[Ip-health] Financial Times: Time to make essential cancer drugs more affordable

Thiru Balasubramaniam thiru at keionline.org
Sun Jul 21 22:23:48 PDT 2019


Opinion Drug prices
Time to make essential cancer drugs more affordable
Governments can do more to pressure makers to bring down prices

Patents thwart the entry of low priced drugs in many countries. Governments
should remove those barriers © Reuters

James Love

Since 1977, the World Health Organization has managed and updated a list of
drugs it calls “essential”. They ask governments, particularly in
developing countries, to make these medicines widely available. Adding a
drug to the list is controversial, because it can expand access but also
places new demands on healthcare budgets.

This week the WHO added 12 medicines for five cancer treatments to its
list, including several that are new and highly priced.

In the past, WHO’s Essential Medicines List has focused almost entirely on
cheap off- patent medicines. In recent years, first with drugs for HIV, and
more recently for hepatitis, cancer and autoimmune diseases, there are
pressures to include new drugs, some of them extremely expensive. This
presents challenges for government healthcare budgets because their use can
potentially divert resources from more cost-effective therapies.

Yet, as we have seen from HIV and hepatitis treatments, governments can
bring down the price of medicines through voluntary licensing of the patent
rights from commercial drugmakers, or more coercively through compulsory
licensing or price controls.

My partner and my co-author’s partner are alive because of access to
effective cancer drugs. One of those medicines was only this week added to
the WHO list. Two other drugs my partner used were rejected, even though
they are seen as effective treatments.

We urge the WHO to develop a second list of medicines — those that would be
labelled “essential” if they were available at affordable prices.

Some of the newly added essential cancer medicines are available at
relatively low prices in some countries, or they can be manufactured
cheaply. The production cost of afatinib, which is used to treat lung
cancer, has been estimated at $8.85 per month, and lenalidomide, for the
treatment of multiple myeloma, is $2.55 per month.

Patents will block competition and thwart the entry of low-priced drugs in
many countries. But governments can and should remove those barriers.
Previously when authorities have shown they are willing to use compulsory
licensing, drug companies have responded by offering voluntary licensing
through the UN-backed Medicines Patent Pool.

But this has rarely happened outside the field of infectious diseases such
as HIV, tuberculosis and hepatitis. In 2016, Andrew Witty, then GSK chief
executive, said the company would consider submitting patents on new drugs
to the MPP, but his successor has not followed through with cancer

Our plea for making these new essential cancer medicines affordable in the
developing world is bound to spark concern that the low prices will deter
research and development spending for new drugs. But most of today’s drug
sales are in high income countries, and returns from developing countries
for many cancer drugs are inconsequential.

These concerns over innovation incentives do not require us to tolerate
high prices and unequal access. They could be addressed through other
measures that delink R&D spending from drug prices, including research
grant programmes or “market entry rewards” that provide payouts for the
development of drugs that meets specific needs.

We also call on the WHO to change its approach to drugs that treat
metastatic cancer. The essential medicines committee rejected the inclusion
of two important medicines used in the treatment of metastatic breast
cancer, saying this was not considered a priority.

This is at odds with evidence that cancer is often diagnosed late in lower
income countries, when cancer has progressed further. Also, as first line
treatments improve and extend lives, that creates a need for treatment for
cancer that has metastasized.

The writer heads Knowledge Ecology International. Ellen ‘t Hoen, the first
director of the Medicines Patent Pool and director of Medicines Law &
Policy, contributed

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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