Reviewed by Raffaella Ravinetto
Over the last decade, a growing attention has been given to the problem of access to essential medicines, especially in what concerns the North-South disparity in access to ARVs (patents’ and prices’ issues), the poor access to effective and safe medicines for neglected tropical diseases (lack of funds for research and development) and, more recently, the need to broaden access to new vaccines.
This approach has achieved important results, but has failed to address the epidemiological transition in the developing world, where the proportion of deaths from chronic diseases has been increasing. Thus, this study addresses an important information gap, by investigating the differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. It comprises data from 50 surveys carried out in 40 countries, using a standard methodology developed and validated by the WHO with Health Action International (the description of the methodology -how to collect and analyze medicine prices across sectors and regions in a country, availability, affordability and price components- is available athttp://www.haiweb.org/medicineprices/. Quality aspects are not included). The fifteen medicines most frequently covered in WHO/HAI surveys for acute and chronic diseases were considered, and “availability” was reported as the percentage of surveyed facilities where a product was found on the day of data collection.
The study shows that availability of all medicines is suboptimal across countries, particularly in the public sector, compared to the WHO benchmark (80%). However, medicines for chronic conditions are significantly less available than those for acute conditions, to an extent that cannot be explained by the epidemiological patterns. The difference is bigger in low- and lower-middle income countries and in the public sector; it is generally smaller in the private sector (where, however, prices are higher, so the affordability to individuals remains lower). Among the possible reasons for this gap, there are the governments’ policies and the slow adaptation of health systems to the epidemiological translation. The authors call for health insurance schemes covering all essential medicines, and for policies promoting quality-assured generics for all conditions, especially in poorer countries. Also, “international financing” can improve the current situation. The potential role of international actors could be further emphasized: the international mobilization for universal access to ARVs has been fundamental to push the creation of initiatives and bodies that have fuelled access to medicines for HIV, malaria and tuberculosis, e.g. the WTO Doha Declaration in 2001, the creation of the Global Fund, the Pepfar, the Clinton’s Initiative, UNITAID and the Patent Pool initiative -now a separate entity (http://www.medicinespatentpool.org/). It is important to mention the WHO Pre-qualification (http://apps.who.int/prequal/), which plays an often underscored but key role for the access to quality-assured essential medicines: the lack of an equivalent initiative covering medicines for non communicable diseases may make it more difficult to select quality assured products for these conditions,
in the international pharmaceutical market.
A massive mobilization of the civil society against the current status quo (a different life expectancy and quality of life for people suffering from the same chronic conditions, but in different contexts) could be of great help to fuel concrete initiatives to push down the prices of these medicines, while keeping their quality assured (no North-South double standards).
This study focused on medicines for “chronic diseases” rather than for “non communicable disease”. It could be interesting to see a similar analysis for anti-cancer medicines, to assess to what extent the high price of medicines, especially the most recent and innovative ones, contributes to the North-South disparity in access to cancer treatment, by reducing affordability to individuals and health system. The study of Cameron et al., and other similar studies (e.g. on cancer drugs) could overall contribute to build evidence that “universal access to quality medicines” should not be a vertical but a transversal theme.