[Ip-health] Health Policy Watch: Draft UHC Declaration Strong On R&D Transparency, Weak On R&D Incentives Reform

Thiru Balasubramaniam thiru at keionline.org
Fri Jun 14 09:20:59 PDT 2019


Draft UHC Declaration Strong On R&D Transparency, Weak On R&D Incentives

14/06/2019 by David Branigan

In the lead-up to the United Nations High-Level Meeting on Universal Health
Coverage (UHC) in September, the latest draft of a planned political
declaration calls on member states to increase transparency of the cost of
research and development (R&D) – in addition to drug prices – but falls
short in the area of R&D incentive reform, with no mention of delinking R&D
incentives from medicines prices.

The new language on transparency of medicines prices and R&D costs,
suggested in a revised draft of the declaration obtained by *Health Policy
Watch*, was welcomed by the advocacy group Knowledge Ecology International
<https://www.keionline.org/> (KEI). But KEI expressed disappointment with
the language on R&D reform, which calls for “innovative incentives and
financing mechanisms,” saying it does little to move the needle on R&D
reform, by not providing a clear starting point.

The latest draft of the political declaration, said to include revisions
that have been suggested by the co-facilitators of the UHC declaration
process, includes extensive highlighted additions to the initial text of
the zero draft
which also span issues including: stronger references to promotion of
health lifestyles and diets; improved health services for emergency care
and mental health; health workforce strengthening; and increased national
public health spending by an additional 1-2% of GDP.

The debate on the transparency of the cost of R&D stems out of last
month’s contentious
the World Health Assembly (WHA) resolution on the transparency of medicines
markets, which was adopted on 28 May, the final day of the WHA – the same
day when informal consultations on the UHC declaration were expected to

The final draft of the WHA transparency resolution strongly called for the
transparency of drug prices, but was much weaker regarding transparency of
the cost of R&D – simply encouraging voluntary disclosures of R&D costs,
rather than requiring them.

The latest draft of the UHC declaration, however, calls on member states to
increase transparency of the cost of R&D, saying *[additions to the latest
draft in bold]*:

   1. Improve availability, affordability and efficiency of essential
   health products by increasing transparency in pricing of medicines,
   diagnostics, medical devices, health products and other technologies as
   well as cost of research and development, through improved regulations
   and building a stronger partnership with industries to address the global
   concern on high prices of essential health products;

KEI Director James Love told *Health Policy Watch *that:

“Paragraph 45 is one part of the text we are watching. We are happy both to
see the language on the transparency of pricing, and the reference to ‘cost
of research and development’ in the text. R&D costs were the most difficult
part of the World Health Organization negotiations, but they are quite
important. There are other issues in transparency that would be important
to add, including the units sold by country, which is something that
companies have access to via IQVIA <https://www.iqvia.com/> databases, but
behind a paywall, and which should be transparent, because this statistic
is the best measure of access and inequality of access.”

Love, however, also contended that while there were other issues KEI would
have liked to see included in the text, this is a declaration where
transparency is not the main topic, and so cannot be expected in include
the same level of detail as the WHA transparency resolution.

On R&D incentive mechanisms, the latest draft of the UHC declaration calls
on member states to *[additions to the latest draft in bold]*:

   1. Explore, encourage and promote a range of innovative incentives and
   financing mechanisms for health research and development, including a
   stronger and transparent partnership between the public and the private
   sectors, recognizing the need for increasing public health-driven research
   and developmentthat is needs-driven and evidence-based, as well as
   incentives in the development of new health products and technologies,
   guided by the core principles of safety, affordability, effectiveness,
   efficiency, equity and considered as a shared responsibility;

Love noted that the draft declaration “opens the door for discussion [on]
the reform of the incentive system,” however he said that the text is not
as clear as it could be with regard to delinking the incentives for
investments in R&D from prices, which he said is “the most important

According to the KEI-run website Delinkage.org <https://delinkage.org/>:
“Under delinkage approaches, combinations of grants, subsidies, and
incentives based upon cash rewards ensure robust funding for R&D. An
international framework will shift from promoting monopolies and high
prices to ensuring that governments can fashion cost-effective R&D
incentives that target advances in life sciences and improvements in health

Love further noted that the “range of innovative incentives and financing
mechanisms” for R&D is a “broad category which includes things like market
entry rewards, and direct government funding or subsidies. From our point
of view,” he said, “overly broad categories are less helpful, if you don’t
know where to start,” which “is really most important.”

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

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