Pharmaceutical R&D Expenditure Insights from 2020
Intro
Pharmaceutical research and development (R&D) is a critical yet complex field, underpinning the creation of new therapies and medicines. In 2020, a year characterized by unforeseen challenges, particularly the COVID-19 pandemic, R&D spending took on new significance. This article offers an in-depth analysis of the spending trends in the pharma industry during that year. The intent is to illuminate the factors influencing investment decisions, the areas of focus within the industry, and the economic implications surrounding these choices.
Research Overview
Summary of Key Findings
In 2020, total R&D spending among leading pharmaceutical companies reached unprecedented levels. The pandemic significantly reshaped priorities, shifting attention and funding towards vaccine development and related therapeutic areas. Key findings show that R&D budgets were not only extensive but also strategically aligned with both immediate and future healthcare needs. Moreover, investment in digital technology became a focal point, enhancing research efficiency.
Background and Context
Understanding the context of R&D spending requires a look at historical trends and the economic environment. Over the past decade, there has been a noticeable increase in investment in pharmaceuticals, surpassing several trillion dollars globally. This surge stems from a growing demand for innovative treatments, coupled with advances in biotechnology and genomics, which has opened new avenues for drug discovery. By early 2020, the onset of the pandemic resulted in an urgent need for rapid responses, catalyzing not only financial resources but also collaboration among various stakeholders.
According to data from the International Federation of Pharmaceutical Manufacturers & Associations, investments in drug development remained resilient even amidst economic turmoil. The shift towards prioritizing specific therapeutic areas during the pandemic highlighted the industry's capacity to adapt and evolve in response to global health crises.
"The increase in R&D investment signifies a robust commitment to innovation, especially during challenging times."
In summary, 2020 can be seen as a pivotal year for pharmaceutical R&D, shedding light on both the challenges and opportunities within the industry.
Foreword to Pharma R& Spending
Pharmaceutical research and development (R&D) spending is a critical area of focus within the healthcare sector. It shapes the future of medicine and directly impacts public health. The recent trends in spending highlight the dynamic nature of pharmaceutical investments and the underlying factors driving these changes. Understanding this landscape helps stakeholders—from policymakers to investors—gauge the industry's direction and its implications on drug availability, pricing, and innovation.
Importance of R& in the Pharmaceutical Industry
R&D plays an essential role in the pharmaceutical industry. It is the process through which new drugs are discovered, developed, and brought to market. This process often involves a high degree of uncertainty and risk. R&D is not merely about inventing new medicines; it also includes improving existing ones and identifying better methods for treating diseases. The outcomes are critical for advancing healthcare and improving patient outcomes.
Moreover, R&D drives economic growth through job creation and enabling technological advancements. An increase in R&D expenditure can stimulate innovation, leading to the emergence of novel therapies. This creates opportunities for collaborations and partnerships, which can further enhance the efficiency and effectiveness of drug development.
Overview of Spending Trends
The spending trends in pharmaceutical R&D have evolved significantly over recent years. Notably, in 2020, expenditures surged as companies reacted to the urgent need for solutions related to health crises like COVID-19. Analysts observed that pharmaceutical companies allocated a larger portion of their budgets to vaccine research and producing treatments for SARS-CoV-2. However, traditional therapeutic areas such as oncology and infectious diseases also maintained substantial investment levels.
"Pharmaceutical R&D is at the forefront of addressing global health challenges, reflecting a growing commitment to innovation in drug discovery."
Historically, R&D spending has been characterized by cyclical patterns, often influenced by market conditions and regulatory drives. Factors contributing to these trends include:
- Increased Complexity: Modern drug development demands more sophisticated methodologies, often leading to higher costs.
- Regulatory Requirements: Changing regulations can impact how much companies need to invest to meet compliance standards.
- Market Competition: With a greater focus on precision medicine, companies are incentivized to invest more to create targeted treatments.
Overall, understanding these trends is essential for navigating the ever-changing pharmaceutical landscape. Stakeholders need to be aware of the implications of spending patterns on access to medicines, healthcare systems, and public health outcomes.
Global Pharma R& Expenditure
The examination of global pharmaceutical research and development expenditure is crucial in understanding the financial landscape of the industry. It provides valuable insights into how resources are allocated, which therapeutic areas are prioritized, and how these initiatives influence innovation. A comprehensive view of expenditure patterns reveals underlying trends that can inform stakeholders about potential opportunities and challenges within the sector.
