1. Healthcare Need & Commercial Opportunity Emerging Markets

2. MeTA Need State of the art care for the few? Basic care for everyone? Quality essential care for everyone?

4. MeTA Needs BRICs – Diabetes, cardiovascualar, anti infectives, vaccines Developing World – Vitamin A, parasite control, malaria, insecticides, reproductive health

5. MeTA The Objective Equitable access – Social cohesion Affordable care – Appropriate price and cost Sustainability – Balance between best care for all and efficient optimisation of care

6. MeTA Healthcare System Design Complex systems in government hands – Efficient? – Cost effective? Role of the Private Sector – Cost efficiency – Allocation of resources – Insurance model

7. MeTA Commercial Opportunity IMS Health Emerging Markets Forecast – 12% growth – By 2020 30% of Global Pharma Sales – 50% of Global Pharma Sales Growth – China drug spend $15 per person per year, US $950

8. Global Pharma Sales Growth Forecasts

10. MeTA Recent Developments Big Pharma looking for growth – GSK new senior Executive – Pfizer major part of new strategy – Sanofi new markets for ex branded drugs J&J referenced need for – Emerging markets appropriate products

11. MeTA Issues Access Reimbursement IP respect Corruption

12. MeTA Access Marginal price should equal Margin willingness to pay, but – In different countries willingness to pay is dramatically different – Universal Global Pricing denies access to enormous numbers of patients Should there be Tiered Pricing?

13. Producer Revenue Price Quantity Demand Curve Efficiency Loss

14. Price Quantity Demand Curve Efficiency Loss Producer Revenue

15. Current drug access No/limited access People Price Access?

16. MeTA Reimbursement Reimbursement system will determine access and cost parameters Fundamental problem with buyer knowledge in healthcare markets Managed Care as the informed pricing agent Government buyers e.g. UK’s not so nice NICE

17. MeTA IP Lack of IP enforcement – IP underpins the innovation model – Investment is unattractive – Multinationals may not participate – R&D cross fertilisation is inhibited

18. MeTA Corruption Negative relationship between economic development and corruption Positive relationship between multinational penetration and lower corruption High human cost of fake drugs – 30% of drugs in government hospitals in India are counterfeit, 60% of which have no active ingredient

19. MeTA Other Opportunties Outsourcing R&D and Manufacturing – well underway Services Offshoring R&D internalisation – The long game Medical Tourism – $160bn market by 2012 per The Economist