Report by the Chairperson of the Round Table Discussions on Securing of Access to Essential Medicines: Exploring the Options Available to Developing Countries
H.E. Dr C P Thakur, Minister of Health,
The discussion, by the Ministers of Health covered six major themes which related to securing access to essential medicines viz; essential medicines policies and national drug policies, affordable prices of medicines, globalisation and international agreements, adequate and sustainable financial resources, building human resources capacity and rational use of medicines.
Essential medicines policies/National drug policies
Health is both a determinant of development and an outcome of development. Access to essential medicines at an affordable cost is also a human right, National essential medicines policies or national drug policies, should be based on solidarity and should be a vital tool for ensuring access to essential drugs. The issue is much more than mere affordability, but also improving access that requires comprehensive strategies and planning. The Islamic Republic of Iran, Mali, and Swaziland were among the countries that described the role of essential medicines policy in expanding access. But, implementing a national essential medicines policy is not easy and often took time. In South Africa, for example, the National Drug Policy was conceived in 1995 and adopted in 1996, yet in 1997 the Medicines Control Act was passed which was aimed at implementing the policy. In 2001 this issue is still being disputed in court.
Affordable prices of medicines
Drug prices remained a barrier to access not just to HIV/AIDS-related medicines, but to many essential medicines. Strategies discussed to reduce drug prices included an essential drug lists, generic medicines, pooled procurement, cheaper imports and local production. Essential drug lists should identify those drugs that were most needed and most effective.
Use of generic medicines was an effective important tool to bring prices down. In some countries up to 80% of medicines were generic. However, several factors were needed for a successful generic medicines programme. The quality of generic medicines should be assured and required effective drug regulation systems. Sharing of information amongst countries and mutual recognition of regulatory actions could helpful. Health professionals and health care workers should be trained and understand the importance of generic prescribing and economic incentives must exist for dispensing generic medicines.
Pooled procurement through national and subregional blocks created economies of scale and helped to achieve lower prices. Local production could also lower prices. Transfer of technology and technical assistance were needed to expand local production capabilities. Economies of scale and local capacity were also important for local production, whilst noting that local production is not feasible in all countries where imports can be resorted to from cheaper producing countries.
Globalisation and international agreements
Globalisation should involve fair exchange and benefit all. The correct balance between public health and commercial interest should be achieved. The World Trade Organisation agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) provided a new stimulus for research and development, but such an international agreement might increase prices and reduce access. It was noted that, "the rules were deaf and blind to issues of health. The rules would still be valid when all the people were dead". Countries should adopt measures that favour competition, such as appropriate national patent legislation, compulsory licensing, and parallel importation where public health interest so require, pharmaceutical companies might need to reassess their approach on these issues.
The patenting of traditional knowledge and medicines were making both modern and traditional treatments unaffordable for poor people.
Adequate and sustainable financial resources
Sustainable financing models for providing public health care were urgently needed and all viable options should be pursued. Within national budgets there was an imbalance between available funds and needs. Health should be active in securing an appropriate share of national budgets.
Public and private medical schemes and other prepayment (insurance) schemes existed in many member countries and were playing an increased role in sharing the burden of health and drug financing.
Funding of essential medicines should be a clear-cut priority for international assistance. Recent examples of global drug funds\ facilities were welcomed, if sustainable. Debt cancellation can also support the cost of medicines, but should not be tied to conditions which interfered with national policies. Loans might not represent the most viable alternative for financing medicines.
Building human resources capacity
Progress depended on human resources capacity. Adequate numbers and appropriate deployment were critical. Staff should have the skills needed to address the complexity of current challenges in access to medicines.
Rational use of medicines
Rational use of medicines was needed to ensure that medicines had their intended health benefits. Training in rational drug use, emphasis on generic prescribing, regularly updated therapeutic guidelines, and a strict marketing code for the pharmaceutical industry could each be important components in promoting rational use. Community involvement and community education on the best use of medicines were needed, especially for HIV/AIDS-related medicines.