Evaluating R&D spending allows for a deeper understanding of the financial commitment that pharmaceutical companies make towards drug discovery and development. This commitment not only reflects the intention to innovate but also directly impacts the pace at which new therapies reach the market.
Total R& Investments in
In 2020, global pharmaceutical R&D investments reached a significant milestone. According to industry estimates, total spending in this domain surpassed $180 billion. This figure demonstrates the ongoing commitment of pharmaceutical companies to advance science and address clinical needs. The pandemic acted as a catalyst, prompting investments that might not have been seen otherwise.
A substantial portion of this expenditure was channeled into vaccine development, specifically focusing on COVID-19. For example, companies like Pfizer and Moderna dedicated considerable resources to the rapid development and distribution of mRNA vaccine technology, a novel approach in the landscape of vaccine R&D.
Now, a closer look at spending distribution reveals major therapeutic areas receiving the bulk of R&D funds. Oncology and infectious diseases attracted the most investment. This trend coincides with rising disease prevalence and an increasing demand for innovative treatment solutions.
Comparison with Previous Years
When comparing 2020 spending with previous years, several trends are noteworthy. Between 2019 and 2020, there was a marked increase in overall R&D expenditure, reflecting the urgency posed by the COVID-19 pandemic.
In years prior, average annual R&D spending ranged from $150 billion to $160 billion. The uptick in 2020 underscores not just a reaction to the pandemic but also a shift in strategic focus toward critical health challenges. Companies are now more inclined to invest in areas with immediate public health relevance.
Several key factors influenced this rise in spending:
- Increased Innovation: The manufacturing and adoption of novel drug modalities.
- Regulatory Support: Favorable conditions for accelerated approvals.
- Collaborative Initiatives: Increased partnerships among pharmaceutical companies, governments, and research institutions.
Thus, analyzing global pharma R&D expenditure provides a clear picture of how the industry is adapting to meet evolving health challenges while also highlighting financial commitments and trends from both a historical and current perspective.
In an ever-changing landscape, understanding R&D spending is crucial for forecasting future developments in healthcare.
Sector-wise Breakdown of R& Spending
The sector-wise breakdown of R&D spending is pivotal in understanding how pharmaceutical resources are allocated. Different therapeutic areas demand varying levels of investment, influenced by factors such as disease prevalence, potential for innovation, and market demand. This breakdown identifies where funds go and why, offering insight into industry priorities. The analysis can help stakeholders determine investment strategies and assess where breakthroughs in drug development are likely to occur.
Therapeutic Areas of Focus
Oncology
Oncology is a central focus of R&D spending due to the rising incidence of cancer globally. The complexity of cancer as a disease necessitates significant investment in research to develop effective treatments. One key characteristic of oncology is its rapid pace of innovation, with continuous advancements in immunotherapy and targeted therapies.
Oncology represents a lucrative area because of high market demand and potential for high returns on investment. The unique feature of oncology is its diverse treatment modalities and the ability to personalize therapies based on genetic information. However, it also comes with high costs and longer development times, posing risks for pharmaceutical companies.
Central Nervous System Disorders
The R&D spending on Central Nervous System (CNS) disorders reflects the growing need to address mental health issues and neurodegenerative diseases. Disorders like Alzheimer's and Parkinson's are on the rise, making them significant areas for research. One key characteristic of CNS disorders is the complexity of brain science, which presents both opportunities and challenges for drug developers.
This sector is popular due to the urgent need for effective treatments and solutions for aging populations. A unique feature of CNS research is its interdisciplinary nature, often requiring collaboration across various scientific fields. However, the high failure rates in clinical trials remain a concern, as many CNS drugs do not successfully reach the market.
Infectious Diseases
Infectious diseases have garnered attention due to global health threats, such as the COVID-19 pandemic. This area of R&D spending is crucial for responding to emerging pathogens and public health crises. Key characteristics include the fast-paced nature of developing treatments and vaccines, as well as the need for global collaboration.
The significance of infectious diseases research is underscored by the immediate impact on global health. The unique feature here is the ability to mobilize resources quickly in response to outbreaks. However, competition for funding can be intense, particularly for diseases that may not receive attention until they pose a significant threat.
