FacebookTwitterGoogle+RedditEmail

Medical R&D That Works in the Developing World

by ROBERT WEISSMAN

Can the world settle on a medical research and development (R&D) system that develops medicines and other products to meet priority health needs and makes those products available on an affordable basis?

Developing a strategy to meet these twin goals is the task of World Health Organization (WHO) negotiations in their final phase this week.

The WHO Intergovernmental Working Group on Public Health, Innovation and Intellectual Property is finishing talks to create a global strategy and plan of action to spur medical R&D focused on the health needs of developing countries, and to ensure that poor populations get access to important pharmaceuticals and other medical technologies.

The world — and especially developing countries — needs more innovation. To have public health benefit, however, the fruits of the innovative process must be available to people who need them.

The current patent monopoly-based system of R&D has proven inefficient at advancing a needs-driven public health agenda. This is true for rich countries as well as poor, but the situation is much worse in poor countries. This has nothing to do with the ethics of Big Pharma. It is how the system is designed.

The current corporate sector system of R&D is driven by the prize offering of a patent monopoly. Patents are not worth much if they offer monopolies on sales to a population that — no matter how large — has little buying power. And if the prize incentive is too small, it will not induce R&D, no matter how much it may be needed as a public health matter.

Here’s what this means in practice: Developing countries comprise 80 percent of the world’s population but amount to only 13 percent of the global market for medical products. A review by Doctors Without Borders of new drugs introduced between 1975 and 2004 found that of 1,556 new drugs put on the market, only 21 were for “neglected diseases” — diseases endemic to developing countries.

The value of the patent monopoly is based on the holder using it to profit maximize as a monopolist. It is therefore no surprise that companies holding patent monopolies charge high prices. This is what the patent enables. High prices are an increasing problem in rich countries, but the brand-name pharmaceutical industry’s current pricing model — which commonly runs into the thousands of dollars a year for a single medicine, and may involve charges of more than $100,000 — leaves new medicines completely out of reach of the vast majority in developing countries.

How to respond to these problems? There are two basic alternatives. One is to rely on charity. Private foundations and companies seeking good will may contribute to R&D for products targeting diseases in developing countries. They may offer discounted versions of their drugs, or give some away. Charitable initiatives may accomplish quite a bit, but in general they suffer from being ad hoc, unsustainable, erratic, episodic, short-lived and insufficiently resourced. Charity may be helpful, but it is no solution to meeting public health priorities on a sustained basis.

The second option is to examine systemic approaches to support R&D that do not rely on patent monopolies or the prospect of charging high drug prices as a reward, and to identify mechanisms to make the fruits of R&D widely accessible.

There are a lot of good ideas, large and small, about how to do this. Notably at the WHO talks, Bolivia and Barbados have put forward a series of concrete proposals for non-patent prizes to incentivize R&D, with the resulting fruits of the innovation made available at competitive prices.

One of the Bolivia/Barbados proposals is for a Priority Medicines and Vaccines Prize Fund. The fund would offer large cash prizes to entities developing new products for neglected diseases, antibiotics or products for emerging public health threats (like avian flu or SARS). It would offer smaller prizes to parties that made advances toward these goals, meeting benchmarks short of bringing new products to market. It would also offer separate prize money to parties that openly published and shared their research. A condition of receiving the prizes would be licensing all resulting patent, data and know-how so that end products could be made available immediately on a competitive basis. In other words, there would immediately be generic competition and low-cost pricing.

There is no guarantee that the prize fund would work in creating innovation where now there is none or much too little. But it is an interesting and provocative proposal.

There is no legitimate rationale, on the merits, to oppose ongoing discussion of this prize proposal. Remember, in keeping with the focus of the WHO talks, the Bolivia/Barbados proposal focuses on health problems specific to developing countries. It involves areas where there is no effective market (or, in the case of antibiotics, special market problems) to incentivize R&D. So, there is nothing for Big Pharma to lose here.

But the industry and its allies are viewing this and similar proposals very cautiously. Some ideologues oppose any tinkering with the patent monopoly system. The industry is concerned that tinkering in the case of health problems related to developing countries will eventually threaten the patent monopoly system in the rich world, or interfere with its ability to expand sales to the wealthy in middle-income countries. (More on the role of Big Pharma and its proxies in my next column.)

