Legacy & Leap

We can now cure some cancers that failed every other treatment and correct genetic disease with a single dose, at prices few health systems can absorb. The orphan drug gold rush rewarded profitable niches; is that the incentive working as designed, or working against population health? At the other end of the scale, GLP-1s, direct-to-consumer channels, and AI-driven risk prediction are reshaping who captures value and when. The paradoxes multiply. Why invest in cures when chronic management generates predictable revenue, and what happens when chronic treatments become essential for millions? Hepatitis C cures shrank their own market; are GLP-1s the next version of that, or the warning? Does direct-to-consumer align incentives with patients, or just move who gets left out? And as AI predicts disease before it manifests, who pays for prevention that never shows what it prevented?

The past 20 years proved that the biggest health challenges don't respect borders, and neither do the best solutions. And capability itself is redistributing: research strength, manufacturing capacity, and capital are no longer concentrated where they were in 2006, which means more partners, more infrastructure, and more patients who can participate in research and benefit from it. Yet collaboration is getting harder when we need it most, as data nationalism, political tension, and climate-driven shifts in disease patterns pull in the opposite direction. Where are the shared challenges that transcend commercial competition, and how do we protect collaboration in those spaces when political winds shift? What governance and trust-building would enable distributed innovation? Which existing partnerships are working, and what makes them resilient?

Carl Johan Sundberg
Vice President, Karolinska Institutet Nord