[Ip-health] The Lancet: UK, Germany, dissociate from WHO drug pricing resolution

Thiru Balasubramaniam thiru at keionline.org
Wed Jun 12 02:28:32 PDT 2019


WORLD REPORT| VOLUME 393, ISSUE 10188, P2287, JUNE 08, 2019

UK, Germany, dissociate from WHO drug pricing resolution

John Zarocostas

Published:June 08, 2019

DOI: https://doi.org/10.1016/S0140-6736(19)31329-7

The passage of a landmark resolution on improving the transparency of
markets for medicines at the latest WHA fails to narrow the political
divide. John Zarocostas reports from Geneva.

Few issues are as politically charged in multilateral diplomacy forums as
pricing and access for medicines, vaccines, and other medical products, as
was revealed, once again, by the marathon negotiations that led to the
adoption by the World Health Assembly (WHA) on May 28 of a resolution that
aims to enhance transparency in global markets.

“We addressed one of the most complex and polarising issues in 21st century
global health…We are glad that member states found common ground”, Silvia
Paula Valentim Lutucuta, Angola's minister of health and chair of a WHA
committee that hosted the negotiations, told delegates.

Dagmar Reintenbach, head of global health at Germany's federal ministry of
health, said the negotiating process was marred by states being
strategically targeted, among other things, “by leakage of perceived
positions with a view to intimidate some delegations publicly, accompanied
by incorrect information regarding the reasoning of this positioning”.

The resolution was initiated by Giulia Grillo, Italy's minister of health,
on Feb 1, 2019. It was initially backed by Portugal, Spain, and Greece,
followed by a growing list of countries including Malaysia, Egypt, South
Africa, Uganda, Turkey, Serbia, and Slovenia.

The negotiations became what WHA delegates called a real diplomatic
thriller, as Germany and the UK, backed by Japan, Switzerland, Denmark, and
Sweden—all countries with major pharmaceutical manufacturing
sectors—attempted to water down the resolution, particularly when it came
to the language relating to transparency for research and development (R&D)

Although the USA supported the inclusion of language relating to
transparency of medicine pricing, they also pushed hard against the
inclusion of language that prescribed transparency on R&D costs—a red line
for the pharmaceutical industry but an anathema for the sponsors of the
resolution and health advocacy groups who were eager to address the
inequities and hardships caused by high prices.

In an open letter dated 24 May addressed to Jens Spahn, Germany's minister
of health, a group of 66 civil society organisations working in sub-Saharan
Africa—which included Médecins sans Frontières Southern Africa—called on
Berlin to abandon “its obstruction” of the resolution. An identical public
letter was addressed to Mathew Hancock, the Secretary of State for Health
and Social Care, and also to Rory Stewart, the Secretary of State for
International Development.

At the time of the drafting sessions, co-sponsors were forced to concede
ground on the R&D cost language in a bid to save the resolution. But a
series of late developments ultimately secured the passage of the

One such decisive event was when the WHO secretariat accidentally posted
the drafting text of the resolution, which included the individual
countries' negotiating positions, without having secured the consensus of
the drafting group. The text was quickly posted and widely distributed by
advocacy groups before WHO pulled the text from the site. The WHO
secretariat apologised for the error, but Germany, furious at the repeated
press leaks and the targeted campaign by health advocacy groups, walked out
of the negotiating session, sources said.

Germany's exit from the negotiations coincided with the timely entry of a
group of countries as co-sponsors of the resolution, which included India,
Brazil, Kenya, Uganda, and Sri Lanka.

The co-sponsorship by India and Brazil, a surge of support coming from
African nations, and a shift in position from the USA, which came in late
with strong support for the language relating to transparency in drug
prices, “turned the tide”, diplomats said.

However, the same sources said that the inclusion of wording such as “as
appropriate”, “if publicly available”, or “voluntarily provided” in the
language relating to R&D cost watered down what was originally quite a
strong text. The big gain for the sponsors, diplomats told The Lancet, was
the retention of language calling for measures to share information on net
prices of health products, for rapid and timely adoption of generic and
biosimilar products, and text requesting that WHO Director-General Tedros
Adhanom Ghebreyesus analyse the availability of data on inputs throughout
the value chain, including trial data and price information—viewed as a
coded de-facto approach that can also capture R&D costs.

After the adoption of the resolution by consensus, Germany, the UK and
Hungary went on the record saying they were dissociating themselves from
the resolution, arguing it “was rushed through” and faulting the “serious
governance concerns”. Julian Braithwaite, the UK's ambassador to the UN in
Geneva, declared: “…we believe that more time should have been allowed to
enable all involved the time to carefully consider the potentially
far-reaching implications of the resolution ….The UK is left with no option
but to disassociate ourselves from this resolution.”

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

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