Promising Trends in Access to Medicines
| Author | Jean‐Frédéric Morin,E. Richard Gold |
| DOI | http://doi.org/10.1111/j.1758-5899.2011.00110.x |
| Date | 01 May 2012 |
| Published date | 01 May 2012 |
Promising Trends in Access to
Medicines
E. Richard Gold
McGill University
Jean-Frédéric Morin
Université libre de Bruxelles
Abstract
It is a vast understatement to say that the problem of access to medicines in developing countries is complex. Access
is limited by a range of factors including inability to pay, a lack of infrastructure, and corruption in some countries.
Surrounding and exacerbating these structural and technological problems is the layer of legal rights created by
patents and their licensing that complicate and render more expensive the preparation and delivery of needed
medicines, particularly those that need to be adapted to the social, health and cultural environment of developing
countries. This article provides a survey of innovative strategies that aim at maximizing the potential of patents to
facilitate the development and delivery of medicines against diseases, the burden of which falls principally on
developing country populations. To understand the context in which these strategies are being proposed and
implemented, the article reviews the battles over access to medicines beginning in the late 1980s. It then surveys
some of the principal suggestions put forward to better direct innovation systems in addressing the critical health
needs of the world’s majority including advance market commitments, patent buy-outs, prize funds, public–private
partnerships and patent pools.
While the focus on reducing the costs of HIV ⁄AIDS drugs
in the developing world has increased the availability
these of drugs by 30 per cent between 2008 and 2009,
low- and middle-income country coverage for AIDS ⁄HIV
drugs remains below 36 per cent (UNAIDS, 2010a). What
is worse, for every two people for whom treatment is
provided, five are infected (UNAIDS, 2010b). The difficul-
ties in providing greater access to treatment are multiple
and intertwined. While much of the debate over access
to medicines since the 1980s has surrounded patent
rights and their effect on access to and price of medi-
cines (All-Party Parliamentary Group on AIDS, 2009;
Smith et al., 2009), the key to moving forward is to
understand drug innovation as part of an integrated
process of delivering medicines and services to those in
need.
This article provides a survey of strategies that aim at
maximizing the potential of patents to facilitate the
development and delivery of medicines against diseases,
the burden of which falls principally on developing
country populations. The article is structured as follows.
First, to understand the context in which strategies are
being proposed and implemented, we review the battles
over access to medicines beginning in the late 1980s.
We then survey some of the principal suggestions put
forward to better direct innovation systems in addressing
the critical health needs of the world’s majority.
Despite the promising suggestions put forward, the
hostile nature of relations between stakeholders – for
our purposes, NGOs, corporations and governments –
has either taken attention away from areas of common
interest or has led to the implementation of good
ideas in a less than optimal fashion. Instead of concen-
trating on strategies that are best designed specifically
to ease problems over delivery and compliance – for
example, single pills incorporating combinations of
drugs that ease compliance, heat-insensitive formula-
tions that can be transported at lower cost, or pediat-
ric formulations that address the very specific needs of
children – discussions too often end in finger pointing
over solutions that do not, in the end, address in form
and quantity the full extent of the problem. One exam-
ple of this is the continued and long discussions over
the implementation of the World Trade Organization’s
(WTO) rules that allow for the issue of a compulsory
license to export drugs (Morin and Gold, 2010). While
these rules are admittedly largely unworkable, at least
as implemented in developed countries, fixing them
will likely have limited benefit as there are few natural
trade relations with respect to generic medicines
Global Policy Volume 3 . Issue 2 . May 2012
Global Policy (2012) 3:2 doi: 10.1111/j.1758-5899.2011.00110.x ª2012 London School of Economics and Political Science and John Wiley & Sons Ltd.
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