In memoriam

Dr John C Martin, former chairman and CEO of Gilead Sciences, Inc, passed away on March 30 in California at the age of 70.

A true innovator, John transformed Gilead from a mid-sized player into a juggernaut in the virology space, pioneering a series of revolutionary single-pill treatments that effectively reduced HIV from a deadly pandemic to a disease that is now both preventable and controllable with highly effective antiretroviral medicines.

Under his stewardship, Gilead created highly effective treatments for hepatitis B and revolutionized the treatment of the hepatitis C virus (HCV) with the launch of Sovaldi, the first oral treatment for HCV in 2013. This was followed by a series of even more effective treatments, which have reduced treatment duration to 12 weeks and cure rates to above 95 percent.

Despite leading a large global pharmaceutical company, John remained a scientist at heart. He religiously attended and actively participated in scientific sessions at international liver meetings. In deference to his critical role in creating global access for HCV treatments, he was often honored as a keynote speaker at these meetings.

However, even more impressive than John’s contributions to the science of medicine was his trail-blazing approach to patient access. The access philosophy, unique in the world of big pharma, continues to define Gilead and was John’s incredible gift to the company and to patients across the planet. Starting with HIV, John and his team at Gilead rewrote the playbook on access to treatment for patients in low- and middle-income countries (LMICs) when he introduced voluntary licensing of Gilead’s innovative medicines.

At the peak of the HIV epidemic in the 1990s, Gilead entered into a series of Voluntary Licensing agreements with generic producers to make quality-assured HIV treatments available at accessible prices across the developing world. As a result, between 2002 and 2017, the number of people on antiretroviral therapy increased from 300,000 to 21.7 million. Treatment with antiretrovirals has averted an estimated 13.1 million AIDS deaths since 2000. Over 20 million HIV patients today have the opportunity to live healthy, productive lives on Gilead’s branded or licensed generic treatments.

Normally, companies tend to launch blockbuster drugs in the most profitable markets such as the US, EU and Japan before planning for LMICs. New drugs, even lifesaving ones, often take years to reach developing countries, and often at prices that are unaffordable for the common person.

When Sovaldi, the first oral treatment for hepatitis C was granted FDA approval in December 2013, Gilead urgently launched a special access programme that made Sovaldi available in developing countries like Pakistan and Egypt within months of its FDA approval. In fact, Pakistan was the first country in the world where patients began treatment with Sovaldi under the Gilead Access Program, at a fraction of the international price of the drug.

In the first 18 months of the programme, over 70,000 patients with hepatitis C were treated in Pakistan, with excellent cure rates. Thanks to the efficacy of Gilead’s HCV cure and the broad reach of its access programme, the elimination of viral hepatitis as a public health threat, once an impossible dream, is now an achievable goal.

At a personal level, through the John C Martin Foundation, which he established in 2014, John and his life-partner, Lillian Lou, actively supported the elimination of viral hepatitis across the developing world, including supporting a project to eliminate hepatitis C in the slums of Islamabad. Lillian made it a point to visit Islamabad to oversee the project and attend the launch of the Prime Minister’s Program for Viral Hepatitis Elimination on World Hepatitis Day 2018. More recently, during the Covid-19 pandemic, when many organizations laid off their domestic workers, the John C Martin Foundation supported them with provision of PPEs and sessions on disease awareness and prevention. Thanks to the Foundation’s efforts, 20 percent of domestic workers were rehired by their employers.

Although John stepped down as the executive chairman of Gilead in 2018, the company’s access approach remained very much alive. When the Covid-19 pandemic struck in early 2020, Gilead’s remdesivir, originally developed for the Ebola virus under John’s leadership, was the first treatment to receive FDA emergency use authorization (EUA). Within two weeks of obtaining the EUA, Gilead signed Voluntary Licensing agreements with nine manufacturers – seven in India, one in Pakistan (Ferozsons) and one in Egypt, to manufacture and supply remdesivir to 127 developing countries.

This was for the first time that a manufacturer in Pakistan was selected to be part of a global manufacturing solution. Within three months of licensing and technology transfer, all of Gilead’s licensees began production and scale-up. By the end of 2020, in only six months, more than 1.74 million people in more than 56 developing world countries had access to the remdesivir medicine .

As a result of Gilead’s voluntary licenses, remdesivir quickly became available in all parts of the globe at prices the LMICs could afford. Sadly, the Gilead Voluntary License approach has not been emulated by manufacturers in the Covid-19 vaccine space. In fact, vaccine nationalism and vaccine diplomacy have upended even the WHO’s efforts to ensure equitable access to vaccines. It is a shame that this proven approach to access has not been employed to address the global vaccine challenge.

Although John Martin is sadly no longer with us to support the fight for access, his legacy continues to shine bright, and the voluntary licenses he introduced to effectively tackle the HIV and hepatitis epidemics could light the way in addressing the vaccine challenge, if others were to follow his example.

Prof Saeed Hamid is professor,Department of Medicine, anddirector of the Clinical Trials Unit at The Aga Khan University.

Dr Huma Qureshi is a consultant gastroenterologist. She is also aresearcher in the field of

gastroenterology.

Osman Khalid Waheed is the CEO of Ferozsons Laboratories Limited.