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Introduction

Obtaining treatment is today more like a privilege of the rich than a matter of course for all. Despite the major medical and technological advances of recent decades, millions of people in developing countries are dying of treatable diseases every year for lack of access to treatment and drugs.

While formerly the developing or emerging countries were primarily confronted with infectious diseases – such as AIDS, malaria or tuberculosis – they now carry a «double burden»: they have more deaths from non-transmissible diseases than the rich countries. Access to treatments for cancer and diabetes today represent one of the principal issues for poorer countries. According to the UN, over 2 billion people in the world have no access to essential medicines. Improving this access would make it possible to save 10 million lives per year, including 4 million in Africa and South-East Asia.

Access to drugs in the countries of the South is dependent on two categories of factors:

  •  national health systems, in line with the national drugs policy, the supply, storage and distribution of drugs, the training of health personnel and providing information to users
  •  the research, development, production and price of drugs, the latter being a central factor 

It is on this last category, related to the drugs market and the policy of the Swiss stakeholders in this field, that Public Eye is focusing in the framework of its «health» programme.

AIDS, emblematic of the fight for access to medicines

Unequal access to health among the populations of the South has taken centre stage for the last twenty years with the creation of the World Trade Organisation (WTO) and with the HIV/AIDS crisis. In the face of the pandemic, countries such as South Africa have been forced to take urgent measures to stem the progression of the disease. These measures have often been challenged before the courts by the pharmaceutical industry when counter to their economic interests. This desire to maximize profits at all costs has provoked the indignation of public opinion, and political discussion on the problem of access to medicines has been initiated.

The question of the price of antiretroviral treatments has also been an important trigger factor. In fact, while most patients are located in the countries of the South, the new treatments have long been inaccessible to them. The reason: the prohibitive prices related to patents.

Thanks to the arrival of generic producers, especially Indian, the price of an individual treatment has gone from more than 10,000 dollars per year at the beginning of the millenium to less than 100 dollars today! This drastic price reduction has made it possible to massively increase the number of people under antiretroviral treatment in the world (2 million in 2005 as compared to 20 million in 2017. Nevertheless a lot remains to be done in this area to reach the objective to treat all 36 million people that are living with HIV according to the United Nations (UNAIDS 2016).

Patents at the root of the price inflation

The priorities in the research and development (R&D) of new drugs are determined essentially by the market and not in function of real public health needs. The current model, based on patents, effectively sanctions the domination of the pharmaceutical multinationals. The disadvantaged populations of the Global South and East, who do not represent a profitable market, have to face the absence of R&D for effective drugs against the diseases that affect them almost exclusively. And where treatments for those diseases do exist, patients are confronted with the unaffordable price of the new drugs.

Patents confer on their holders an exclusive right of production and commercialisation for twenty years. This temporary monopoly enables pharmaceutical companies to determine the price of a drug. And yet the price is crucial for the poor countries whose budgets for health are limited, and where the frequent absence of a health insurance system obliges patients to pay for the drugs out of their own pocket. Where prices are high, drugs are quite simply inaccessible for most patients.

The companies justify the high prices of their patented drugs by the need to recoup their R&D costs. However, their pricing policy is opaque and the publicized estimates of the average cost of developing a drug are very controversial. Even if prices can vary significantly from one country to another, they have as a reference the (non-controlled) price set for the US market. Protected from any competition during the validity of their patents, the pharmaceutical multinationals thus impose their « global prices » on the whole world. Their business model is based on highly profitable flagship products popular with the investors. And for good reason: the annual turnover of these ‘blockbusters’ exceeds a billion dollars.

Patents, a break on R&D

The pharmaceutical industry constantly claims that patents guarantee innovation. However, despite a constant increase in the number of patents being granted, the number of new molecules approved by the medicines agencies has remained stable or even sometimes decreased, while expenditure on R&D has gone up. Worse still, several independent studies have shown that 2/3 of the ‘new’ drugs put on the market every year do not present any significant added therapeutic value, and 1 out of 6 in general are even worse than those already being marketed. In order to secure profits and gain market shares, the pharmaceutical companies don’t hesitate to multiply patents around a same substance, thus prolonging a product’s period of market exclusivity and delaying the competition of generics. This practice, called «evergreening», is an integral part of the sector’s business model. It threatens the access of poor populations to vital drugs, and stifles the whole system of pharmaceutical discovery.