24 February 2017

High-level panel on access to medicines – “A smooth navigation on a rough sea”

As highlighted by Ruth Dreifuss, co-chair of the Secretary General’s High-level panel on access to medicines at the dialogue session organised by the Global Health Centre on 23 February 2017, access to medicines is a global challenge, affecting not only developing countries but also high-income countries. The Panel was tasked to recommend solutions addressing the policy incoherence between the human right to health, and intellectual property rules. In this regard, Ms Dreifuss highlighted that as different ministries represent countries in different international organisations, an initiative at the UN-level was required to foster a consistent approach in this area.

Transparency of the pharmaceutical sector was a recurring theme in the discussion. The need to de-link the price of medicines from the costs of R&D through public financing has been recognised for several years. However, Ms Dreifuss pointed out the irony that we already have de-linkage, but in the wrong direction, as current business models in the pharmaceutical industry have effectively been de-linking the price of drugs from the underlying development costs: the financialisation of R&D means that a small firm can sell a newly developed medicine to the highest bidder for production and distribution at very high prices – the auction price will have no relationship to the R&D costs but rather will reflect the highest price the market can bear.

The absence of the public sector, which does not provide enough stewardship, regulation or financing, was pointed out as one of the factors enabling this trend. Collaboration with the pharmaceutical industry – and not its suppression – needs to be part of the solution. The right balance between public and private components must be found in exploring new business models, learning from success stories such as DNDi.

On the other hand, full transparency on the price of medicines across countries still has its detractors: it is argued that because of price disparities between the Global North and the Global South, so-called rich countries would not accept to bear higher costs for the same products. However, Ms Dreifuss underlined that transparency is important to ensure that countries do not overpay for medicines and to have a better understanding of the prices that countries can negotiate. It was further pointed out that there has been full price transparency for HIV medicines, and that major price differences between richer and poorer countries have been accepted by all.

Among current obstacles to access, the issue of patents on medical devices was also raised. Citing the example of the Epi-Pen, Ms. Dreifuss illustrated how monopolies on medical devices can raise the price of treatments – the epinephrine contained inside the Epi-Pen is available at low cost, but the monopoly on the delivery device allowed the seller to charge increasingly high prices for the product. Regional and bi-lateral trade agreements were also mentioned as hindering access, as they might reduce the ability of countries to use the public health flexibilities of the TRIPS Agreement.

Many other obstacles exist, but the mandate of the High-level panel was restricted to intellectual property and the right to health. In this regard, Ms Dreifuss underlined the importance of tri-lateral cooperation among the World Health Organization (WHO), the World Trade Organization (WTO) and the World Intellectual Property Organization (WIPO), and wished for the recommendations of the panel to be discussed at WHO and other relevant multilateral fora. She described the Panel’s work as a “smooth navigation on a rough sea”, but it will be important to now find ways to foster the implementation of the report’s recommendations – the debate has been going on for too long without adequate progress.

 

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