A New Frontier: The Access to Medicines Movement and NCDs
Daniel Hougendobler | Leave a Comment
Ensuring access to medicines requires a two-pronged approach. First, medicines must be invented and developed. For conditions that widely affect both the rich and poor, this presents little problem. Because those in the developed world can afford to pay large sums for these medicines, pharmaceutical companies have a strong financial incentive to develop treatments. However, where diseases affect primarily those living in poverty (e.g., schistosomiasis), or where these populations need different formulations from those used in developed countries (e.g., heat-stable versions of pediatric drugs), companies have little incentive to develop medicines—it makes little economic sense to create a product for a population that has no money to pay for it. Second, those drugs that are developed must be available at an affordable cost, with sufficient safeguards for quality, and against the backdrop of adequate distribution networks.
The campaign for access to medicines grew up alongside HIV/AIDS. When the first antiretroviral treatment, AZT, came to market in 1989, it cost a staggering $8,000 per year, putting the patented drug out of reach for many Americans and Europeans, along with virtually all of the rest of the world. The World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which required all member countries to guarantee patent protection for medicines, further galvanized activists. The movement has been largely successful in reducing the cost of HIV/AIDS medicines, largely by promoting generic competition. AZT’s price, for instance, has plummeted to just $70 per year.
Until recently, access to medicines has been virtually synonymous with access to medicines for HIV/AIDS. That is beginning to change. A recent paper by Thomas Bollyky argues for the importance of expanding access to medicine for non-communicable diseases (NCDs). His paper is not the first discussion of this issue, but rather reflects an increasing recognition that NCDs are an increasingly important contributor to the burden of disease globally.
Once considered a problem limited to the “rich world,” NCDs are growing quickly in high-, middle- and low-income countries. Of the 35 million annual deaths from NCDs, approximately 80% occur in low- and middle-income countries. The good news for patients living in low- and middle-income countries is that largely the same NCDs that impact them also affect the Global North. This means that pharmaceutical companies have a financial incentive to develop new and better treatments for diabetes, cardiovascular health, and cancer, for example. However, the problems of price, quality and distribution remain. As a result, “NCDs that are preventable, such as cervical cancer, or treatable, such as juvenile diabetes, are often death sentences in developing countries.”
A few countries have begun to take measures to ensure that intellectual property rights do not compromise the health of their populations. India’s Supreme Court recently held that Novartis should not be given a patent on an anti-cancer drug, because of the similarity to an existing product. Thailand and India have used a mechanism in the TRIPS Agreement to grant “compulsory” licenses to drugs for cancer and coronary artery disease, thus allowing generics to compete with the brand-name, before the patent expires.
These country-specific measures, while significant, remain piecemeal. If patients are to receive effective treatment, regardless of income or country of residence, a more holistic approach is needed – one that values patients above patents.