Cardiovascular Diseases
Cardiovascular diseases remain the leading cause of death worldwide, making them a critical area in R&D spending. Investment in this sector is driven by the necessity to develop innovative treatments that improve patient outcomes. One key characteristic is the ongoing research into risk reduction and personalized medicine strategies.
This focus is beneficial due to the chronic nature of these diseases, which often require long-term management solutions. A unique feature of cardiovascular research is its potential for preventative strategies, which may reduce the overall burden of disease. However, with large populations affected, the challenge remains to effectively differentiate products in a crowded market.
Emerging Markets vs Established Markets
The distinction between emerging markets and established markets is significant in terms of R&D investment behavior. Established markets typically see higher spending due to mature health systems and extensive regulatory frameworks. In contrast, emerging markets often present new opportunities for growth but may have limited resources and infrastructure. Understanding these dynamics can guide pharmaceutical companies in their investment decisions and highlight areas where innovation can thrive.
Impact of COVID-19 on R& Spending
The COVID-19 pandemic has profoundly influenced pharmaceutical research and development expenditures in 2020. Its effects were both immediate and far-reaching, leading to significant shifts in priorities and allocation of resources. Understanding how the pandemic has altered R&D spending is critical to comprehending current trends in the pharmaceutical industry.
Shift in Priorities and Focus Areas
As the pandemic spread, pharmaceutical companies faced an urgent need to address a global health crisis. This led to a realignment of research priorities. Companies redirected funds from existing projects to focus on developing therapies and vaccines for COVID-19. This was a drastic shift, especially for firms that had been primarily investing in research for chronic diseases like diabetes or heart conditions.
The urgency of responding to the pandemic compelled companies to innovate rapidly. Collaborative efforts increased among various stakeholders in the healthcare ecosystem. For instance, many companies entered into partnerships with governmental and academic organizations to accelerate research processes. A clear example of this can be seen in the collaboration between Pfizer and BioNTech, which focused on developing an mRNA vaccine in record time.
Additionally, funding was concentrated on therapeutic areas directly impacted by the virus. Health technologies, diagnostic testing, and supportive care received new investments, exhibiting how the landscape of pharmaceutical R&D can change swiftly in response to external pressures.
Funding for Vaccine Development
Vaccine development became one of the central themes of pharmaceutical R&D spending during the pandemic. Governments and private entities invested unprecedented sums into developing COVID-19 vaccines. For instance, the U.S. government initiated Operation Warp Speed, funneling significant financial resources into various vaccine candidates to expedite their development and distribution.
The immense funding facilitated not only faster research but also crucial trial phases that would ordinarily take years. The focus was on ensuring safety and efficacy through diverse approaches.
Various platforms, like mRNA technology used by Moderna and Pfizer-BioNTech, received large-scale investments to demonstrate their potential in vaccine creation. Companies realized that the public eye was on them, and the stakes were higher than ever, necessitating a commitment to transparency and rapid results.
"The investment in COVID-19 vaccines has set a precedent for future R&D initiatives, demonstrating what is possible when urgency and funding align."
In summary, the focus on vaccine development not only reshaped funding priorities but also opened discussions about future epidemic preparedness. The dramatic changes brought about by COVID-19 have laid a new foundation for how R&D spending will be approached in the future.
Understanding these influences is crucial for industry stakeholders. They must recognize that adaptability and collaboration are essential elements in navigating the changing landscape of pharmaceutical R&D.
Economic Factors Influencing R& Spending
Pharmaceutical research and development (R&D) is a costly undertaking, where economic factors play a crucial role in shaping investment decisions. Understanding these factors is vital for stakeholders to navigate the complexities of the pharmaceutical landscape. Considerations such as the cost of drug development and return on investment (ROI) significantly affect how pharmaceutical companies allocate their resources.
Cost of Drug Development
The drug development process is notoriously expensive. Traditionally, it has been estimated that developing a new drug can cost upwards of billions of dollars. This expense encompasses a series of phases, from preclinical research to clinical trials, each with its own set of financial demands.
The factors contributing to these high costs include:
- Research Staff: Salaries and benefits for the specialized workforce needed.
- Clinical Trials: Expenses related to recruiting patients, monitoring their health, and ensuring compliance with regulations.
