NATIONS - The world's poorest nations continue to suffer
from high prices for life-saving drugs and a shortage of generics --
specifically to treat HIV/AIDS -- despite assurances by the some of the
major pharmaceutical companies to help lower costs.
must act to bring prices down and improve availability, or else Target
8e [of the Millennium Development Goals] will be a U.N. failure,"
Margaret Ewen of the Amsterdam-based Health Action International (HAI)
When Secretary-General Ban Ki-moon met with senior executives
of 17 of the world's generic pharmaceutical and diagnostic companies
last week, he stressed the need to increase access to cheaper vaccines
and medicines to millions of people deprived of life-saving medications
because of exorbitant prices.
Pointing out that the focus was primarily on HIV/AIDS, which
is particularly ravaging the African continent, Ban said: "We noted
that despite the gains, the epidemic continues to outstrip our best
Only one-third of those who need antiretroviral treatment in low-and
middle-income countries are getting it, he said. And each day, for
every two people who are placed on antiretroviral treatment against
AIDS, five more are infected.
"Collectively, we still have more work to do," the secretary-general declared.
Besides the reduction of extreme hunger and poverty by 50 percent by
2015, the U.N.'s Millennium Development Goals (MDGs) also call for
access to affordable essential medicines in developing countries --
known as Goal 8e.
Asked what progress has been made to achieve Goal 8, Ewen told
IPS: "At the half way stage to the MDGs, there is more a chasm than a
gap between the goal of access to affordable essential medicines in
developing countries and the current situation."
As data shows, medicine prices are too high and availability too low, she said. And many treatments are simply not affordable.
For example, in the private sector in Pakistan, the lowest paid
unskilled government worker has to work about five days to buy a
month's supply of omeprazole to treat an ulcer, even when purchasing
the lowest priced generic.
Omeprazole is on the National Essential Drug List and supplied free in
the public sector -- but availability was only 13 percent, she pointed
out. This forces people to buy in the private sector at prices they
In Indonesia, a low-paid unskilled government worker has to
work more than four days to buy just one salbutamol inhaler, an asthma
medicine, in the private sector.
While a few governments have acted on the survey findings, many have
not. "This simply isn't good enough as people, especially the poor, are
spiraling into debt or going without the treatments they need," Ewen
To help countries struggling with high prices for drugs, HAI and the
World Health Organisation (WHO) are currently developing guidance on
policy options to reduce prices.
"We need to look at what policies work and don't work in
various settings. We hope that by providing such information countries
will act," Ewen said.
The Geneva-based WHO is also looking to scale-up efforts to
improve the care of those with major chronic diseases, such as
cardiovascular disease, diabetes and asthma, with emphasis on improving
the availability and affordability of chronic disease medicines.
There definitely needs to be greater focus on chronic diseases as they
kill an estimated 35 million people a year, according to WHO.
For the last eight years, both HAI and WHO have been working together
to improve the availability and affordability of essential medicines.
To date, over 50 surveys have been conducted across the globe by ministries of health, researchers, and/or civil society groups.
The results from these surveys were reported in the MDG Gap Task Force Report released by the United Nations last month.
In the public sector, generic medicines are only available in
34.9 percent of facilities, and on average cost 250 percent more than
the international reference price, according to the study.
In the private sector, those same medicines are available in
63.2 percent of facilities, but the cost on average is about 650
percent more than the international reference prices.
"Prices are so high that people on a low wage have to work any
number of days, or in some cases weeks, to buy treatments," the study
At the national level, the U.N. study calls for explicit
targets in several areas, including the elimination of taxes and duties
on essential medicines; updating of national policy on medicines;
adoption of generic substitution policies for essential medicines; and
ways to reduce trade and distribution mark-ups on prices of essential
At the global level, the study calls for measures to increase
funding for research and development in areas of medicines relevant to
developing countries; encourage pharmaceutical companies to apply
differential pricing practices to reduce prices of essential medicines
where generic equivalents are not available; and enhance the promotion
of the production of generic medicines and remove existing barriers.
Asked if there has been any increase in the production of
generics, Ewen said: "I don't know if the production of generics has
But generics are commonly produced my many manufacturers in
India, Asia and China for the domestic market, with some manufacturers
exporting them as well. And in some countries, some of the essential
medicines are not available in generic versions.
"Local manufacturers may not be producing them as they don't think
there is enough profit, or they don't have the capacity [for example,
three multinational companies have 80 percent market share for
insulin]," she said.
Ewen also said it is vital that generics are available as competition is needed to bring prices down.
"But what is also important is that pharmacists dispense low-priced generics and patients use them," she added.
For this to happen, she said, people need to have confidence in
generics. Regulatory agencies need to ensure only quality generics are
available in the country, provide incentives for dispensing them, and
educate health professionals and consumers so that generics are
accepted and used.
"This is needed to improve access to medicines," she added.
After his meeting with senior executives of pharmaceutical companies
last week, the secretary-general said: "We look forward to greater
collaboration between the private sector and the U.N. to expand
existing efforts in the spirit of Goal 8 of the MDGs on building a
global partnership for development."
On HIV/AIDS, he said: "We agreed that our work to increase access to
HIV prevention and treatment had contributed to the development of
health care systems, but that more strengthening needed to happen."
While this is primarily the responsibility of national governments,
important efforts have already been made through partnerships with
"More can be done, especially to address shortages of the health workforce and improve managerial capacities," he declared.