Managing the Hydra: The Herculean Task of Ensuring Access to Essential Medicines
INTERNATIONAL PUBLIC GOODS AND TRANSFER OF TECHNOLOGY AFTER TRIPS, pp. 393-424, K. Maskus, J. Reichman eds., Cambridge Univ. Press 2005
32 Pages Posted: 22 Aug 2011
Date Written: December 21, 2004
The task of ensuring access to essential medicines presents a complex and embedded set of problems that will remain a persistent feature of the international governance landscape for the foreseeable future. The WHO’s recommended list of essential medicines has been developed with a view to aiding procurement authorities in determining the supplies needed to treat local populations. The price of medicines is a signiﬁcant factor in determining what should be included on the list since there is small utility in recommending expensive therapies that are not affordable.
Nonetheless, the most recent WHO Essential Medicines list includes a signiﬁcant number of antiretroviral medicines (ARVs) that are under patent. These drugs may not be affordable for many HIV-positive individuals, even taking into account recent price declines, unless public health budgets in developing countries are supplemented by international assistance.
The world community is presently confronted with tremendous public health challenges due to HIV/AIDS, malaria and tuberculosis. Yet, populations around the world, and especially in developing and least-developed countries, face heavy public health burdens from many sources, including other infectious diseases, diarrheal diseases, cancer, diabetes, heart and circulatory disease, and other conditions. While HIV/AIDS is the most immediate problem, it is not enough to address only this scourge.
Although there has been considerable public debate concerning the effect of patents on access to medicines, ensuring adequate supplies involves an extensive regulatory framework encompassing a multiplicity of factors. These include:
* Research and Development * Safety and Efﬁcacy (including Liability) * Manufacturing Systems and Controls (Good Manufacturing Practices) * Intellectual Property * Procurement, Distribution and Dispensing * Health Care Personnel and Infrastructure * Financing
Each of these elements in the essential medicines supply chain can and does act as a roadblock. Yet, each element is present for a reason. It is not helpful to supply inexpensive medicines if they are not safe and effective, or if they are prescribed to treat the wrong condition.
The mythical Hydra was a many-headed beast with a remarkable regenerative capacity. The public health situation in developing countries shares these characteristics. The problem is multi-faceted, and addressing one aspect often reveals new challenges. Even Hercules was unable to slay the Hydra single handedly. He required the help of an assistant. Hercules did, however, provide strong leadership and commitment. Political leadership and commitment is likewise needed to address the problem of access to essential medicines, and it isnot yet clear from where such leadership and commitment will emerge.
Keywords: Public Health, Essential Medicines, HIV-AIDS, Research and Development, Procurement
JEL Classification: H41, H42, I18, K32, K33, L65, O34
Suggested Citation: Suggested Citation