Patents not an obstacle to drug access
DEBATES on how to improve healthcare in developing countries often start from the same premise: patents can potentially raise drug prices, so they should be abolished for better public health.
In the early 2000s, this argument drove the campaign against patents on HIV drugs in SA. This month, it anchors new nongovernmental organisation (NGO) campaigns against a proposed European Union (EU)-India Free Trade Agreement and the Regional Comprehensive Economic Partnership in Asia — both of which may include heightened intellectual property provisions.
NGO disquiet about drug patents has even led to the creation of a UN high-level panel on access to medicines, due to report its recommendations next month.
Such concerns may, in fact, be overblown. This is an implication of an interesting new study by researchers at the University of Ottawa, published last month by the World Intellectual Property Organisation in Geneva.
To better understand how patents affect access to medicines, the researchers counted how many of the World Health Organisation’s (WHO’s) list of essential medicines are subject to patent protection in developing countries. This list contains 375 or so medicines considered most important by WHO experts.
The researchers checked national patent registries in developing countries and double-checked with manufacturers. They found that patents for 95% medicines on the list had expired. Put simply, patents are not relevant to the vast majority of drugs typically used by physicians in developing countries.
Most of the remaining 5% of medicines — about 20 products — on the list with patent protection are for HIV/AIDS. But patent owners either don’t register or do not enforce their patents in the poorest countries.
One implication of the study is that if patents were abolished tomorrow, it would make little difference to the cost or availability of most medicines used in developing countries. Even so, these medicines are frequently unavailable in public health systems.
In 2014, researchers at the University of Utrecht in the Netherlands found that, on average, essential medicines were available in public sector facilities in developing countries only 40% of the time.
While generic medicines are cheap to make, with no royalties to pay, they are still too costly for most people in developing countries. One example from the WHO list is budesonide, commonly used by asthma sufferers. A single inhaler costs a staggering 50 days’ wages in Mozambique. In the US, one inhaler costs only $5 to $7, about 30 minutes of work on the median hourly wage.
The reasons behind the expense and scarcity of essential medicines in developing countries are complex, but failures of governance loom large. Mark-ups along the distribution chain inflate the final price of medicines and include import tariffs, sales taxes, value-added taxes and retailers’ and wholesalers’ margins.
In Kenya, mark-ups add 300% to the manufacturer’s price, says IMS, the global healthcare data provider.
Dysfunctional medicine supply chain management is another culprit. A 2015 survey by Medecins Sans Frontières (MSF) reported one in three health facilities in SA have shortages of crucial HIV and tuberculosis drugs. The drugs are imported in sufficient quantities, but fail to reach patients due to “local logistical and management problems, ranging from inaccurate forecasting to storage or transport issues”, said MSF.
Many governments underinvest in health too. While most EU countries commit 8%-11% of gross domestic product to health, few Asian and African countries spend more than 5%.
These are the major influences on access to medicines. Public health would be best served if the political focus were on these issues, rather than patents.