[Ip-health] Statement by Dr Tido von Schoen- Angerer, MSF at the IGWG

[Ellen T HOEN]

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Dr Tido von Schoen- Angerer, M=C3=A9decins Sans Fronti=C3=A8res=0D
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The ongoing activities in research and development mentioned by different=
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Member States yesterday are welcome.  But they must not distract us from=0D
the enormous gaps that still exist in research and development for diseases=
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that disproportionately affect people in developing countries.=0D
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These gaps exist at different levels.=0D
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Entire areas of need remain unaddressed. Weak levels of investment into=0D
diagnostic tools for different diseases is a striking example. There are=0D
desperate and immediate needs for better and simpler diagnostics which are=
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not matched by financing decisions: diagnosing tuberculosis, for example,=
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with the most widely available tool, microscopy, only detects 40-60% of=0D
patients - yet only 4% of the already limited TB R&D spending goes into=0D
diagnostics.  There are no robust point-of-care methods to diagnose HIV in=
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infants, nor do we have suitable tests to diagnose sexually transmitted=0D
infections =E2=80=93 and hardly any funding is made available.=0D
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Because no public body has undertaken the exercise of mapping the needs and=
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set priorities for health R&D depending on potential outcomes for world=0D
health, these gaps go unnoticed.=0D
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Five years ago, the R&D pipelines for neglected diseases were empty.=0D
Today, there are at least pipelines again.  However, these pipelines are=0D
still very weak and will not give us the breakthroughs that we need.=0D
M=C3=A9decins Sans Fronti=C3=A8res has recently released an analysis of the=
 pipelines=0D
for TB diagnostics and drugs [1].  The analyses conclude that the pipelines=
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are weak because of an insufficient number of compounds, insufficient=0D
investment into the drug discovery stage, and the lack of clinical trial=0D
capacity and funding for clinical trials.=0D
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Five years ago, we documented that only 1% of the drugs reaching the market=
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between 1975 and 1999 were developed for neglected diseases.  We updated=0D
the research last year and found that the figure had not changed.[2]=0D
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The current investment by public bodies into product development is highly=
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insufficient.=0D
Taking again the example of tuberculosis, the funding needs have been=0D
estimated at $2 billion per year, of which only one fifth is covered at the=
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moment. [3]=0D
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The global pharmaceutical market today is worth over US$ 500 billion. Most=
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of this money is made in wealthy countries. It is therefore no surprise=0D
that the market opportunities in these wealthy countries dictate the R&D=0D
agenda - with devastating effects for people in developing countries.=0D
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R&D financing is largely dependent on monopoly pricing of patented drugs.=
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As long as this remains the core of the global R&D system we will continue=
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to see huge neglect in R&D, and we will continue to see access problems=0D
because of high prices.=0D
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Through the WTO TRIPS Agreement, this innovation system is now globalised.=
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The CIPIH report very adequately describes how the promises of increased=0D
innovation that came with the TRIPS Agreement have not been fulfilled and=
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how monopoly pricing leads to access problems.=0D
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With the right policies and agreements between countries in place, it=0D
should be possible to turn some of the US$ 500 billion towards addressing=
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the health needs of developing countries.  A key first step in our view is=
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the identification of the gaps and needs =E2=80=93 the drawing up of an ess=
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medical R&D agenda.=0D
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We need policies to steer financing towards meeting these needs. We need=0D
financing mechanisms that ensure that R&D financing is not dependent on=0D
high drug prices.  Priority setting and financing mechanisms is a key=0D
government responsibility and cannot be left to private charitable=0D
foundations only.=0D
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In summary, this working group has to do two things:=0D
1.make a plan of action to implement the CIPIH recommendations=0D
2.At the same time, it must draw up a framework for needs driven R&D.=0D
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R&D and drug pricing issues are rarely discussed in the same forum while=0D
both issues are interlinked. Therefore this intergovernmental working group=
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is a historic opportunity to ensure that they are considered together,=0D
giving health concerns the primacy that they deserve.=0D
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References:=0D
1.    Tuberculosis R&D pipeline reports, October 2006, available from=0D
    http://www.accessmed-msf.org/documents/TBPipeline.pdf and=0D
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   http://www.accessmed-msf.org/documents/Diagnostics%20Pipeline%20Report.p=
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2.    Chirac P, Torreele E, Global Framework on essential health R&D, The=
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Lancet 2006: 367:1560-61=0D
3.    Tuberculosis Research and Development: a critical analysis, Treatment=
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Action Group, available from http://www.aidsfornyc.org=0D
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______________________________________=0D
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Ellen F.M. 't Hoen LL.M.=0D
Director Policy Advocacy=0D
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Medecins sans Frontieres=0D
Access to Essential Medicines Campaign=0D
8, rue Saint - Sabin=0D
75544 Paris cedex 11=0D
France=0D
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tel: + 33 1 4021 2836=0D
fax: + 33 1 40212960=0D
e-mail: ellen.t.hoen@paris.msf.org=0D
www.accessmed-msf.org