I keep a private test for the word “breakthrough.” When I see it in a press release or a pitch deck, I ask who, specifically, is living differently because of it, and since when.
Most of the time the honest answer is nobody yet. I don’t say that as a criticism of the science. Discovery is hard, and I’ve spent enough years in research to respect every molecule that makes it out of a dish. My concern is with the word, and how often our industry uses it to mark the start of a story as if it were the finish.
The Cure Most People Haven’t Received
Hepatitis C is the example I return to most, because by any scientific standard it is one of the great achievements of modern medicine. For more than a decade, a disease that once meant months of interferon injections and uncertain odds has been curable with a short course of pills. If any therapy has earned the word, this one has.
Yet the World Health Organization’s 2024 Global Hepatitis Report found that of the roughly 50 million people living with hepatitis C at the end of 2022, only 36% had been diagnosed and 20% had received curative treatment. Four out of five people with a curable infection had not been cured.
Hepatitis B tells a similar story with starker numbers. We have had an effective vaccine for decades and inexpensive antivirals for years; the WHO’s global benchmark price for tenofovir is about $2.40 a month. Of the 254 million people living with hepatitis B, 13% had been diagnosed and roughly 3% were on treatment. Viral hepatitis killed an estimated 1.3 million people in 2022, up from 1.1 million in 2019.
Every one of those deaths occurred in a world that already had the molecules. The people who died were lost somewhere in the long stretch between a scientific answer and the person who needed it.
Walking the Distance
Hepatitis C makes a good guide for walking that stretch one step at a time.
The science was settled first. Clinical trials showed the new regimens worked, and regulators agreed. That part generated the headlines, the awards, and most of the investment.
Then came diagnosis, and the numbers fell off. Hepatitis C can stay quiet for years, so a person has to be tested before they know there is anything to treat. As of 2022, nearly two-thirds of people living with the virus hadn’t reached that point. No amount of pharmacology can help someone who doesn’t know they are sick.
Then access. A diagnosis has to turn into a prescription, the prescription into a medicine someone can obtain, and the medicine into something a health system or a household can pay for. The WHO report found that only four of 24 reporting countries paid at or below the global benchmark price for a standard 12-week hepatitis C course. Generic medicines exist; many health systems still don’t buy at those prices.
And finally daily life. I started my career as a pharmacist, and this last step is the one a pharmacy counter teaches you to see. A prescription is a piece of paper until someone fills it, understands it, and keeps taking it. The questions people bring to a pharmacist are rarely about mechanism of action. They are about cost, timing, food, side effects, and whether the medicine will fit around a shift at work or a child’s school schedule. Those questions decide outcomes as surely as any receptor does.
A 2003 WHO report on long-term therapies found that adherence among people with chronic diseases averaged only 50% in developed countries. The same report made an observation I still think about: “Improving adherence may well result in better health outcomes than making available new technologies.”
That sentence should be uncomfortable for anyone in biotech, me included. Our industry celebrates the first step. The ones that follow decide whether anyone’s life changes.
Keeping the Finish Line in View
I don’t think the answer is for scientists to stop chasing novelty. New biology is how patients get options they never had. The shift I’d argue for is smaller and more practical: keep the patient’s life in view at every decision point, starting with the first experiment, so that diagnosis, access, and daily use are designed for instead of discovered as problems after approval.
Some of that work sounds commercial, and some of it is. Much of it is plain science. Whether a drug stays stable without refrigeration, whether it is absorbed the same way with or without a meal, whether it interacts with the medicines a patient already takes: these are laboratory questions with answers that land, eventually, at someone’s kitchen table.
The patient’s life shows up in early decisions that rarely make headlines. A company can choose to study its drug in the populations most affected by a disease, even when they are harder to reach. It can pursue an oral formulation that takes longer to develop. It can start talking with diagnostic companies and public health programs while its lead candidate is still in Phase 2. Each of those choices costs time or money up front, and each one shortens the distance between approval and impact.
Keeping the end in view also changes what a team celebrates along the way. A positive Phase 2 readout is worth celebrating. So is a partnership that will get more patients tested, or a dosing schedule that lets someone keep their job. Only one of those tends to make the news.
Where I Sit Now
My current work has made this concrete. At EIT Pharma, we focus on chronic hepatitis D, a serious and progressive liver disease. The hepatitis D virus is incomplete on its own and needs hepatitis B to replicate, so every patient has both infections. The first U.S. therapy for the disease, bulevirtide, a daily injection, won FDA approval in May 2026. Our own oral candidate, lonafarnib, is investigational; the FDA accepted our new drug application in August, and approval is not guaranteed.
Even if every program in this field succeeds, the hepatitis B numbers above set a ceiling on how many people with hepatitis D can be helped. Someone who has never been tested for hepatitis B is unlikely to be tested for the infection that depends on it. So I’ve come to see hepatitis B vaccination and screening as part of the same work, even though neither involves a new molecule. The gaps there are wide. The same WHO report found that only 18% of newborns in its African Region receive the hepatitis B birth-dose vaccine, decades after that vaccine became a standard tool. Prevention is the most complete version of a patient’s life changing, because the disease never arrives.
Counting Differently
A breakthrough has a date, and the date belongs to a patient. It is the day someone takes a medicine at home, without the rest of their life coming apart around the treatment, and starts to get better. Everything before that is preparation. It deserves respect, and it deserves a different word.
I’d like our industry to keep score that way, too. Count the molecules discovered, by all means. Then count the patients diagnosed, the patients treated, and the patients still on therapy a year later. Those numbers are harder to raise money on, and slower to move. They are also the only numbers a patient will ever notice.
Leen Kawas, Ph.D., is CEO of EIT Pharma and co-founder and managing general partner of Propel Bio Partners, a Los Angeles–based life sciences venture firm.