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

SnHuman and Social Development Issues

substantially lowering prices, goes in the right
direction.
But, in order to make sense to developing
countries' populations, such differential pricing
policies should be much more important than
what the five big pharmaceutical firms are
currently committing themselves to:indeed.
even if the price of a triteraphy goes down to 200
S/per year (which represents a 700 0 fall in price).
none of the poorest countries could afford it on a
wide scale. In any case. developing countries
should not renounce the protection on essential
drugs they benefit under the WTO (compulsory
licensing and parallel importing). and should
remain free to set their social and fiscal policies
(import duties) according to their overall
development pnriorities.
True. up to 80~o of the price paid for drugs by the
consumer consists of import du:nes, taxes.
distribution costs, and dispensing fees.
Consequently,. the reduction or even elimination
of import duties for pharmaceuticals could
facilitate the import of drugs. In the same way
developing countries could address the reduction
of value-added and other national and local taxes.
But this is a decision which calls for a choice
among several priorities in each country
concerned, in dialogue with donors.
Increasing investment in research
and development of drugs and
vaccines targeted at the diseases
affecting the poorest (medium to
long term)
Developing countries represent a very small
proportion of the world pharmaceutical market
and this is why extremely limited investments are
made into the diseases that disproportionally
affect people in developing countries. Research
and development in the pharmaceutical industry
follows the market in industrialised countries and
international public goods such as an AIDS
vaccine are insufficiently invested in.

Development of vaccines against HIV/AIDS or
malaria will be very costly, ranging from
hundreds of millions of dollars to perhaps a
billion dollars or more for each vaccine marketed.
Nonetheless, the social returns to such efforts are

likely to be extraordinarily high, given the
remarkably heavy health and economic burdens
of these target diseases.
There is therefore a need to create international
mechanisms that drive research and
development towards those diseases that
disproportionately affect developing countries.
An effective pull mechanism would, for example,
need to promise a market of several hundred
million dollars per year for an effective vaccine
for AIDS, malaria, or TB. As a rough estimate. a
future commitment of S 5 to S 10 billion dollars.
from all donors, might be required to support the
necessary R&D for the three disease groups.
Obviously this kind of solution has to be
examined carefully, be balanced out with other
potential incentives and not directly financed from
scarce development public funds.
The EU has already started to support these types
of initiatives in relation to the development of an
HIV AIDS and Malaria vaccine. The cooperation between the EC and the World Bank on
international public goods and on poverty and
health offer the opportunity' to reinforce existing
mechanisms and explore the opportunities to
accelerate and increase these efforts.
CONCLUSIONS
he renewed commitment to reduce poverty
and address the major social inequities is. timely for the new century. This needs a
new international effort and partnerships
focussing on key illnesses, such as Malanria.
Tuberculosis and HIV/AIDS that hold back
development and the reduction of poverty.
With sufficient political commitment and the
mobilisation of additional modest resources, a
substantial reduction in the burden of ill health in
the world can be achieved. This burden is born
disproportionately by the poor.
The international community, and especially
the World Bank and the EU, have a

responsibility and an opportunity in addressing
areas, which are crucial in ensuring sustainable
growth and investment in improved health in
developing countries. The provision of urgently
needed commodities, greater access to key