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A new organisation is being set up to increase transparency in the regulation, procurement, distribution, and sales of drugs in developing countries. Its objective is to drive the cost of drugs down to levels that patients can afford.
The UK led initiative, called the Medicines Transparency Alliance, 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 poor countries; to allow patients to see what they should pay and give them confidence in the quality and safety of the drugs; and to create a forum in each pilot country that will bring together patients, doctors, non-governmental 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 available in the poorest countries are fake or substandard. Even when the right medicines are available they are unaffordable for the majority of people in developing countries, with mark-ups of up to 500% by some pharmacists.”
The UK Department for International Development is also creating an international 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 department and the Lancet, the department's undersecretary of state, Gareth Thomas, challenged the drug industry, non-governmental organisations, and governments to find new ways to ensure that drugs reached people in developing countries at affordable prices. He invited participants at the conference to contribute to further debate at the department and to put themselves forward to join the advisory body.
“Finding new, innovative solutions—through new partnerships and networks, bringing down costs, accelerating research, [and] jumping over legal hurdles—is vital if we are to get serious about improving access to medicines for the poorest people of the world,” said Mr Thomas.
Presentations at the conference showed that success in reducing the cost of drugs in developing countries is not just about obtaining discounts from the industry and engineering flexibility in patent rights—the subjects of media attention. Access to drugs is affected by every aspect of the supply process, delegates heard. Relevant factors included research into and development of treatments 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; government support of health priorities; and the means by which hospitals and clinics are able to get payment for services to patients.
Jonathan T Mwiindi, from the Ecumenical Pharmaceutical Network, Kenya, commented on the difficulty of dealing with the unethical and often invisible practices of intermediaries in the supply chain. For instance, retailers may receive incentives (such as a television) for stocking certain products; and prescribing patterns may be sold to agents, who then put pressure on individual doctors. He believes that there has been a shift from a culture of medical representatives offering information on the best use of drugs to one of sales representatives who are paid incentives to maximise volume generated from prescribers.
Trevor Jones, former head of the Association of the British Pharmaceutical Industry, suggested a naming and shaming mechanism to counter bad practices. However, one of the conference participants pointed out that such a procedure might endanger the lives of the whistleblowers and the perpetrators in 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 that are most often heavily marked up.