- Regulatory Compliance: Costs incurred to meet the stringent requirements set forth by agencies such as the Food and Drug Administration (FDA).
- Time Frame: The lengthy duration of drug development, often spanning years, increases costs due to inflation and the need for continuous funding.
Moreover, the failure rates in drug development remain high, with many candidates not making it to market. This uncertainty further complicates the economic landscape.
Return on Investment Analysis
Return on investment is a critical metric that influences R&D spending decisions in the pharmaceutical industry. Executives are often compelled to evaluate the projected returns relative to the costs incurred in drug development. A favorable ROI motivates increased investment in R&D, while unfavorable projections can lead to cautious spending.
Several aspects influence the return on investment in pharma R&D:
- Market Potential: A drug that addresses a significant or unmet medical need is likely to generate substantial revenue, thus enhancing ROI perspectives.
- Patent Life: The exclusivity period granted by patents directly impacts the time available for a company to recuperate R&D investments before generic alternatives enter the market.
- Market Access and Pricing: The ability to negotiate favorable pricing and access within healthcare systems plays a crucial role in overall profitability.
- Competitive Landscape: The number of existing and potential competitors may affect the projected revenue, thus impacting financial strategies.
Regulatory Environment and Its Impact
The regulatory environment plays a crucial role in pharmaceutical research and development (R&D), shaping how companies conduct their studies and bring new drugs to market. A well-defined and responsive regulatory framework encourages innovation while ensuring that safety and efficacy standards are met. This section explores significant regulatory changes that occurred in 2020 and examines the speed of drug approval processes, factors that influence R&D spending, and the overall impact on the industry’s landscape.
Regulatory Changes in
In 2020, several notable regulatory changes influenced pharmaceutical R&D spending. These adjustments were largely responses to the urgent need for COVID-19 treatments and vaccines. Regulatory agencies, such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA), implemented measures to enhance flexibility in the approval processes.
Some key changes included:
- Emergency Use Authorizations (EUA): The EUA allowed companies to gain rapid access to market for promising COVID-19 therapies, bypassing some traditional lengthy approval stages. This created precedence that might continue beyond the pandemic.
- Accelerated Approval Pathways: For drugs with significant unmet needs, regulatory bodies emphasized quicker pathways to market, promoting faster clinical trial designs and encouraging adaptive trial designs.
- Real-World Evidence (RWE): Increased acceptance of real-world data became a trend in 2020. Regulatory bodies recognized the value of post-market surveillance and patient outcomes in informing decisions about drug efficacy at a broader scale.
These changes paired with the urgency of the global health crisis led to increased funding for R&D in 2020. Companies shifted their focus to align with these rapid regulatory changes, necessitating adjustments in their strategic planning.
Speed of Drug Approval Processes
The speed of drug approval processes significantly affects R&D spending. In 2020, the pandemic prompted regulatory bodies to prioritize efficiency without compromising patient safety. This acceleration led to a paradigm shift in how quickly drugs could be developed and brought to market. The following factors contributed to this change:
- Innovations in Clinical Trials: Adoption of virtual trials and digital health technologies streamlined data collection and patient recruitment, allowing for faster analysis and reporting.
- Coordination Among Stakeholders: Increased collaboration between pharmaceutical firms, regulatory agencies, and public health organizations expedited the processes necessary for approvals. This environment fostered better communication and alignment on expectations and requirements.
- Resource Allocation: With heightened investments in biotech and vaccine development, companies allocated more resources to ensure compliance with new regulatory expectations. This focus also included training for staff on navigating new processes and guidelines.
"In 2020, the regulatory landscape became more responsive, demonstrating the critical balance between safety and the need for rapid advancements in drug approval."
The adjustments made in 2020 set a precedent for future regulatory practices in the pharmaceutical industry, paving the way for a potentially more rapid and adaptive approach to R&D spending and drug development.
Collaboration and Partnerships in R&
Collaboration and partnerships are crucial in the pharmaceutical research and development (R&D) landscape. The complexity of drug development requires diverse expertise and shared resources. Establishing strategic alliances enables companies to pool knowledge and capabilities, leading to more effective and efficient processes.
Collaborations can take many forms, from joint ventures between pharmaceutical firms to partnerships with academic institutions and research organizations. Such partnerships can enhance innovation, accelerate timelines, and reduce costs. By leveraging the strengths of different entities, the pharmaceutical industry can respond more adeptly to market demands while also addressing the increasing challenges of drug development.
