Towards a Balanced and Sustainable Global Health Innovation and Access Policy
| Date | 01 November 2013 |
| Published date | 01 November 2013 |
| Author | Lenias Hwenda |
| DOI | http://doi.org/10.1111/1758-5899.12040 |
Towards a Balanced and Sustainable Global
Health Innovation and Access Policy
Lenias Hwenda
The African Group of Health Diplomats, WHO and UNAIDS
The twin challenge of innovation and access
Today’s global health research and development (R&D)
priorities are driven by market incentives and donor pri-
orities rather than by health needs. Consequently, medi-
cal innovation –that is, the research and development of
medicines (therapeutics, diagnostics, vaccines and other
medical products) –fails to meet the health needs of all
people, particularly the poorest people in low- and mid-
dle-income countries (LMICs) (Commission on Health
Research for Development, 1990). Global research agen-
das based on donor priorities and market incentives dis-
tort R&D investment towards diseases affecting a small
proportion of the global population and neglect the
health needs of the poorest. Lack of innovation for dis-
eases endemic in poor countries is exacerbated by insuf-
ficient mechanisms to ensure adequate, predictable and
sustainable financing or that medicines are accessible to
most people who need them. LMICs can and should do
more to ensure that global health research addresses the
health needs of their populations.
While some progress towards improving access to
selected essential medicines such as antiretroviral ther-
apy (ARVs) has occurred, poor access to quality, effica-
cious and affordable medicines remains a longstanding
global public health policy challenge. Existing medical
needs such as lack of paediatric formulations for HIV and
tuberculosis medicines occur alongside a tsunami of non-
communicable diseases (NCDs) such as cardiovascular ail-
ments, diabetes and cancer. This increasing incidence of
NCDs, currently estimated at 80 per cent in LMICs, has
associated growing demand for chronic care (World
Health Assembly, 2008).
Poor access is a complex and multifaceted challenge
that is more than a problem of poor affordability. The
cost of treating some of the world’s most malign ill-
nesses can be nominal, but the treatment of patients is
hindered by dysfunctional and weak health, procurement
and governance systems and infrastructure (Peiffer and
Boussalis, 2010) –even when medicines are available for
free. Therefore, poor access is symptomatic of govern-
ment policy failure. It reflects, among other things, insuf-
ficient political prioritisation of the strengthening of
health systems, inadequate allocation of government
resources to health, and inappropriate taxes, tariffs and
mark-ups within the medicines supply chain.
Therefore, inadequate innovation and poor access
must be viewed in a broader context of health systems’
failure to deliver quality care. Without adequate systems
to deliver medicines to people, access gaps in LMICs can-
not be ameliorated. For example, India has a thriving
generics industry that is capable of ensuring the domes-
tic supply of affordable medicines, yet large sections of
Indian society remain without access to these (Holt et al.,
2012). The value and benefit of medical innovation
derives from its availability to those who need it. There-
fore, global policy solutions need to concomitantly
address innovation bottlenecks (Wilsdon et al., 2011) and
other additional factors that limit access.
This requires that national and global health policy mak-
ers cease treating innovation and access as distinct issues,
or reducing the complex multifaceted challenge of poor
access to being primarily about intellectual property (IP).
Such oversimplification neglects other vital contributing
factors that must be tackled in order to improve access.
Global policy discourse on IP has highlighted limitations to
what can be achieved through excessive focus on IP with-
out know-how transfer to countries that lack pharmaceuti-
cal manufacturing capacity. Global policy discussions on
innovation and access has largely overlooked other aspects
that are fundamental to improving access, such as func-
tional health systems and appropriately balanced policies.
Innovation and access policies: a zero sums
game?
Increasingly, poor access is perceived as being primarily
an IP issue. This narrow policy focus has distorted global
access and innovation policy discussions into a zero
sums game in which the research-based pharmaceutical
industry is an adversary. The adversarial approach under-
mines cross-sectoral stakeholder collaboration on prob-
lem solving, and the implementation of comprehensive
constructive approaches to efficient innovation and
better access. This perception is partly due to the legal
wrangles associated with the implementation of the
©2013 University of Durham and John Wiley & Sons, Ltd. Global Policy (2013) 4:4 doi: 10.1111/1758-5899.12040
Global Policy Volume 4 . Issue 4 . November 2013
442
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