Department of State %

⁵ National Center for Advancing Translational Sciences. "Strategic Goal 2: Advance translational team science by fostering innovative partnerships and collaborations with a strategic array of stakeholders," accessed May 5,2023.

⁶ National Center for Advancing Translational Sciences (NIH). “November 4, 2021: Accelerating Health Solutions for All: Reflections on NCATS and ARPA-H,” accessed May 5, 2023.

⁷ Yasser Bhatti et al., “Putting humans at the center of health care innovation,” HBR, Mar 2, 2018.

⁸ Alejandra Casillas et al., “Community engagement to address the disparate impacts of the COVID-19 pandemic in California,” NCBI, Nov 30, 2022.

⁹ About DARPA.

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.

Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

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