Improving Access of the Poor to Essential Drugs and Key Drugs for Major Disease in Developing Countries

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Human and Social Development Issues

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INTERNATIONAL CONTEXT
/he poor in developing countries continue to
live in conditions where inadequate water
Ssupplies, food insecurity, lack of access to
education -particularly for girls -, lack of access
to information, inadequate access to essential
health care and a polluted environment are the
norms of daily life. The combined impact leads
to high levels of morbidity and mortality and
poor health status.
Properly targeted development assistance can lead
to improvement in the health conditions and
wellbeing of the poorest. Over recent years a new
consensus has been developed on the intemrnational
development agenda. More attention is being
given to ensure that the right investments are
made in the social and health environments of the
poorest countries and populations and that the
social services and financing mechanisms benefit
the poorest. A set of ambitious. international.
shared development targets have been agreed and
set the new agenda over the next 15 years.
Development assistance. while provided in an
increasingly co-ordinated manner is. however.
reaching the poorest too slowly and in
inadequate amounts to significantly reduce
poverty and ill health burdens, such as HIAIDS
Malana. Tuberculosis and Maternal Mortality.
In addition to more efficient and co-ordinated
external aid, there is also increased emphasis on
the need to integrate poorer countries better in the
global economy, through stronger trade relations
under the WTO and at bilateral level. But the
nature of trade and the logic of private
investment, both of which are based on the need
for growth and profit, do not always stroke with
social and more specifically health-related
needs. This is true in countries but also at global
level.
Global financing mechanisms and appropriate
incentives to stimulate research and development
of new health technologies that would benefit the
poorest have not been adequately developed.
Stark examples include the lack of effective

vaccines for Malaria, AIDS and Tuberculosis.
At present only 10 per cent of the global health
research effort is allocated to target 90 per cent
of the global disease burden.r

On the other hand, the Agreement on Trade
Related Intellectual Property Protection
(TRIPS), within the framework of the WTO,
establishes standards in the field of intellectual
property. With respect to pharmaceuticals, there
is the obligation to grant patent protection to
pharmaceutical products and process inventions:
the high price of patented drugs has raised
concern among developing countries and NGOS
which fear that the TRIPS Agreement would
strenghten the dominant position of
pharmaceutical companies with respect to
maintaining high prices. Essential drugs and
drugs for major communicable diseases are
indeed a public good and require different
considerations than other commodities: this is the
reason why the TRIPS Agreement prov:des for
safeguards to protect public health. One of them
is parallel importing which allows developing
countries to avoid the manufacturer and to buy
directly from another country where pnces are
lower: another one is compulsory licensing,
which allows to copy, manufacture and use of
drugs without the agreement of the patent holder.
But it remains questionable whether these
safeguards would allow, by themselves, essential
and key drugs to reach the patients in developing
countries.
In the past years the international community has
played a role in leveraging more support for
national and international health issues. including
Preventable Childhood diseases. Malanria and
AIDS, through increasing political visibility and
through specific initiatives, such as GAVI. Roll
Back Malaria and HIPC. National and global
initiatives are therefore needed to improve the
health status, especially of the poorest. What kind
of initiatives? The Commission has identified the
following.
KEY ACTIONS
Improving access to essential
commodities for the major deseases
affecting the poorest populations

(short term)
HO estimates that one third of the world's
/population still lacks access to essential
_.z drugs and other commodities, which could