A broken system – Access to Medicines.

By Key Correspondent: Quwam Kelani

“Are medicines produced to solve human problems?” “Are they produced to make profitable gain?” “Who are the major stakeholders in medicine production?” “How can we achieve universal access to medicine globally?” These questions kept running through my mind while listening to Sheila Fitzgerald of Access to Medicines Ireland (AMI) speak at the 2019 Global Health Exchange at Dublin City University.

According to the World Health Organization (WHO), access to medicine is the equitable availability and affordability of essential medicines during the process of medicine acquisition. The WHO estimates that one-third of the global population do not have access to regular medicines. This is a major call for concern for both highly developed and less highly developed countries.

Ireland is considered a wealthy European state but the slowest to approve payment for new medicines. 71% of orphan medicines (drugs for very rare illnesses, which are not considered profitable to produce) are unavailable in Ireland. Nusinersen (also known as Spinraza) – a drug used to improve the quality of life for children with Spinal Muscular Atrophy (SPA) – was denied approval for reimbursement by the Health Service Executive (HSE) because it was deemed too expensive.

Less highly developed countries face a different challenge in the pursuit of access to medicine. Countries with 90% preventable diseases are allocated 10% of the global healthcare resources. This is mainly because medicines for preventable diseases do not generate profit. The antibiotic research program is at risk of not developing new antibiotics for antimicrobial resistant bacteria because of this. This makes the average availability of medicines in the public and private hospitals to 35% and 65% respectively.

The pharmaceutical system offers 20 years of patent exclusivity to pharmaceutical companies. This system is exploitative, expensive, and inequitable. Drug production becomes monopoly based and profit driven to increase shareholder value rather than to address human need. This leads to high prices of essential medicines and high pressure on the healthcare system to be able to keep up with patient need.

The pharmaceutical industry is guilty of lack of transparency around the cost of research and development, marketing, production and distribution of new medicines. The Drugs for Neglected Disease Initiative (DNDi) estimates €1.3 million for a new drug’s production compared to €2.6 billion by the pharmaceutical industry. We also do not sufficiently acknowledge the investment of public funds in research institutes and universities towards the early stage development of medicines. The lack of transparency makes it difficult for the healthcare system to negotiate a fair price on medicines.

The ultimate burden of this broken system is placed upon the patients in need. They cannot access some medicines, particularly for severe ailments like cancer, and fall to relying on public campaigns and crowd funding to battle for their lives. This increases disparities between people of different socioeconomic classes.

The public is a major contributor to drug development research through taxation, and has the right to benefit from a public health gain in return. The pharmaceutical industry argues that without patent based incentives, there would be no development of new drugs. However, major drug inventions such as insulin, penicillin and polio vaccines were developed before the normalization of patent based incentives.

Access to medicines for illness treatment is a human right. The government has a duty to protect this right, and has the bargaining power to negotiate with the pharmaceutical industry to ensure access by those most in need. Unfortunately, human rights have not accounted for in the current landscape of medical research and development.

“My message is clear: The system is broken, the cost is human globally, and it needs to be fixed” – Sheila Fitzgerald

20 September 2019