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.

November 21, 2017
Gregory Elich
What is Behind the Military Coup in Zimbabwe?
Louisa Willcox
Rising Grizzly Bear Deaths Raise Red Flag About Delisting
David Macaray
My Encounter With Charles Manson
Patrick Cockburn
The Greatest Threats to the Middle East are Jared Kushner and Mohammed bin Salman
Stephen Corry
OECD Fails to Recognize WWF Conservation Abuses
James Rothenberg
We All Know the Rich Don’t Need Tax Cuts
Elizabeth Keyes
Let There be a Benign Reason For Someone to be Crawling Through My Window at 3AM!
L. Ali Khan
The Merchant of Weapons
Thomas Knapp
How to Stop a Rogue President From Ordering a Nuclear First Strike
Lee Ballinger
Trump v. Marshawn Lynch
Michael Eisenscher
Donald Trump, Congress, and War with North Korea
Tom H. Hastings
Reckless
Franklin Lamb
Will Lebanon’s Economy Be Crippled?
Linn Washington Jr.
Forced Anthem Adherence Antithetical to Justice
Nicolas J S Davies
Why Do Civilians Become Combatants In Wars Against America?
November 20, 2017
T.J. Coles
Doomsday Scenarios: the UK’s Hair-Raising Admissions About the Prospect of Nuclear War and Accident
Peter Linebaugh
On the 800th Anniversary of the Charter of the Forest
Patrick Bond
Zimbabwe Witnessing an Elite Transition as Economic Meltdown Looms
Sheldon Richman
Assertions, Facts and CNN
Ben Debney
Plebiscites: Why Stop at One?
LV Filson
Yemen’s Collective Starvation: Where Money Can’t Buy Food, Water or Medicine
Thomas Knapp
Impeachment Theater, 2017 Edition
Binoy Kampmark
Trump in Asia
Curtis FJ Doebbler
COP23: Truth Without Consequences?
Louisa Willcox
Obesity in Bears: Vital and Beautiful
Deborah James
E-Commerce and the WTO
Ann Garrison
Burundi Defies the Imperial Criminal Court: an Interview with John Philpot
Robert Koehler
Trapped in ‘a Man’s World’
Stephen Cooper
Wiping the Stain of Capital Punishment Clean
Weekend Edition
November 17, 2017
Friday - Sunday
Paul Street
Thank an Anti-War Veteran
Andrew Levine
What’s Wrong With Bible Thumpers Nowadays?
Jeffrey St. Clair - Alexander Cockburn
The CIA’s House of Horrors: the Abominable Dr. Gottlieb
Wendy Wolfson – Ken Levy
Why We Need to Take Animal Cruelty Much More Seriously
Mike Whitney
Brennan and Clapper: Elder Statesmen or Serial Fabricators?
David Rosen
Of Sex Abusers and Sex Offenders
Ryan LaMothe
A Christian Nation?
Dave Lindorff
Trump’s Finger on the Button: Why No President Should Have the Authority to Launch Nuclear Weapons
W. T. Whitney
A Bizarre US Pretext for Military Intrusion in South America
Deepak Tripathi
Sex, Lies and Incompetence: Britain’s Ruling Establishment in Crisis 
Howard Lisnoff
Who You’re Likely to Meet (and Not Meet) on a College Campus Today
Roy Morrison
Trump’s Excellent Asian Adventure
John W. Whitehead
Financial Tyranny
Ted Rall
How Society Makes Victimhood a No-Win Proposition
Jim Goodman
Stop Pretending the Estate Tax has Anything to do With Family Farmers
Thomas Klikauer
The Populism of Germany’s New Nazis
FacebookTwitterGoogle+RedditEmail