Scientists of Hefei Institutes of Physical Science of Chinese Academy of Sciences study new anti-cancer drugs in the lab (XINHUA) 

Released on July 5, the caustic drama-comedy Dying to Survive quickly found its way to the top of the box office earnings, with ticket sales hitting nearly 3 billion yuan ($439.87 million). The movie is based on the true story of Lu Yong, who was diagnosed with leukemia in 2002 and went on to help himself and more than 1,000 cancer patients acquire cheaper, but unapproved medication from India, where the drugs are much cheaper. Lu's predicament touched millions of Chinese and sparked heated debate over the availability of cancer drugs in China. 

China's National Cancer Center said last year in its annual report that China saw 4.29 million new cases of cancer every year, accounting for 20 percent of the world's total; in addition, cancer kills 2.81 million people every year in China alone. However, cancer requires expensive and long-term treatment, which many Chinese families cannot afford. For example, the average monthly cost per patient of osimertinib, a medication for lung cancer, can amount to more than 50,000 yuan ($7,330). 

As if this was not enough, cumbersome approval procedures are also a major bone of contention for a frustrated public. China Food and Drug Administration estimates that it can take up to several months before a pharmaceutical company is permitted to market a medicine. There are also extreme cases: Cervarix, a vaccine used to prevent cervical cancer and designed by GSK, was approved in 2009 in the United States. However, the British-made vaccine only received the green light from China in 2016. 

Action is, therefore, needed from both the health authorities and pharmaceutical companies to improve access to these drugs and make life easier for patients. 

Cutting red tape 

The Chinese Government's reaction was swift following the release of the film. According to the website of China's State Council on July 18, Chinese Premier Li Keqiang gave specific instructions and urged the department concerned to strengthen measures to reduce the price of cancer drugs and ensure their stable supply. In fact, it is already the fourth time since the beginning of this year that the premier has publicly addressed this issue. 

Following a decision taken at a State Council Executive Meeting chaired by Li in April, China began to eliminate tariffs on all imported cancer drugs as of May 1. Meanwhile, the value-added tax on the production and importation of cancer drugs has also been lowered to 3 percent, compared to the previous 16 percent. According to a rough estimate, these two measures should result in a 20-percent reduction in the price of cancer drugs. 

Authorities are also seeking to negotiate with Chinese and foreign drug companies to lower prices by making cancer drugs available for medical insurance reimbursement. According to industry insiders, even if the price of drugs is reduced, pharmaceutical companies can still see their profits increase arising from more affordable prices and improved sales. 

The first round of negotiations launched in 2017 has already helped cut prices by an average of 44 percent for 15 clinically effective but expensive anti-cancer drugs, such as trastuzumab, rituximab and bortezomib. These drugs have now also been listed for medical insurance reimbursement. 

China's Ministry of Human Resources and Social Security announced in July that it has opened a new round of negotiations for reducing drug prices, which should be completed by the end of September. 

Meanwhile, China has taken steps to shorten the approval time for imported cancer drugs. According to official statistics, the average approval time for imported cancer drugs to be available on the Chinese market was 111 days last year, compared to 420 days in 2014. As proof, regorafenib, a drug for advanced liver cancer, became fully available for Chinese patients in March 2017, just seven months after its approval in the United States. Previously, such approval might have taken five to eight years. 

A new chapter 

However, in the eyes of several industry experts, despite the government measures, these medicines will only be truly affordable for patients when the high costs of research and development (R&D) have been reduced. 

Having worked for 12 years in a couple of international pharmaceutical companies, Li Xing could not agree more. She is well aware of the problems that are part of the traditional R&D process of innovative medicines, which, according to her, is still at the labor-intensive stage. 

"It takes 10 years, 100 scientists working together and $2.7 billion in financing for a drug to be clinically available," she said. Even then, the success rate is only 7 percent, due to many reasons, one of which is information asymmetry in decision-making process. 

Li has been researching on artificial intelligence (AI) since early 2016. She believes that the application of this new technology in the R&D process of innovative drugs will have a decisive impact on the availability of cancer medications. Clinical trials, for example, are a key step that requires a lot of time and effort. Indeed, when clinical trials prove unsuccessful, pharmaceutical companies will suffer huge economic losses. 

On the other hand, AI can foresee certain experimental results at an early stage, thus helping to eliminate experiments whose rate of failure is seen as too high, looking instead for more effective and targeted solutions to reduce costs, she said. According to her conservative estimates, by using AI, the R&D process could be shortened by two to three years. 

As the president and founder of Deep Intelligent Pharma, a global startup dedicated to empowering and accelerating drug development through the most advanced AI technologies, Li hopes that the Chinese Government will be able to increase investment in this area. 

"AI is definitely a historic opportunity for Chinese pharmaceutical companies wishing to expand internationally, all the while closing the gap with their foreign counterparts," she said. 

For her, AI's main advantage resides in the fact that it is able to assimilate the world's most advanced experience, thus solving the problem of lack of experience and manpower of Chinese companies. 

(Comments to lixiaoyu@chinafrica.cn)