Experts Gather to Address Low Access, High Prices of Drugs.
Universal health care coverage, while a significant step, has not resolved the critical problems of global access and affordability of life-saving medicines.
That was the consensus of a group of international experts in pharmaceutical policy convened at the School of Public Health for a September 15 Dean’s Symposium, titled “The Role of Pharmaceuticals in Public Health.”
The experts—from the CEO of a multi-national pharmaceutical and technology company, to a director of the World Bank Group, to an activist for industry reforms—discussed the myriad barriers to access to affordable drugs, ranging from patent rules to hobbled distribution systems to a lack of government resources. Which barrier to try to overcome first, and how to do it, was at times a source of contention.
But this much was clear: Without change, millions will die needlessly of treatable diseases.
“Our industry can only be an effective partner if we work together to create the right social and economic conditions in the populations and communities we serve,” said Stefan Oschmann, CEO and chairman of the executive board of Germany-based Merck KGaA.
Oschmann, who also is president of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), acknowledged the role of industry patents and pricing practices in restricting access to drugs in resource-poor countries, saying, “I must admit, it took the industry some time to wake up to this challenge and the focus of trying to do more to bring products to what one of my colleagues once termed ‘the other 5 billion.’ I feel there’s clearly a lot more to do. But I also feel strongly that the industry has opened up to these challenges.”
But a leading advocate for price structure reforms said the industry hasn’t had to open up, in terms of transparency and negotiating lower prices, because it wields unmatched influence in Congress through lobbying and campaign spending.
“We don’t have to be dealing with a 500-percent price increase for EpiPens. We could introduce legislation against price spikes that would curb that in an instant,” said Peter Maybarduk, who works on global access to medicines for the Washington, DC-based consumer advocacy group, Public Citizen. “The problem fundamentally is, we have allowed . . . monopolistic power to price-control, to price-set, by the industry, to a point that leads inevitably to treatment rationing.”
Margaret Ewen, coordinator of global projects/pricing for Amsterdam-based Health Action International, said there is a need for “differential pricing” in low-income countries, more transparency on pricing, and more availability of high-quality generics. “I would really ask the industry to resist denigrating generics,” she said.
Oschmann took issue with the focus on generics and criticism of intellectual property rights, which allow companies to hold patents and protect data on drugs.
“If you abolish patents right now and you make all drugs for free, you will not change anything,” he said. “If you abolish all the profits of the pharmaceutical industry worldwide, you will not change anything.
“If you want to tackle cancer in Africa, you need tertiary care centers, you need to have medical oncologists, you need to have pathologists, you need to have radiologists, you need surgeons—and you need access to drugs.”
Dean Sandro Galea said the school, which has a pharmaceutical public health program, organized the symposium in an effort to “help to shape the conversation” around an issue that has profound effects for population health. The gathering came a day after a United Nations panel released a report calling for major changes to the way in which research and development (R&D) of life-saving medicines is funded, in order to make them more affordable worldwide. The report also called for more price transparency by the industry.
Olusoji Adeyi, director of health, nutrition, and population global practice for the World Bank Group, said the issue of access to drugs lies at a “complex intersection of challenges and compelling opportunity.” He said equitable access to essential medicines is a human rights issue, and he urged public health researchers to be “social engineers” in devising solutions.
Adeyi said public-private partnerships, such as global subsidies, have worked to improve access to drugs. One such program he cited, which provided low-cost, effective antimalarial drugs in seven countries, had measurable success—but the Global Fund discontinued the program, citing factors other than the evidence of lives saved.
“This tells us something about the dynamics, the narratives, the inter- and intra-institutional dialogue that influences choices made in global health,” Adeyi said. “How much of it is likely driven by science, and how much of it is driven by factors other than science?”
Other experts made clear that the problem of access was distinct from pricing. Pius Tih (MPH ’92), director of health services for the Cameroon Baptist Convention Health Services, said that health centers in Cameroon have frequent shortages of critical drugs, including those for non-communicable diseases. Patients turn to poor-quality or fake drugs in desperation.
“Why do you even talk of cost when [the medications] are not available?” he asked his co-panelists.
Veronika Wirtz, associate professor of global health and co-chair of The Lancet Commission on Essential Medicines Policy, said the attention to “formal insurance affiliation” has been insufficient to ensure that patients in need are receiving essential medicines.
Expanding health coverage “does not mean we are the end. It means we are at the beginning” of an effort that must strengthen health-care delivery in developing countries, she said.
Ye Lu, professor and director of health economics at the School of Public Health at Fudan University in China, said her country has made progress in expanding health coverage, but is grappling with problems including drug pricing and insufficient reimbursement to hospitals.
Vin Sharma (MPH’02), senior director of business planning and program/alliance management at Alnylam Pharmaceuticals in Boston, noted that moving one drug from discovery to the market could take a decade. To finance those discoveries, he said, companies need to re-invest profits from drug sales. Cost-based pricing would “limit how much you’re able to invest,” he said.
Professor of Global Health Richard Laing, who organized the symposium, said more transparency by both the industry and regulatory agencies was an important step in identifying pricing and access problems.
“For some reason, regulatory agencies have a knee-jerk response (that) all information should be secret,” he said. “There’s absolutely no good reason for secrecy like that.”
Audience members peppered Oschmann with questions about access and pricing, including why drug companies seemed to rely on short-term, high pricing in small markets, versus long-term, moderate pricing for larger markets.
Oschmann said the industry was committed to continuing the “encouraging progress” of the last 30 years in combatting neglected tropical diseases, non-communicable diseases, and antibiotic drug resistance.
“There is so much work that needs to be done,” he said. “My message is, this industry is very willing to partner and do its share.”
For the benefit of readers unable to attend the event, we have archived the symposium agenda, individual presentations, and full video of the proceedings.