Cost Shouldn’t be a Barrier for Access to Essential Medicines
By Dave Ross, ScD
President and Chief Executive Officer
The Task Force for Global Health
Most people in the world do not have access to medicines available to people in the United States and Europe. As many as 6 billion people cannot afford drugs that we take for granted in the United States such as beta blockers to control hypertension.
At The Task Force for Global Health, we seek social justice and health equity through our programs – that is, we believe all people should have access to the means for good health including essential medicines and vaccines. Our pharmaceutical partners also share in a commitment to access. While these values are important to us all, we must acknowledge that pharmaceutical companies are accountable to their shareholders and must be able to return a profit on their products.
Our programs to eliminate a group of infectious diseases called the neglected tropical diseases (NTDs) depend on significant drug donations from pharmaceutical companies. In 2016 alone, The Task Force received $3.2 billion in antibiotic and antiparasitic medicines for the elimination of three NTDs – trachoma, river blindness, and lymphatic filariasis – that currently burden hundreds of millions of people mostly in developing countries. These diseases will be eliminated within a decade because of these generous donations.
Drug donation models work well for diseases like those NTDs that can be eliminated through mass treatment of entire populations. People burdened by NTDs cannot afford to buy medicines that prevent and treat these infections. Pharmaceutical companies have recognized their moral and ethical imperatives to donate their products to NTD elimination programs. But these donations can end after these diseases have been eliminated, which ensure that companies don’t have to give away their products indefinitely.
The drug donation model, however, is not sustainable for chronic diseases such as hypertension that require people to take medicines for life. Different business models are needed that protect the financial interests of pharmaceutical companies while ensuring medicines are affordable to people who need them.
The Clinton Foundation successfully tackled the issue of access to HIV medicines, which were originally prohibitively expensive to most people outside of the United States and Europe. The foundation negotiated deep discounts on these drugs with pharmaceutical companies with the promise that they could make up for lower profit margins by selling more medicine than they might otherwise. From 2002 to ’10, the annual cost of HIV medicines dropped from $10,000 to $200 or less per person annually. This approach has helped ensure an estimated eight million people in developing countries have access to antiretroviral medications.
Gavi, The Vaccine Alliance, has used differential pricing models to increase access to vaccines for people in low- and middle-income countries. Gavi also negotiates deep discounts with pharmaceutical companies for vaccines, which they in turn sell to countries based on their abilities to pay. Pharmaceutical companies offset the costs of selling discounted vaccines by selling vaccines to high-income countries at market prices.
Differential pricing holds tremendous promise for ensuring people in developing countries can access medications for controlling hypertension, diabetes, and other chronic diseases. But there is need for more innovation in pricing approaches. This will become a more pressing issue over the coming years as the prevalence of chronic diseases continues to rise in developing countries and the corresponding need for these medicines increases.
The Task Force is committed to helping identify new approaches for increasing access to essential medicines. In the future, we plan to host a workshop of thought leaders from the global health community and pharmaceutical industry to discuss the state of this issue and begin to identify new approaches that could be useful going forward.
We must take steps to assure that cost is not an insurmountable barrier for people to access essential medicines. Health is a human right.