[Ip-health] Global Fund ³equitable access initiative² doesn¹t answer concerns first raised by tiered pricing task force plan

Baker, Brook b.baker at neu.edu
Fri Jun 6 15:23:08 PDT 2014


Global Fund “equitable access initiative” doesn’t answer concerns
first raised by tiered pricing task force plan


Plan to address access to drugs and other health commodities should be
led by countries, civil society, advocates say

“As part of our move to better accommodate and adjust our business
model according to the different stages of the development continuum,
we have developed a new multi-agency initiative to help expand access
to essential health commodities,” Mark Dybul wrote in his Executive
Director’s Report to the board of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, for its meeting last November. If the
sentence had ended there, it would might have gotten a positive, if
expectant response. But the sentence continued: “through a
multi-tiered pricing framework.”

It was a solution, advocates said, that would exacerbate the problem
it was meant to solve.

Tiered pricing, which allows drug makers to make up for a lower price
charged in a country categorized as “low-income,” with a high price
charged in a company deemed “middle-income,” advocates have pointed
out, has led to countries that are home to more people in need of
affordable medicine paying prices in excess of 60 percent higher than
those paid in “low-income” countries. That is because, as Dybul
acknowledges in a May update on the plan, more than 100 countries
classified as “middle income” are home to 75 percent of the world’s
poorest people and to the greatest disease burdens.

The May update of the Equitable Access Initiative summary, the first
document on the plan to be released officially and publicly since
Dybul met with advocates in December, discards the term “tiered
pricing,” saying it was used “in error.” It was released after 220
civil society organizations signed on to a letter criticizing a plan
that would give pharmaceutical company representatives a role in
establishing how to improve access to affordable medicines and
retained a goal that would “validate and institutionalize a single
failed strategy.”

Those concerns have not been allayed by the newly released document,
or by assurances by Dybul, who met for an hour with advocates at the
recent World Health Assembly, that he would continue to take their
points under consideration at a meeting set for June 20th.

One reason for that is timing. According to the released summary, that
is the meeting at which a draft of the plan is set to be completed.

In addition, a summary of civil society concerns and correspondence on
the plan so far says, the definition of the problem itself remains a
point of contention.

“It should be focused on the problem of classification of countries
and the ability of poor people in those countries to receive
donor-funded support for crucial health needs,” said Brook Baker, a
law professor at Northeastern University and policy analyst for Health
GAP, who wrote the summary. Baker emphasizes that middle-income
countries should be expected to shoulder the responsibilities they can
bear for public health care. But, he added, the income classification
tiers don’t recognize continuums that exist in developing countries.

“They are arbitrary boundaries,” he said. What they don’t take into
account, he added, is the strength of countries’ health systems, the
degrees of inequality within countries and how much of the population
lives in poverty, and disease burden.

And while the Global Fund and other charities voice a need to
prioritize poor countries, at the current rate of transition, “by
2020, there aren’t going to be any,” Baker said. “They’re all going to
be like Zambia – they’ll have five more dollars per person.”

But, he adds, “going from significant funding to no funding” is not
the answer. “It is not a natural response to the persistence of
poverty, inequality and disease burden.”

While that is a problem the Global Fund, and other donors should
contemplate, he said, it should not be taking a leadership role in
determining what prices countries can and will pay for medicines their
populations need.

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