UN Recommendations Will Spur Drug Innovation for Entire World, Not Just Select Markets
This op-ed is a response to John Graham's Oct. 12 oped: The United Nations Report on Access to Medicines is a Public Health Hazard
In his Oct. 12 op-ed “The United Nations Report on Access to Medicines is a Public Health Hazard,” John Graham took issue with UN recommendations, making what is essentially an argument for maintaining the status quo in our approach to bringing new drugs to market. Unfortunately, Mr. Graham misrepresents the current state of affairs and his argument shows disregard for the lives of people afflicted with illness in poor countries.
Completely absent from his point-of-view is the fact that under the status quo, people who have terrible diseases but live in wealthy countries have a private sector that is willing and able to do its best to come to the rescue for paying customers, whereas sick people in poor countries often do not.
The private sector’s record of success is notable. The past few decades have seen impressive innovations that have led to the development of effective drugs for control of HIV infection, cures for hepatitis C infection, and novel and effective drugs for advanced cancers. Millions of lives have and will be saved as a result, but at present most of those lives are in affluent countries, as the cost of these drugs is often in the tens or even hundreds of thousands of dollars annually, per person.
Meanwhile, those living in poor countries and afflicted with terrible diseases such as malaria or tuberculosis aren’t so lucky. Last year alone, 1.8 million people globally died from tuberculosis, making it the sixth leading cause of death in the world. Nearly half a million people in the world have resistant forms of the disease that are difficult or impossible to treat with available drugs. In contrast to the dozens, if not hundreds, of drugs now on the market for HIV infection, hepatitis, cancer and heart disease, only two new anti-TB drugs have been licensed anywhere in the world in the past 50 years. A recent report by Treatment Action Group demonstrates how little private sector investment there has been in TB drug development compared to other diseases.
The system we have has not worked well for sick people in poor countries. This reality is made graver by the fact that, as with the two examples above, many diseases exist mostly in those poorer countries. In response to the failure of the market-driven private sector to address this crisis, the UN recently endorsed recommendations that urge governments to increase their current levels of investment in health technology innovation to meet unmet needs and to enter negotiations for a binding research and development treaty. Doing so would separate or “delink” the costs of innovation from the end prices of health technologies in order to address issues that existing innovation mechanisms have failed to adequately address.
In protest of the recommendations, Mr. Graham writes that,
"Economic freedom leads to income growth, which reduces the burden of many illnesses even without medical intervention. Few Americans fear infection by rabies or leprosy, because our affluence ensures we live in an environment in which outbreaks are almost impossible.”
This is patronizing, condescending, and also misleading. When drugs are available to treat conditions such as HIV and hepatitis but are too expensive for people in poor countries to afford — or when millions die of diseases such as TB and malaria because new drug development is close to non-existent — lecturing about economic freedom, affluence, leprosy, and rabies seems beside the point, to say the least.
It should also be noted that much of the work of the pharmaceutical industry, impressive as it is, rests on basic science research by agencies, such as the National Institutes of Health, INSERM, and others, funded by the federal government — not “supplemented” by it, as Mr. Graham says in his article. Similarly, in contrast to what Mr. Graham would have us believe, many advanced market economy countries, such as the U.S., Great Britain, and Israel, have thriving and successful pharmaceutical industries in a heavily regulated environment. Finally, current patent laws and protections do not prevent companies from suing one another over patent protection in the U.S. and elsewhere.
Science is a collaborative effort, generally advancing incrementally rather than in great leaps. The achievements of the pharmaceutical industry in many areas are amazing, and millions of lives each year are saved or improved because of their work. But for people in poor countries suffering from illnesses that seemingly are not shared with those in advanced market economy countries, the status quo isn’t good enough.
All human lives are of equal value, and every person deserves dignity and respect. New approaches are needed for the billions of people too poor to serve as attractive customers for private companies, however effective their R&D.