FacebookTwitterRedditEmail

Medical R&D That Works in the Developing World

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.

bernie-the-sandernistas-cover-344x550
February 18, 2020
John Pilger
Julian Assange Must be Freed, Not Betrayed
Peter Harrison
Religion is a Repeating Chapter in the History of Politics
Norman Solomon
The Escalating Class War Against Bernie Sanders
Conn Hallinan
Irish Elections and Unification
Dean Baker
We Shouldn’t Have to Beg Mark Zuckerberg to Respect Democracy
Sam Pizzigati
A Silicon Valley Life Lesson: Money That ‘Clumps’ Crushes
Arshad Khan
Minority Abuse: A Slice of Life in Modi’s India
Walden Bello
China’s Economy: Powerful But Vulernable
Nicolas J S Davies
Afghan Troops say Taliban are Brothers and War is “Not Really Our Fight.”
Nyla Ali Khan
The BJP is Not India, and Every Indian is Not a Modi-Devotee
Binoy Kampmark
Buying Elections: The Bloomberg Meme Campaign
Jonah Raskin
Here’s Hoping
Evaggelos Vallianatos
Herakles in the Age of Climate Chaos
Bob Topper
The Conscience of a Conservative
John W. Whitehead
We’re All in This Together
Gala Pin
Bodies in Freedom: a Barcelona Story
Laura Flanders
Democracy, Dictatorship and Bloomberg
James Chandler
Among Cruel Children
February 17, 2020
Sheldon Richman
Anti-BDS Laws Violate Our Freedom
John Horning
NEPA is Our National Defense System

Evelyn Leopold
How the UN’s Middle East Peace Plan Was Trounced by Its Own Members
Stephen Cooper
“Just Mercy” and Justice Don’t Exist in Alabama
Patrick Cockburn
Sinn Fein’s Victory is Ireland’s ‘Brexit Moment’ When Left-Out Voters Turn on the Elite
Ralph Nader
“Democratic Socialism” – Bring it on Corporate Socialists!
Phillip Doe
Every Day’s a Holiday for the Oil Business in Colorado
Binoy Kampmark
Fashion Fetishism, Surgical Masks and Coronavirus
Cesar Chelala
The Democrats’ New Chapter
Robert Koehler
The Wall: Separating Democracy From Voters
Peter Cohen
Time to Retire the “He Can’t Beat Trump” Trope
Sr. Kathleen Erickson
Lessons From Ministering on the Border
Alvaro Huerta
Another Five Lessons for Democrats to Defeat Trump in 2020
Wim Laven
Donald Trump’s Plan for America: Make it Ignorant
Christopher Brauchli
You Tube’s Trump Predicament
Steve Klinger
Trump Shoots Romney at Prayer Breakfast; GOP Shrugs
Elliot Sperber
Ode to the City Bus 
James Haught
Megachurch Mess
Weekend Edition
February 14, 2020
Friday - Sunday
Andrew Levine
Mayor Mike, Worse Than Mayor Pete
Bruce E. Levine
“Sublime Madness”: Anarchists, Psychiatric Survivors, Emma Goldman & Harriet Tubman
Jeffrey St. Clair
Roaming Charges: Leader of the Pack
Jennifer Matsui
The Doomsday Cuckoo Clock
Paul Street
Things Said in Confidence to 4000 Close Friends This Week
Jonathan Cook
Even With Corbyn Gone, Antisemitism Threats Will Keep Destroying the UK Labour Party
Thomas Klikauer
Cambridge Analytica: a Salesgirl’s Report
Joseph Natoli
Vichy Democrats vs. the Master Voice
David Rosen
Sanders vs. the Establishment Democrats: McGovern All Over Again?
FacebookTwitterRedditEmail