Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

Why? Secretary-General Ban Ki-moon has told the panel to focus on intellectual property and the pharmaceutical companies’ protection of patents and ignore the other issues that hamper access to medicine — weak health systems, questionable government policies and a lack of doctors, nurses and community health workers.

Reports like this one suggest that the panel not only attacks the patent system but proposes to put the United Nations in charge of drug development. The High-Level Panel has denied this and said the panel is still actively working on the report. When it is released, the report will be published on the panel’s official website.

There are so many more issues that influence access to medicines than intellectual property and patents. Some would argue that patents are not an obstacle to health at all but a tool of health.

“Far from being a threat to public health, patents are indispensable to promoting life-saving medical research,” writes Joseph Allen, who consults on intellectual property and formerly headed the National Technology Transfer Center.” If companies couldn’t protect their inventions through intellectual property laws, they’d have little reason to take the enormous risks involved in drug discovery. It’s not a coincidence that drugs are only created in a few countries with strong patent systems.”

And Dr. Kristina Lybecker, as associate professor at Colorado College, writes that patents not only foster pharmaceutical innovation, but also inhibit counterfeiting and fake drugs, which are widely recognized as serious barriers to access to high-quality drugs.

In recent interviews conducted by Baird’s CMC Ltd. with nine high-level Kenya public health professionals, none of them mentioned intellectual property as a key barrier to access to medicines. The two most common responses were weak health systems and cost of medicines and doctor consultations. Other reasons included late diagnosis, sub-standard drugs and a lack of health-seeking behavior on the part of the patients.

“Many times, consultancy fees are more expensive than the medicines,” said Professor Isaac Kibwage of the College of Health Sciences, University of Nairobi. “It is a bigger barrier in access to medicine.”

Similarly, in Senegal, none of three public health officials interviewed identified intellectual property as as issue but all of them identified cost of doctor visits or user fees for diagnostics.

Of 16 people active on pharmaceutical issues interviewed by Fundamento RP, a Brazilian qualitative market research consultancy, only one of them (described as an AIDS activist) identified patents as a problem. Three of them specifically said patents were not the problem.

Taila Lemos, the founder of Gentros, the Campinas Start Up, the Beta Lounge consulting innovating and Corporate Garage, with a long history in the pharmaceutical field in Brazil, said that the panel needs more industry participation. She said the two Brazilians are very qualified, but are both from government, and the panel needs people who have actually developed medicines in the private sector.

"Here in Brazil we have people who say they are experts in Amazonia forests but they have never set foot in the Amazon," she says."It's the same thing with this panel."

She said patents are the drivers of innovation. " We developed four vaccines for animal health. It took 10 years to bring them to market. If we don't have the protection of intellectual property, no one will invest in the development of these drugs."