Pharmaceutical and Biotechnology Collaborations
Pharmaceutical and biotechnology collaborations have become a fundamental aspect of R&D in recent years. These partnerships focus on combining the technical skills of biotechnology firms with the financial and regulatory experience of established pharmaceutical companies.
A notable benefit of these collaborations is the idea of shared risk. Drug development inherently involves high levels of uncertainty. Both parties can share this burden, making it more manageable. For instance, when a larger pharmaceutical company collaborates with a smaller biotech firm, the smaller entity benefits from additional funding and expertise, while the larger company gains access to innovative technologies or drug candidates that it may not have developed internally.
In 2020, many companies entered into such collaborations to expedite the development of COVID-19 vaccines and therapies. These partnerships facilitated rapid progress in research by leveraging existing technology platforms and expertise.
"Successful collaborations can significantly cut development time and costs, all while enhancing innovation."
Public-Private Partnerships
Public-private partnerships (PPPs) play a vital role in the landscape of pharmaceutical R&D. These collaborations often involve governmental agencies, non-profit organizations, and private entities working together to tackle public health challenges. Such partnerships can address significant issues like infectious diseases, which often require vast resources and coordinated efforts.
The GOARN initiative is a prime example of a successful public-private partnership. This global network combines diverse resources from public health organizations and private sectors to enhance preparedness and response to health emergencies. In 2020, the emphasis on public-private partnerships increased, driven primarily by the urgency of the COVID-19 pandemic.
PPPs facilitate access to funding, expertise, and infrastructure, enabling faster and more effective responses to health threats. They provide a platform for collective action, bringing together stakeholders with different areas of expertise and sharing goals. This collaboration can lead to innovative solutions that might not be achievable by individual entities.
Technological Advancements in Drug Development
Technological advancements in drug development have become a cornerstone in the field of pharmaceutical research and development. These innovations enhance the efficacy of procedures and increase the success rate of drug approvals. In 2020, the surge in technology use significantly influenced the dynamics of R&D spending. Companies recognized the necessity of integrating advanced technologies to streamline processes, reduce costs, and ultimately deliver better therapeutic options to patients.
Role of Artificial Intelligence
Artificial Intelligence (AI) is at the forefront of these advancements. AI algorithms enable researchers to process vast amounts of data rapidly. This capability is essential in identifying potential drug candidates with higher accuracy than traditional methods. By analyzing patterns within existing data, AI can predict the interactions of compounds with biological targets. This predictive ability minimizes the time and resources spent on unsuccessful trials.
Moreover, AI enhances the design of clinical trials. Adaptive trial designs, supported by AI, allow for real-time adjustments based on incoming data. This flexibility can lead to more efficient trials, giving a significant competitive advantage in bringing new drugs to market. Companies like IBM are already leveraging their Watson platform to sift through literature and clinical trial data, aiming to uncover new insights that could lead to novel therapies.
Data Analytics and Drug Discovery
Data analytics has also transformed the landscape of drug discovery. Data-driven approaches facilitate deeper insights into disease mechanisms and improve the targeting of therapies. By utilizing advanced analytics, researchers can decode biological data and environmental factors that affect drug efficacy. This shift toward a more evidence-based framework leads to informed decision-making throughout the R&D process.
The importance of integrating data analytics is evident when evaluating the success rates of drug candidates. With precise data models, the probability of successful outcomes in the later stages of development increases drastically. Companies are now capable of adopting an evidence-based strategy, which allows them to allocate resources more effectively.
"The integration of AI and data analytics is redefining drug development, promoting a more predictive and evidence-driven approach that escalates the pace of innovation."
In summary, advancements in technology, through tools like AI and data analytics, are not merely optional enhancements; they are essential for the pharmaceutical industry to thrive in a competitive market. The shift toward adopting these technologies illustrates a significant paradigm shift in how R&D spending is approached, paving the road for efficient and successful drug discoveries.
Outlook for Pharma R& Spending Post-2020
Understanding the outlook for pharmaceutical research and development (R&D) spending after 2020 is vital. As we emerge from a tumultuous global scenario, the landscape of pharma R&D will likely shift significantly. Factors including ongoing technological advancements, regulatory changes, and a greater emphasis on public health will shape future investment strategies. Adapting successfully to these influences will allow companies to maintain competitiveness and innovation.
