[Ip-health] UK initiative to drive down cost of drugs in poor countries

[Ira Glazer]

< cross posted from the e-drug mailing list>

http://www.bmj.com/cgi/content/full/334/7599/870-a

BMJ  2007;334:870 (28 April), doi:10.1136/bmj.39195.388356.DB
[copied as fair use]

Robert Short
London

A new organisation is being set up to increase transparency in the regulati=
on, procurement, distribution, and sales of drugs in developing countries. =
Its objective is to drive the cost of drugs down to levels that patients ca=
n afford.   The UK led initiative, called the Medicines Transparency Allian=
ce, has just had its first stakeholder meeting and will be launched in the =
coming months. It will run pilot projects in up to nine countries. Its aim =
is to publish information on the amount, quality, and price of drugs in poo=
r countries; to allow patients to see what they should pay and give them co=
nfidence in the quality and safety of the drugs; and to create a forum in e=
ach pilot country that will bring together patients, doctors, non-governmen=
tal organisations, and those involved in supplying drugs.

Hilary Benn, secretary of state for international development, said at the =
stakeholder meeting: "One third of the world's population has no access to =
the drugs they need to help them fight disease, and up to 30% of drugs avai=
lable in the poorest countries are fake or substandard. Even when the right=
 medicines are available they are unaffordable for the majority of people i=
n developing countries, with mark-ups of up to 500% by some pharmacists."

The UK Department for International Development is also creating an interna=
tional advisory body to inform it of new developments and to identify ways =
to obtain and deliver drugs at sensible prices to the developing world. At =
an international conference on access to drugs, hosted jointly by the depar=
tment and the Lancet, the department's undersecretary of state, Gareth Thom=
as, challenged the drug industry, non-governmental organisations, and gover=
nments to find new ways to ensure that drugs reached people in developing c=
ountries at affordable prices. He invited participants at the conference to=
 contribute to further debate at the department and to put themselves forwa=
rd to join the advisory body.

 "Finding new, innovative solutions=97through new partnerships and networks=
, bringing down costs, accelerating research, [and] jumping over legal hurd=
les=97is vital if we are to get serious about improving access to medicines=
 for the poorest people of the world," said Mr Thomas.   Presentations at t=
he conference showed that success in reducing the cost of drugs in developi=
ng countries is not just about obtaining discounts from the industry and en=
gineering flexibility in patent rights=97the subjects of media attention.

Access to drugs is affected by every aspect of the supply process, delegate=
s heard. Relevant factors included research into and development of treatme=
nts for neglected diseases; patent control over the manufacture and sale of=
 drugs; competition with generic drugs; the supply chain by which the drugs=
 are delivered; unethical local incentives to supply specific drugs; govern=
ment support of health priorities; and the means by which hospitals and cli=
nics are able to get payment for services to patients.

 Jonathan T Mwiindi, from the Ecumenical Pharmaceutical Network, Kenya, com=
mented on the difficulty of dealing with the unethical and often invisible =
practices of intermediaries in the supply chain. For instance, retailers ma=
y receive incentives (such as a television) for stocking certain products; =
and prescribing patterns may be sold to agents, who then put pressure on in=
dividual doctors. He believes that there has been a shift from a culture of=
 medical representatives offering information on the best use of drugs to o=
ne of sales representatives who are paid incentives to maximise volume gene=
rated from prescribers.

 Trevor Jones, former head of the Association of the British Pharmaceutical=
 Industry, suggested a naming and shaming mechanism to counter bad practice=
s. However, one of the conference participants pointed out that such a proc=
edure might endanger the lives of the whistleblowers and the perpetrators i=
n some countries.

It was also pointed out that the local mark-up of drug prices is not always=
 caused by corruption. In many hospitals most patients are unwilling to pay=
 for "non-tangibles," such as a consultation that results in no drug being =
prescribed. So the mark-up is sometimes the main way by which hospitals can=
 cover their consultation and other costs, and it is the cheapest drugs tha=
t are most often heavily marked up.