Letter to the WHO Executive Board
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MSF Statement for the WHO Executive Board - 14 January, 2002
Can be found at:
http://www.accessmed-msf.org/prod/publications.asp?scntid=3D14120021123512&contenttype=3DPARA&
Contents:
* Next steps for the Essential Drugs List (EDL)
* Equity pricing
* Pre-qualification of low cost producers
* The Doha declaration on TRIPS and public health
* Gap in research and development
MSF would like to take the opportunity of the WHO Executive Board to
highlight a series of issues related to the WHO and the important
role it must play in increasing access to essential medicines in de-
veloping countries.
* Next steps for the Essential Drugs List (EDL)
The EDL is one of the most important public health tools, promoting
access to vital medicines and their rational selection and use. Es-
sential drugs are those that satisfy the health care needs of the ma-
jority of the population; they should therefore be available at all
times in adequate amounts and in the appropriate dosage forms, and at
a price that individuals and their communities can afford. The Essen-
tial Drugs concept guides countries in selection of drugs, in deci-
sions about procurement and pricing policies and rational drugs use.
The essential drugs concept also provides guiding principles for
NGOs.
MSF welcomes the revised procedure for updating WHO's Model List of
Essential Drugs as outlined in document EB109/8. The procedure en-
sures an evidence-based, transparent, and independent process for re-
vising the EDL. We particularly welcome the fact that expensive
drugs, when their use is justified, will no longer be excluded from
the list solely because of price.
The expansion of the EDL should go hand-in-hand with measures to en-
sure that these medicines become affordable for the individuals and
communities involved.
* Equity pricing
WHO should actively support equity pricing of essential medicines,
many of which are currently too expensive for developing countries.
While some progress has been made in bringing the prices of certain
medicines down, a lot remains to be done by governments and interna-
tional organisations. An equity pricing system should include politi-
cal and legal measures to increase generic competition, global / re-
gional procurement and distribution, local production through compul-
sory or voluntary licensing and technology transfer.
MSF would like to warn against unwarranted optimism with regard to
the multinational industry's willingness to bring drug prices down to
an affordable level. Equity pricing will not be achieved by relying
on voluntary actions by pharmaceutical companies only. Without deci-
sive action from key players such as the WHO, the price of medicines
for many diseases will remain too high. For example, the price of an
essential drug used to treat AIDS-related meningitis, fluconazole,
varies greatly depending on who produces it and where it is sold: in
Thailand, a generic producer sells it for US$ 0.29 (per 200 mg cap-
sule; June 2000) but in Guatemala, where the drug is patented and
manufactured by Pfizer, it costs as much as US$ 27.60.
In the case of a high-profile disease such as AIDS, where public
pressure and media attention is intense, lack of transparency from
the pharmaceutical companies about pricing their products in differ-
ent countries is emerging as a new challenge. Obtaining up-to-date
pricing information is difficult, and negotiating drug prices with
different companies for each individual product is time-consuming for
the governments of poor countries. WHO should support across the bor-
der negotiations regarding the pricing of medicines for neighbouring
countries with similar needs.
MSF is pleased to work with the WHO, UNAIDS and UNICEF on providing
information on drug prices and welcomes the collaboration within the
NGO Roundtable process on development of price monitoring methodology
for NGOs. We hope to expand the work on drug price information even
further in the future.
* Pre-qualification of low cost producers
Medicines should be essential, available, affordable and of quality.
To offer treatment to the highest number of people possible in devel-
oping countries, it is essential that all funds be used to buy qual-
ity medicines at the best possible price. This is simple mathematics:
using the lowest cost suppliers, whether proprietary or generic com-
panies, will increase the number of people who can be treated and
will allow for greater investments in other important components of
care and prevention.
The WHO should support countries and NGO's in procuring affordable
medicines for these particular diseases by identifying quality pro-
ducers through a pre-qualification process. This will also facilitate
procurement that will take place as a result of the activities of the
Global Fund for TB, malaria and HIV/AIDS. Cheaper alternatives of im-
portant products, such as antiretrovirals, are becoming available on
the markets of developing countries, and it is paramount to assist
countries to assure the quality of these products. The added value of
the pre-qualification process cannot be underestimated.
* The Doha declaration on TRIPS and Public Health
2001 was marked by progress in the discussions on patent barriers to
access to medicines at the World Trade Organisation (WTO). The Doha
declaration on TRIPS and Public Health lays out the options countries
have to take measures when prices of existing patented drugs are too
high for their populations. 2002 is the perfect opportunity for the
WHO to take up the challenge, together with other relevant interna-
tional organisations, to provide practical technical assistance to
make sure that the Doha declaration makes a difference at the na-
tional level. One pragmatic and effective way of doing this is to
provide countries with examples or models of intellectual property
legislation that will allow them to develop TRIPS compliant laws -
all the while making maximum use of the safeguards of the TRIPS
agreement to ensure that pharmaceutical patents do not hamper access
to medicines.
* Gap in research and development
2002 is also the time to improve the availability of essential medi-
cines to treat neglected diseases, such as leishmaniasis, sleeping
sickness and Chagas disease, affecting populations with no purchasing
power and no vocal advocacy groups. MSF would like to see firm action
to compensate for the lack of research and development into these
diseases, and other infectious diseases such as malaria and tubercu-
losis - an issue that was flagged in Doha but not resolved.
Again, this is where the WHO clearly must play a major role, along
with governments and donor countries, in determining the R&D needs
and stimulating R&D activities. R&D for neglected diseases cannot be
left to the market place. Public Private partnerships alone will not
offer a solution because there is insufficient market incentive.
Radical new approaches are needed to kick-start R&D, including new
funding mechanisms in areas that are now totally abandoned. Not-for-
profit drug development initiatives should be explored to take drug
R&D for neglected diseases out of the marketplace altogether.
MSF looks forward to contributing to an active dialogue and joint ac-
tion to resolve the issues addressed above.
Courtesy of Fawzia Rasheed
--
Claudio Schuftan
mailto:aviva@netnam.vn
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