Access to medicines: A global concern

A complex issue

The World Health Organization proposes a framework which includes: research, development and innovation; production; regulation; marketing, pricing and reimbursement; purchasing and supply; prescribing; dispensing; and use. All these elements can influence availability and affordability of medicines. Both availability and affordability are essential in that when people need medicines, they should be able to find them within the health system and be able to pay for them, or ideally receive the medicines for free within UHC benefit packages. Recent shortages in high-income countries (HIC), including Switzerland, have put a spotlight on the issue of availability of medicines. However, this reality of lack of access to medicines is a daily reality in many LMICs.

Access to medicines plays a vital role in achieving universal health coverage (UHC) and is included as one of the health-related Sustainable Development Goals.

Why are medicines not there when people need them?

Recent shortages of medicines have often been blamed on manufacturing issues, delays and lack of capacity and also shortages within the supply chain. In Europe cancer medicine shortages have had significant impacts on the care of individuals, including the pediatric population, as alternative treatments are hard to find. Beyond shortages, lack of availability can also be that no treatments exist for the condition that people have. For example, some Neglected Tropical Diseases (NTD) suffer from a lack of research and development because they impact poor people not representing an “interesting” market.

Insulin for example, despite having been discovered over a century ago, is still not available in many LMICs due to its cost to the health system as well as failures at both global and national level in the delivery of medicines and care. The same is true for some new medicines to treat cancer.

In other situations, it can be that the medicine is simply not available in the health system as it is not registered or purchased. Insulin for example, despite having been discovered over a century ago, is still not available in many LMICs due to its cost to the health system as well as failures at both global and national level in the delivery of medicines and care. The same is true for some new medicines to treat cancer. The organization of the health system and delivery of care are also barriers to access medicines. Both cancer and diabetes care in LMICs is centralized in large cities meaning the whole population cannot necessarily access services.

In many LMICs high out of pocket payments mean that the majority of people cannot afford the medicines they need. The cost of a month of insulin represents almost 9 days of salary of the lowest paid government employee in Mali.

Can people and systems pay for the medicines they need?

In looking at affordability there is the need to look at the cost to the individual and the cost to the health system. In many LMICs high out of pocket payments mean that the majority of people cannot afford the medicines they need. The cost of a month of insulin represents almost 9 days of salary of the lowest paid government employee in Mali. Although Switzerland has price control measures in place the prices of medicines are significantly higher than in neighboring countries as well as larger compared to the cost of production. For insulin, the price of a vial of insulin in Switzerland to the individual is 8.7 times more than the estimated cost of production. High costs of cancer treatments and of other medicines means that these are unaffordable to individuals needing to pay out of pocket. This also has an impact in HICs where systems can no longer cope with the ever-increasing prices of new medicines.

Although significant research into medicines is funded by the public sector ultimately the private sector determines the market for these products as well as reaping the benefits from their sale.

Thoughts and perspectives

Availability and affordability are intertwined in that medicine production is dependent on the pharmaceutical industry. The global insulin market worth more than US$ 20 billion is dominated by 3 large multi-national companies. These companies thus impact insulin’s global availability and affordability. Although significant research into medicines is funded by the public sector ultimately the private sector determines the market for these products as well as reaping the benefits from their sale. Many companies have established donation, differential pricing, or other initiatives to improve access to their products in LMICs.

However, governments and civil society need to act as counterweights to the pharmaceutical industry. Governments need to protect their citizens from the cost of ill-health and ensure that policies improve the availability and affordability of medicines. In addition, HICs have a global responsibility to ensure access to medicines in LMICs. Civil society has a role to hold the private sector and governments to account and in many cases “fix” market failures by finding innovative solutions to ensure access to medicines for LMICs as has been done for NTDs by the "Drugs for Neglected Diseases initiative (DNDi)". Each sector, private, government and civil society have a role to play in addressing the complex global and national factors that impact access to medicines.

Civil society has a role to hold the private sector and governments to account and in many cases “fix” market failures by finding innovative solutions to ensure access to medicines for LMICs.

VIDEO

VIDEO of the conference "L'accès aux médicaments: un défi global" at University of Geneva, on December 13^th December 2022 (Video is in French).