Perspectives on access to medicines and IP rights

• Author: John Zarocostas
• Position: Freelance journalist

Thomas B. Cueni (right), Director General at the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), offers an industry perspective on the hurdles to access and the challenges that lie ahead in the search for innovative healthcare solutions.

The high cost of medicines is straining health budgets in all countries. What is the way forward?

Thomas Cueni: I understand concerns surrounding the cost of individual drugs and that companies have to justify the value they bring, but I believe the price debate is overblown. On aggregate there is no sign that drug costs are out of control. The latest OECD data, for example, show that between 2009 and 2015, there was a 0.5 percent annual reduction in per capita expenditure for pharmaceuticals. More importantly, expenditures on health should be seen as an investment towards increased welfare, productivity and economic growth. They should not be seen exclusively as a fiscal cost at a given point in time. The research-based biopharmaceutical industry is delivering breakthrough medicines for patients. Over the last 10 years, we have seen dramatic improvements in treatments for HIV, HCV (hepatitis C), oncology and many rare diseases that have transformed the lives of patients. The wider developments driving healthcare spending, and the systemic challenges that limit access to high-quality, safe and effective medicines around the world, need to be considered.

It is now widely acknowledged that the biopharmaceutical industry has made tremendous progress in addressing public health needs and the cost of drugs. One among many examples is the use of tiered-pricing for treatment of HIV/AIDS, malaria and vaccines, and more recently in treating multi-drug-resistant tuberculosis (MDR-TB). Johnson & Johnson’s new drug (bedaquiline), for example, both brings an effective therapy for MDR-TB to the table and introduces a very innovative and clearly structured, tiered-pricing approach.

Are there opportunities for more public and private partnerships?

Thomas Cueni: Basically, all of the therapeutic progress that has been made comes out of the labs of private industry. But now many more public-private partnerships are emerging and there is greater openness to collaboration and open innovation. There are, in fact, currently over 300 active health partnerships listed in our directory. There is a strong sense that we have to tackle healthcare issues together. This is most evident in tackling neglected tropical diseases (NTDs). The pharmaceutical industry together with the Gates Foundation, the United Nations (UN) and the World Health Organization (WHO) have made great progress in meeting targets set out in the 2012 London Declaration on NTDs. With this Declaration, pharmaceutical companies, donors, endemic countries and civil society groups pledged to work to control, eliminate or eradicate 10 NTDs by 2020. The work of the Medicines for Malaria Venture (MMV) and GAVI, the vaccine alliance, are two important examples of progress in terms of research and access. But there is clearly scope to do much more.

The UN High-Level Panel on Access to Medicines and the Lancet Commission on Essential Medicines have called for R&D to be de-linked from drug prices. What are your views on this?

Thomas Cueni: De-linkage as called for by the UN High-Level Panel is a dead end. Companies should be paid for the therapeutic value of their drugs to society and patients rather than the cost of research and development or manufacturing. You want to pay for outcomes rather than input. In my view, the delinkage debate focuses too narrowly on intellectual property and fails to address the multi-faceted and complex issues that prevent so many people from accessing the medicines they need.

Health is one of the priorities of the Sustainable Development Goals (SDGs). What can be achieved between now and 2030?

Thomas Cueni: Clearly, any progress in...