Access to Essential Medicines

James Curry & Jessica Antonel

GLOBAL LEADERSHIP HEALTH INSTITUTE

Nov, 2008

The Big Picture1) Status quo of inequity

1) What is it?

2) The Global Imbalance

3) Relation to HIV/AIDS1) Pharm Free Initiative

2) The AMSA Agenda

2) Institutional Foundations

3) What’s wrong and how do we fix it?

What is it?•Status quo of inequity

•Unfairness, Discrimination, Injustice, Inequality, Disproportion, Imbalance•The social, economic, political, and sovereignty infringing system of international dominance or disenfranchisement.

How does this play out in global access to essential medicines?

In the beginning…

• First patent in US, 1790• Article I, Section 8 of the constitution

– Congress may have a right….

• Three types of patents• Utility• Design• Plant

• Universities, depending on material, fall into one of these categories

• Laws different between national and international– Treaties created to respect international business

World Balance

• Institutions created after WWII– WTO – IMF– World Bank

• Much of world policy created in regard to trade, patent, and intellectual property laws are created within the parameters of these institutions and incentives

World Balance• Representation of the third world within

international forum is little

• Developing countries are at the whim of the first world

• Developing countries are desperate for trade, investment, infrastructure, jobs etc.

• International loans put developing countries at an extreme disadvantage with decisions directly affecting their sovereign nations

What is Balance?

• What is balance?• Equal representation from each participant• In the context of an international forum this includes

– international policy – international institutions and organizations

• Yet, is not upheld due to the complexity and definition of power – Between the needs of the first world– And the monetary limitations of developing countries

What is balance?

• Thus on an individual level & as a nation US policy/first world policy, pervades and affects the third world by two different interests from the same place…

• By both:– TNC’s/companies of the first world– by treaties and larger agreements of trade by the first

world

What is balance?

•Many first world companies (ie. Pharmaceutical companies, and TNCs) have more…

•Capital•Investment•Wealth

…than most developing countries

•The power and influence of international policy, treaties, trade agreements, and accepted policy reflects that imbalance of power

Let’s Take an Example:HIV/AIDS

The Concentrated Burden of HIV/AIDS:Country size is proportional to percentage of population

with HIV.

Let’s See How Many HIV/AIDS Affects

Distribution of HIV/AIDS Mortality:Country size is proportional to the number of AIDS related deaths in

a single year.

Now, Let’s See How It isBeing Dealt With..

Public Expenditure on Health Care:Country size is proportional to global spending on public health

services

Pharma Market Share by Region

Europe and North America= 86.9%

Asia: 2.7%

All of Indan Subcontinent: 1.4%

Africa: 1.2%

All of Africa, Asia & Latin America : 13.1%

…And How It Isn’t...

Distribution of Affordable Medicines:Country size is proportional to percentage of population with access

to essential drugs

Is this Pharm Free?...

• Pharm Free is:– The campaign to end conflicts of interest

between medicine and Pharma– Pharma Relations>

• - Jeopardize medical/Hippocratic professionalism• - Undermine evidence-based medicine• - Strain the patient-physician relationship• - Alter prescribing habits (patient & system effects)• - Trend toward over-medicalization/over-medicating• Increase drug prices through advertising and over prescribing, leading to unequal

access down the road.

The Connection:Pharm Free and Access

• It is clear that the same companies whose lunches and pens physicians partake of in the U.S., are perpetrating crimes against humanity in the developing world, refusing to offer medicines at affordable cost to a market that collectively comprises a mere 11% of the market for pharmaceuticals.

• What you can do on World AIDS Day, December 1st

• Join other physicians-in-training by pledging to be PharmFree, which is simply:

• - taking no gifts for personal benefit from drug companies (e.g. lunches, pens, notepads, books, etc.)

• - vowing to seek un-biased, non-industry sources of information for your education on prescription drugs

– http://www.amsa.org/prof/pledge.cfm

Is this on the AMSA agenda?...

• YES!– As the next generation of physicians, we must

advocate for increased access to treatment and evidence-based prevention in order to continue our promising gains against the

global AIDS pandemic.– This applies to:

GLOBAL HEALTH EQUITY

Science

• Universities are a large player in developing new medical developments to disease

• In 2001, Universities within the US received 3000 patents

• Universities receive funding from private donors and from the state and federal government

• These patents are usually eventually sold to pharmaceutical companies for profit

Science

• Without money for the resources of research, most developing countries are unable to develop drugs for diseases unique to their location

• Tropical diseases are neglected because– there is little profit incentive– few home institutions capable of such

development– there is little demand within capable countries

What about Health?

• Fundamental Question:

– Is health a RIGHT?

– Is health a commodity?

– Does capitalism and business mean that millions of people worldwide should suffer from curable diseases?

– Does the lack of monetary and political power within the third world mean they have no say in the justice of international trade agreements such as TRIPS?

Is Health a RIGHT or a COMMODITY?

• Does poverty mean that millions of people should suffer from curable diseases because such people do not affect the profit margin of a business?

• How are we as individuals contributing to these problems?

• What are some solutions?

Solutions • 1.) To allow the third world to exercise

certain essential patents to produce medicines either – In the first world at wholesale OR– In the home third world country at inexpensive

production cost

• 2.)To add an additional clause within the initial patent from University Company– Requiring the patent not include essential

medicines within developing countries

Solutions

• The demand that reaches the patents at issue do not affect more that 1.3% of the profit margin of companies…

• This is because – Developing countries cannot otherwise afford

these essential medicines– The profit margin would thus not be affected

because there is no opportunity cost and sunk costs are already lost

Solutions

• Thus making a change to initial patent contracts would be an easy, virtually free, and effective way to begin to aid in international suffering.

Contradictions

• Do international policies contradict the right to healthcare?

• Do international policies promote suffering?

• How can we create a more balanced international system to represent countries based on more than GDP?

Conclusions• Demand that US representatives of international

institutions be chosen by ballot rather than be appointed

• Understand the correlations of US business interests and its role in maintaining third world poverty

• Promote University patents to allow the third world to exercise these issues

• Create and promote research designed to investigate tropical and rare diseases

Conclusions

• Influence legislators on international policy positions to aid in the alleviation of third world poverty

• Insist that these positions do not involve:– The interests of first world investment– Or the extraction of resources out of the third

world– Insist that development remain locally

contracted (with medical production as well)– That countries are able to ensure for

themselves a better future

What should be done?

By Government: In the developed world,

promote an equitable interpretation of global trade laws that promote access to life-saving medicines

Reaffirm the Doha Declaration and flexibilities in TRIPS

– AMSA’s World AIDS Day demands for our next president:• NO new free trade deals

(FTAs)• NO non-enforcement of

TRIPS and other existing trade flexibilities

What can you do?

Contacts: Find you elected officials:

Senators, Representatives, State legislators.. The PRESIDENT!

Be clear that this issue has effects abroad as well as at home. We are all connected and AMSA is behind you.

o Action:oWrite a letteroContact your local

media with an opinion piece

o Start a petitionoPick up the phoneo Lobby!o Take it to the streets

AMSA’s Legislative Action Center