Predictions for Future Investments
Predictions about future investments in pharma R&D are influenced by several driving forces. Here are the key areas to watch:
- Increased Focus on Personalized Medicine: The shift toward personalized medicine indicates that companies will allocate more funds to research and development in genomics and biotherapeutics. This may lead to a more tailored approach in addressing diseases, potentially improving patient outcomes.
- Boost in Digital Health Technologies: Spending on digital health solutions will likely grow. The need for innovative technologies that support telehealth and remote patient monitoring can drive new investment opportunities.
- Sustainability as a Driving Factor: Pharmaceutical companies may prioritize sustainable practices in R&D. Investments focused on developing environmentally friendly drug manufacturing processes will gain traction, aligning with broader corporate responsibility trends.
Predictions suggest a compound annual growth rate in R&D spending, indicating a strong post-2020 recovery and renewed investment.
Potential Disruptions in the Industry
As we project forward, it is essential to identify potential disruptions that could alter the trajectory of R&D spending in the pharmaceutical industry.
- Regulatory Changes: Evolving regulations, while necessary for patient safety, may create challenges for R&D timelines and costs. Companies will have to navigate this landscape carefully to comply while retaining agility in drug development.
- Economic Uncertainty: Factors such as inflation, drug pricing pressures, and reimbursement policies can influence funding decisions. Economic shifts could lead to companies reassessing their financial commitments in R&D endeavors.
- Market Competition: The increasing number of biotech start-ups can disrupt traditional pharmaceutical companies. These emerging players may bring innovative solutions faster, therefore influencing investment strategies among larger firms.
- Global Collaboration Trends: Increased partnerships across borders, including public-private collaborations, may redefine traditional funding models and project frameworks.
Closure
In concluding this comprehensive analysis of pharmaceutical R&D spending in 2020, it is vital to grasp the core elements that this review has highlighted. The landscape of pharmaceutical research and development has undergone significant shifts, driven by economic factors, global health crises, and evolving technological advancements. This overview has illustrated not only the expenditures in various sectors but also the strategic importance of these investments in fostering innovation and meeting public health needs.
Key findings reveal that despite the challenges presented by the COVID-19 pandemic, many companies increased their focus on priority therapeutic areas, notably vaccine development and treatments for infectious diseases. The economic implications are profound, as investments in R&D do not merely contribute to company profitability but also influence broader market stability and societal well-being.
The implications of these findings extend beyond the immediate data; they pave the path for future investments and could potentially redefine industry practices. With the shifting regulatory environment and the emerging role of technology such as artificial intelligence, understanding how these forces interact will be critical for stakeholders in the pharmaceutical sector.
"Investment in R&D is not just an expense but a building block for future health solutions."
This conclusion emphasizes the importance of sustained investment in pharmaceutical R&D, ensuring the industry can adapt and thrive in response to both challenges and opportunities in the future.
Summary of Key Findings
Several key points emerged from the analysis of pharma R&D spending in 2020:
- Increased Spending: Overall, investment levels rose, particularly in vaccine research prompted by the pandemic.
- Focus Areas: Oncology and infectious diseases dominated the therapeutic investments.
- Strategic Partnerships: Collaborations between pharmaceutical companies and biotech firms increased significantly, aiding in rapid development cycles.
- Regulatory Adaptations: Regulatory bodies adapted processes, speeding up approval times for pandemic-related solutions.
Implications for the Future of Pharma R&
Looking ahead, the implications of the 2020 spending patterns are far-reaching. The following points represent potential shifts and considerations for the pharmaceutical industry:
- Sustained Investment: Companies will likely maintain robust R&D budgets to keep pace with public health needs and competition.
- Innovation Drivers: Continuing advancements in technology (like AI) will streamline drug development processes and increase efficiency.
- Economic Considerations: There will be an emphasis on analyzing return on investment to justify R&D expenditures.
- Global Collaboration: Increased cooperation across borders in research and data sharing can enhance drug development efforts worldwide.
In summary, the lessons learned from 2020 are critical for informing future directions in pharmaceutical R&D, ensuring that the industry remains adaptable, innovative, and responsive to global health challenges.
