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Look at each stakeholder:

Pharmaceutical Companies: Incentivized to
Launch, Not Last

For drug developers, the clock starts ticking the moment a
biologic enters the pipeline. Patent protections are finite.
Shareholders are impatient. And return on investment
depends on how quickly a therapy reaches market and
gains traction. The commercial model for biologics heavily
rewards early success—regulatory approval, uptake by
prescribers, and inclusion on payer formularies.

Once those milestones are met, the pressure to innovate
around immune durability fades. If a biologic works for
12 months, it generates significant revenue. If it fails in
year two, and the patient is switched to another therapy
within the same portfolio, revenue continues. There’s no
financial penalty for tolerization—only a continuation of
the revenue cycle. Investing in long-term immune
compatibility would require retooling development
programs, extending trial timelines, and accepting greater
scientific risk—none of which aligns with quarterly
reporting pressures.

So, biologics are engineered to pass trials, not to persist.
And the system keeps rewarding that strategy. Nobody
involved has any incentive to change how things are.
Pointing out and addressing tolerization is inconvenient.

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