For the Many

Trying to fathom the frustration felt by a mother who is unable to afford her child’s life-saving drugs is difficult in the extreme. But during my time with the World Hepatitis Alliance (before I joined the Medicines Patent Pool), I was faced with just that situation. I met a mother who had sold everything she owned to help purchase medicines for her son, but she still had a long way to go to give her child the drugs he so desperately needed.

And it’s far from an isolated case. Over 2 billion people worldwide don’t have sufficient access to essential medicines and health products. Those of us who have been involved in patient advocacy anywhere will not be unfamiliar with the feelings of frustration and failure in not being able to help such patients in meaningful ways. So how do we move forward?

In the early days of public health organizations like the Medicines Patents Pool (MPP), the focus was solely on facilitating access to drugs to treat specific conditions like HIV in developing countries. Though this was a critical initiative that has resulted in millions of people getting access to medicines they need, it failed to recognize that patients (including some of those same people on HIV treatment) were still waiting for many other essential medicines to become affordable. 

I strongly believe that no new drug should be launched without a plan that outlines how patients everywhere stand to benefit. Traditionally, the pharmaceutical industry has developed drug launch plans for the countries where they stand to make the most profits. And then, at a later date, they may expand those plans to include countries in the developing world. This can leave people in the developing world feeling as though they are merely an afterthought.

Fortunately, global public health is becoming an area of increasing attention, and the resulting debates and discussions are helping to structure a roadmap for improved medical access. The World Health Organization has contributed to identifying those medicines (as well as diagnostics) that are deemed essential to meet the priority healthcare needs of populations. And tools like the Access to Medicines Index are becoming increasingly important for the pharmaceutical industry; they help identify best practices and highlight those companies taking positive action. Such tools also have the added incentive of improving the perception of an industry that has been plagued by bad press for decades. According to the Access to Medicines Index rankings, GlaxoSmithKline, Norvartis and Johnson & Johnson are proving to be frontrunners in issues associated with R&D and pricing – helping to set a precedent for the rest of the industry. Novartis, for example, has said that it will not launch any new drug products without an access program – a bold and welcome move that should help people in the developing world feel that they are no less important than those in high-income countries.

Despite the positive steps forward, the need for multiple sources that are capable of producing high-quality drug products for patients in low- and middle-income countries is still very much apparent; in this regard, creating more competition from generics can help. And so, at the MPP, we partner with patent holders for public health driven licenses that enable the sublicensing of drugs to companies who can focus on the sale of generic drugs at more accessible prices in developing countries. 

Today, more now than ever before, companies are showing their willingness to engage with us. But there are still many who lag behind – in some cases, worried that public health licensing could come at the expense of their growth. This certainly need not be the case. The objective of organizations like MPP is to help companies reach as many people as possible with their innovative medicines in a way that is win-win. In fact, there is a good business case for our model and as more companies sit down with us to have in-depth discussions, they are coming to understand what public health licensing can do for them as well as for patients.

Access is part of the zeitgeist – because universal health coverage will be unattainable for many countries without it. We want the opportunity to help companies engage in thinking about access in the broadest sense. Our model is far from the only one and we have no interest in promoting it where it wouldn’t work. For certain products it will work beautifully – as it has in HIV and hepatitis C – but for others it may not. What is important, however, is that companies should be aware of the full range of access options available to them so they can make the best choices that will maximize access to those who need it.