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Info Service on Health Issues (Jun16/07) WHO: Member States concerned over unaffordable prices of medicines Geneva, 11 June (Mirza Alas and K M Gopakumar) – World Health Organization Member States once again raised concerns over unaffordable prices of medicines at the recent annual meeting of health ministers and high level officials. Many countries expressed the view that high prices of medicines will be a barrier for the implementation of key global health strategies during their interventions on the adoption of the three global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) (Documents A69/31, A69/32 and A69/33) for the period 2016-2021 at the 69th World Health Assembly (WHA) that took place in Geneva from 23 to 28 May. These three different strategies pave the way for compressive actions in prevention of, and treatment for, HIV, viral hepatitis and STIs. Sustainable Development Goal (SDG) 3 sets specific targets on these diseases along with other health conditions as part of the 2030 Agenda for Sustainable Development adopted last year by Heads of States and Governments. [SDG target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. SDG 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.] All three strategies aim to enhance access to treatment along with prevention. For instance, the strategy on viral hepatitis states: “where viral hepatitis transmissions is halted and everyone living with viral hepatitis has access to safe, affordable and effective care and treatment.” However, while the strategy identifies medicines and diagnostics as unaffordable for most, it also identifies the main priority actions by WHO as advocating for strategies to reduce prices and provide technical support to countries for developing strategies to negotiate price reductions with manufactures. Access to treatment for hepatitis C is a tremendous challenge in both the developed and developing countries due to the exorbitant high prices of originator medicines. The challenges put forward by developing and developed countries on access to affordable treatments resonates with a recent study: Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30 Countries: An Economic Analysis published by the medical journal, PLOS Medicine where the authors looked at the prices for hepatitis C and how current prices will represent huge proportions on the health budgets and therefore many countries have had to restricted access to treatment. The
study found that: “The total cost of treating all patients with
hepatitis C would be equal to at least a tenth of the current annual
cost for all medicines in all of the countries studied. In some countries
where prices are high and the burden of disease is large, the total
cost of treating all infected patients would be more than the cost
of all other medicines put together” (see the full article in: http://journals.plos.org/plosmedicine/article?id= The WHO strategies stress the need for using the flexibilities in the Trade -Related Aspects of Intellectual Property Rights Agreement (TRIPS) to ensure access to affordable treatment. The Viral Hepatitis Strategy states: “The demand for affordable treatment for viral hepatitis B and C infection requires comprehensive price reduction strategies for medicines, diagnostics and health commodities, including for those medicines and diagnostics in the development pipeline. Strategies include fostering generic competition, including through voluntary licences, and using the Agreement on Trade -Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health. That would include compulsory licences and filing patent oppositions, differential pricing and direct price negotiations with manufacturers, as well as local manufacturing in accordance with the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property, which also notes that intellectual property rights are an important incentive for the development of new health care products”. (Emphasis added.) The last part of the sentence ‘intellectual property rights is an important incentive for the development of new health care products’, clearly aims to appease developed countries and the pharmaceutical transnational corporations. While expressing unanimous support for the strategies many Member States pointed out that the high price of medicines is one of the main barriers against the successful achievement of the strategies. They particularly expressed their concern on the cost of hepatitis C treatment and requested capacity building and technical assistance from WHO to overcome price-related barriers. Concerns on high prices were not confined only to medicines. Member States also referred to prices on vaccines for hepatitis B and for HPV (human papillomavirus that causes cervical cancer) during their interventions on the global strategies. During the discussions on the health sector strategies Timor Leste, on behalf of the South-East Asian Region (SEARO), observed that the cost of medicines for the treatment of hepatitis C such as Sofosbuvir is extremely high and that there is a lack of strategies to promote low cost generics in all countries afflicted with a high level of hepatitis C incidence. Timor Leste also noted that there is a need for scientific information for the introduction of HPV programs as there are large budget implications and that the national immunisation technical advisory groups should be strengthened for evidence-based decision. China supported the progress made and noted that HIV is not just a public health issue but requires a multi-sectoral approach. It stressed that improvements in technical and financial support were needed. China also noted that there is a need to lower the prices of medicines. Thailand pointed out that on viral hepatitis, a crucial challenge is the availability of hepatitis vaccines and that there is a need for a comprehensive package for treatment of viral hepatitis. Saudi Arabia welcomed the strategy and emphasized their concerns regarding access to medicines especially vaccines. It also noted that steps to ensure access to generic medicines were not yet sufficient and called for the production of high quality of generics for hepatitis infections as was with the case of AIDS. Malaysia voiced its support for the strategies but pointed out that coverage cannot be reached if the medicines are very expensive and requested WHO to work on reducing prices with pharmaceutical companies. Brazil also stressed that the high costs of medicines are threating the fight against STIs and hepatitis, emphasizing the importance of the use of TRIPS flexibilities. India commended the Secretariat for the strategies and pointed out the importance of affordable HIV medicines and how India has played a key role at the global level. India also remarked on the importance of working on prevention and that the main challenge for the implementation of the strategies will be how to finance them. Issues regarding prices of medicines were not only raised by developing countries, where this has been a long struggle, but they were also mentioned by developed countries such as Australia, the United Kingdom and Greece. Australia welcomed the three strategies and highlighted that progress remains uneven. Further, Australia acknowledged that the challenges require Member States collaboration and welcomed the hepatitis strategy which recognizes the challenge of affordable access. The United Kingdom emphasized the importance of country investment and called on the WHO to scale up country support to ensure universal coverage. Moreover, it noted that aiming to eliminate hepatitis by 2021 is an ambitious objective for countries to achieve considering the high cost of addressing the problem. Greece remarked on its national efforts to develop a national hepatitis C plan and its commitment to ending viral hepatitis. However, Greece pointed out the moral dilemma it faced given the country’s resource constrains, and how that will be an obstacle for implementation. It noted that it will be important to have negotiations on the price of medicines according to national plans and to encourage tools like joint procurement and exchange of experiences across countries. However, the United States noted that there is a need for more efficient delivery models and about information of how Member States will reach vulnerable groups. The US also noted that providing access to medicines is crucial but expressed concerns about WHO having an advocacy role to increase affordable access to medicines and the focus on prices and intellectual property in the strategies to increase access to hepatitis drugs. At the adoption of the strategies by Member States the WHO Secretariat said that actions are now required for implementation and that there are major opportunities for comprehensive price reductions. It said further that even though price is a challenge the introduction of generics is crucial for low and middle income countries and that now hepatitis C treatment has been produced for less than USD 300. Discussions on challenges related to prices were also present at the adoption of the report of the Global Vaccines Action Plan (Document A69/34)where many Member States again expressed their concerns on the high prices of vaccines. Developing countries emphasized the difficulties in producing their own vaccines and the support needed from WHO to enhance capacity in vaccine manufacturing for countries to be able to keep high vaccination coverage. Member States stressed that WHO should promote collective purchasing of vaccines and an emphasis was made on the need to use TRIPS flexibilities. Moreover, Member States raised important challenges in maintaining the immunization programs particularly for countries that are graduating or are not eligible for the Vaccine Alliance (GAVI) support. They highlighted the need to discuss a plan to reduce high vaccine prices and ensure the affordability of new vaccines. *With inputs from the WHO Watch team of the People’s Health Movement
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