Will country negotiators at the WHO talks ignore those who would subordinate public health to patent veneration or commercial concerns? Will they instead advance experiments with new institutional arrangements to promote the complementary public health objectives of innovation and access? We will know by the end of the week.

ROBERT WEISSMAN is editor of the Washington, D.C.-based Multinational Monitor and director of Essential Action.

 

 

 

 

More articles by:

ROBERT WEISSMAN is president of Public Citizen.

CounterPunch Magazine

minimag-edit

bernie-the-sandernistas-cover-344x550

zen economics

June 28, 2017
Diana Johnstone
Macron’s Mission: Save the European Union From Itself
Jordon Kraemer
The Cultural Anxiety of the White Middle Class
Vijay Prashad
Modi and Trump: When the Titans of Hate Politics Meet
Jonathan Cook
Israel’s Efforts to Hide Palestinians From View No Longer Fools Young American Jews
Ron Jacobs
Gonna’ Have to Face It, You’re Addicted to War
Jim Lobe – Giulia McDonnell Nieto Del Rio
Is Trump Blundering Into the Next Middle East War?
Radical Washtenaw
David Ware, Killed By Police: a Vindication
John W. Whitehead
The Age of No Privacy: the Surveillance State Shifts into High Gear
Robert Mejia, Kay Beckermann and Curtis Sullivan
The Racial Politics of the Left’s Political Nostalgia
Tom H. Hastings
Courting Each Other
Winslow Myers
“A Decent Respect for the Opinions of Mankind”
Leonard Peltier
The Struggle is Never for Nothing
Jonathan Latham
Illegal GE Bacteria Detected in an Animal Feed Supplement
Deborah James
State of Play in the WTO: Toward the 11th Ministerial in Argentina
Andrew Stewart
Health Care for All: Why I Occupied Sen. Sheldon Whitehouse’s Office
Binoy Kampmark
The European Commission, Google and Anti-Competition
Jesse Jackson
A Savage Health Care Bill
Jimmy Centeno
Cats and Meows in L.A.
June 27, 2017
Jim Kavanagh
California Scheming: Democrats Betray Single-Payer Again
Jonathan Cook
Hersh’s New Syria Revelations Buried From View
Edward Hunt
Excessive and Avoidable Harm in Yemen
Howard Lisnoff
The Death of Democracy Both Here and Abroad and All Those Colorful Sneakers
Gary Leupp
Immanuel Kant on Electoral Interference
Kenneth Surin
Theresa May and the Tories are in Freefall
Slavoj Zizek
Get the Left
Robert Fisk
Saudi Arabia Wants to Reduce Qatar to a Vassal State
Ralph Nader
Driverless Cars: Hype, Hubris and Distractions
Rima Najjar
Palestinians Are Seeking Justice in Jerusalem – Not an Abusive Life-Long Mate
Norman Solomon
Is ‘Russiagate’ Collapsing as a Political Strategy?
Binoy Kampmark
In the Twitter Building: Tech Incubators and Altering Perceptions
Dean Baker
Uber’s Repudiation is the Moment for the U.S. to Finally Start Regulating the So-called Sharing Economy
Rob Seimetz
What I Saw From The Law
George Wuerthner
The Causes of Forest Fires: Climate vs. Logging
June 26, 2017
William Hawes – Jason Holland
Lies That Capitalists Tell Us
Chairman Brandon Sazue
Out of the Shadow of Custer: Zinke Proves He’s No “Champion” of Indian Country With his Grizzly Lies
Patrick Cockburn
Grenfell Tower: the Tragic Price of the Rolled-Back Stat
Joseph Mangano
Tritium: Toxic Tip of the Nuclear Iceberg
Ray McGovern
Hersh’s Big Scoop: Bad Intel Behind Trump’s Syria Attack
Roy Eidelson
Heart of Darkness: Observations on a Torture Notebook
Geoff Beckman
Why Democrats Lose: the Case of Jon Ossoff
Matthew Stevenson
Travels Around Trump’s America
David Macaray
Law Enforcement’s Dirty Little Secret
Colin Todhunter
Future Shock: Imagining India
Yoav Litvin
Animals at the Roger Waters Concert
Binoy Kampmark
Pride in San Francisco
FacebookTwitterGoogle+RedditEmail