1. Development of a single new drug costs several billion.[0] There are outliers which cost less, but billions is a decent estimate on average. 2. There is

1. Development of a single new drug costs several billion.[0] There are outliers which cost less, but billions is a decent estimate on average. 2. There is continuing need for new drugs: in 2023, FDA approved 55 new drugs [1] not including new indications for existing drugs (which also cost money to achieve). 3. It therefore follows that (in the current regulatory environment) just maintaining the current level of development and approval of new drugs would probably cost over 100 billion per year (possibly not including manufacturing and supply). 4. Drug development is therefore hellaciously expensive, while being high risk (i.e. high risk of failure) and a long-term endeavor. 5. In our current world, the model that has evolved is that this money is raised from investors, entrusted to experts, and if everything goes well, capital plus profit are recouped via drug prices. Payors swap huge up-front costs with an uncertain outcome, for later huge costs with a known outcome. 6. Replacing this model would therefore likely take global collaboration between governments, funding expensive high-risk long-term projects, with the end-goal of (much) cheaper drugs - an end-goal that would likely take a decade to meaningfully realise (importantly, much more than a single electoral term). It would be politically momentous, as it would effectively destroy a significant and established sector of the economy. 7. As much as I like this concept, I simply don't see any evidence that we're even close to ready for such a model of global collaboration and funding. Even when the challenge was urgent and potentially existential (e.g. a global pandemic) the response was often the opposite of collaborative. 8. Interestingly, though, it wouldn't even be very expensive on a world scale. The GDP of (just) the top 20 nations is roughly 88 trillion.[2] 100 billion is barely over 0.1% of that. If you shared the cost by GDP amongst the top 20, US and China would pay a lot, but involved European nations would pay in the region of 2-5 Bn/year. 9. This obviously doesn't deal with the issue of ongoing costs for already-approved drugs... === [0] https://www.forbes.com/sites/matthewherper/2017/10/16/the-cost-of-developing-drugs-is-insane-a-paper-that-argued-otherwise-was-insanely-bad/ https://www.forbes.com/sites/matthewherper/2017/10/16/the-co... [1] https://www.fda.gov/drugs/novel-drug-approvals-fda/novel-drug-approvals-2023 https://www.fda.gov/drugs/novel-drug-approvals-fda/novel-dru... [2] https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal) https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...