Access to Medication – The Dimensions of the Problem

On November 10th The Kings Think Tank Global Health Policy Centre hosted a public event discussing current issues of drug development, medication distribution and tiered pricing, in particular its crippling effect on developing countries’ healthcare systems. Probing questions were asked regarding who is ultimately responsible for delivering solutions; big pharmaceutical corporations, governments or international policy makers? Three panelists, each with a different expertise and approach spoke on these issues;

Professor John Abraham, from the department of Social Science, Health and Medicine at Kings College London introduced us to the problems surrounding drug availability and accessibility. The first question that is often overlooked is whether these drugs exist. If not, what scientific challenges are standing in the way? Can the recent slump in drug discovery be attributed to the increasing regulatory requirements; a lack of funding for certain neglected diseases or the (amongst scientists unpopular) theory that the easy ‘low hanging fruit’ of drugs have already been discovered? Once a drug is on the market, the problem of accessibility arises. Certain regions do not have access, with poverty making the medicine unaffordable, a lack of infrastructure and suitable transportation, a low drug stock or general weak healthcare system. Professor John Abrahams take home message; the deficit in access to medication is due to market failure and not one lone entity. Complete restructuring of the drug discovery and development model is needed from one where the pharmaceutical industry works on a profit to one where the aim is the treatment of patients (irrespective of profit). This would result in an increase from the measly 10% of global pharmaceutical research and development spent on neglected diseases. Suggested interventions targeting availability include:

– Tax write-offs (for researching neglected diseases).

– Public private partnerships (e.g. The Medicines for Malaria Venture, also have major impact on social awareness).

– Patent extensions and market exclusivity (increase incentive for pharmaceutical companies to spend on research and development however feeds into the accessibility problem once medication is on the market)

Sadly availability and accessibility are not the only problems – the presence of counterfeit drugs highlights the importance of quality control. The difficulty in tackling such issues is that the prosecution of many such cases relies on whistle-blower leads and testimonies, which is why organisations such as the International Medical Products Anti-Counterfeiting Taskforce (IMPACT) do valuable work in promoting standards across the globe.

Possible methods of dealing with this market failure were presented by Mr. François Bompart, current VP, Deputy Head & Medical Director of Access to Medicines of Sanofi, one of the most committed pharmaceutical companies to increasing quality medication accessibility. An important point raised was that the access to diagnosis before that of the medication is often overlooked. In areas were there are few doctors per population it is crucial to educate the local nurses and primary healthcare staff to recognize symptoms of common diseases so as to be able to refer patients to doctors. Refreshingly he praised the changing healthcare response to neglected disease, warning now of the upcoming challenge of moving from a system with strong vertical pillars (great funding and awareness for certain diseases like HIV and Malaria) to a system that is less vertical and more supportive to patients across all treatments. A situation where patients would prefer to have a disease such as HIV as opposed to a rare disease for reasons already mentioned is far from the aim. Mr. Bompart was also conscious of the sustainability of this impact, seeing the value in training healthcare staff to recognize and diagnose as opposed to solving the problem with bank cheques. Chief areas of focus being; diagnosis and care, affordable quality medication, awareness, fighting stigma (especially regarding epilepsy and mental health), highlighting the moral obligation of pharmaceutical companies, the positive benefit it will have on their reputation and innovation (opportunity to test new business models).

Médecins Sans Frontières (MSF) lawyer and researcher Ms Yuan Qiong Hu clarified the current globalisation of the patent regime. The TRIPS Agreement (to date the most comprehensive multilateral agreement on intellectual property) and its requirements were discussed. However in terms of what may be patented differs between nations, dependent on their definition of a ‘new’ compound. The many shades of grey in relation to chemical structure and drug development came to light with the dispute in the scientific community regarding at what point altering or tweaking an already existing compound can be viewed as a ‘new’ drug (and thus is patentable). Lastly the effect of tiered pricing on middle-income countries was discussed. Not qualifying for the lower medication prices and receiving no aid these countries are unable to pay for their populations healthcare.

Clearly there is still much room left for improvement and so if anyone interested is encouraged to submit a related policy recommendation to editor@kingsthinktank.org. No experience is required and the Kings Think Tank Editor Team is happy to offer help.

We look forward to reading your submissions.

Melanie Flury, Global Health Editor

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