Access to medicines
Improving poor people's access to essential medicines means strengthening drug policy and health care delivery systems, constructing access-enabling domestic intellectual property legislation, building effective domestic or regional drug regulatory systems, and providing sustainable finance for affordable and effective drugs.
Although the majority of WHO's recommended essential drugs are off-patent products and subject to generic competition, access to newer on-patent drugs is also needed, to combat anti-microbial resistance to TB and malaria, for example, and to treat HIV and AIDS. Issues of access to medicine for all, affordability and innovation require international, as well as national, policy and action.
The World Trade Organization's (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) impacts access to medicines both by globalising minimum standards of patent protection and by providing key flexibilities for bypassing intellectual property barriers while still providing some compensation to patent holders.
Intellectual property rights, particularly in rich country markets, provide incentive for R&D investment, by conferring patent ownership for a specified time period, thus guaranteeing an exclusive market and supra-competitive pricing. But global incentives to encourage investment in R&D for new products are not ordinarily dependent on small-volume sales in poor countries and even minimal incentives must be balanced by the imperative of affordable prices for poor consumers.
The effect of TRIPS on prices of newer essential medicines and the counter-balancing effects of generic competition are of particular concern for developing countries. Vital flexibilities are set out in principle in TRIPS, to enable poor countries to import patented drugs from the cheapest source (parallel importing), and to compulsorily license generic production to meet a wide range of public health needs.
The importance, indeed primacy of public health, was clarified in the WTO Doha Declaration on the TRIPS Agreement and Public Health and flexibilities for exporting and importing generic medicines pursuant to compulsory licenses were further expanded in the WTO Decision of 30 August 2003 Implementing Paragraph 6 of the Doha Declaration. However, may poor countries do not yet have legal and administrative frameworks in place that would enable them to make appropriate use of available flexibilities, and some of the flexibilities are now being threatened in bilateral and regional trade agreements as well.
Donations, when made according to international guidelines on good practice, can also contribute to access to medicines. Similarly, heavily discounted or differential pricing - where companies voluntarily shape prices to poor consumers' purchasing power - can play an important role in increasing affordability of patent drugs, when arrangements with purchasers are sustainable, predictable and transparent.
However, in the long-run, it is ordinarily competition arising from generic medicines of assured quality that leads to price reductions that dramatically increase access.
- Bangladesh needs to increase the supply of medicines in public facilities so the poor can utilise maternal healthcare
- J. Chandrasiri; C. Anuranga; R. Wickramasinghe / Asian Development Bank, 2012
- The Government of Bangladesh is committed to ensuring access of its population to adequate healthcare services. However, substantial inequalities exist in maternal and child health outcomes in Bangladesh, with child and maternal morta...
- How could Thailand use TRIPS to ensure the affordability of medicines for its poor patients?
- C. Oh / South Asia Watch on Trade, Economics & Environment, 2009
- High prices of medicines is often the major cause of inaccessibility of medicines for poor patients in developing countries, and TRIPS agreement is often deemed as a main cause to raise medicines’ prices. However, there are aven...
- Bridging industry and health objectives, and facilitating technology transfer to cover domestic needs of medicines
- P.G. Sampath; Z. Mirza; K. Adachi / International Centre for Trade and Sustainable Development, 2011
- Poor medicine availability is a key barrier to access to medicines. This report provides an entry point for supporting the local production of medicines, vaccines and diagnostics in developing countries. The paper forms part of a comp...
- Efficiencies in healthcare delivery doesn’t replace financing: donors have to complement their HIV commitments
- T.V. Schoen-Angerer; D. Maher; J. Cohn / Wiley Online Library, 2011
- Much of the funding mobilised for the global response to HIV has supported successful expansion in antiretroviral therapy (ART) access, but funding is now at a critical juncture as the global financial crisis bites and funders hesitat...
- Efforts to confront the deadly combination of TB and HIV need to be scaled up
- Joint United Nations Programme on HIV/AIDS, 2011
- Tuberculosis (TB) is the main cause of death in people living with HIV. This report is a call that TB should not be a death sentence for a two million people living with HIV and expected to die of TB between 2011 and 2015. ...
- The implementation of collaborative TB/HIV activities in a Cameroonian district hospital
- H.A. Yumo; C. Kuaban; F. Neuhann / National Centre for Biotechnology Information, USA, 2011
- In response to the need of integrating tuberculosis (TB)/HIV activities, the WHO in 2004 mapped out a number of key activities to be implemented by countries to ensure effective collaboration between TB and HIV programmes. This study ...
- When should patients co-infected with TB and HIV start ART in Malawi?
- M.V. Lettow; A.K. Chan; A.S. Ginsburg / Ingenta, 2011
- Malawian policy to invite patients co-infected with tuberculosis (TB) and HIV to start antiretroviral therapy (ART) 2 months after initiating TB treatment changed recently; the new policy shortened the period to 2 weeks instead of 2 m...
- Unmet financial needs for malaria control
- R. Snow; E.A. Okiro; P.W. Gething / The Lancet, 2011
- This article analyses whether or not international funding for malaria control has been equitable and adequate. Has international funding been meeting the required needs both in terms of biological needs and national income? ...
- Bringing practical changes for more pharmaceutical innovation in Africa
- Council on Health Research for Development, 2010
- This report is the first step in a process aiming to move forward the practical changes needed to increase innovation for health in Africa by Africa. Specifically, it provides the evidence base and direction for the initiative 'Streng...
- Differential pricing as a tool to improve access to medicines in developing countries
- P. Yadav / Department for International Development, UK, 2010
- This report analyses the existing literature on differential pricing, examines successful and unsuccessful examples of differential pricing, and recommends actions for improvement. It argues that adapting drug prices to the purchasing...