[Ip-health] Health Policy Watch: Little Progress Over Price Transparency Resolution; Negotiators Behind Closed Doors

Thiru Balasubramaniam thiru at keionline.org
Fri May 24 20:14:07 PDT 2019

Little Progress Over Price Transparency Resolution; Negotiators Behind
Closed Doors
24/05/2019 by Catherine Saez
Secrecy was the watchword Friday as countries huddled together behind
closed doors trying to reach agreement on a WHA resolution that would shed
more sunshine on the real prices of medicines in national and global
pharmaceutical markets.

A formal plenary session scheduled for today was delayed until at least
Monday, while debate continued into Friday evening over the most
contentious issue: public pharma disclosure of costs for R&D, including any
public subsidies or incentives received, at the time of a drug’s regulatory
approval. The negotiations were to resume again Saturday morning.

Among the leading critics of the transparency resolution, the United
Kingdom remained vocally critical of the draft text in today’s sessions,
while Germany’s opposition was somewhat more muted, observers told *Health
Policy Watch*.

A group of civil society organisations working in sub-Saharan Africa,
meanwhile, lambasted the resolution’s three leading opponents, Germany,
France and the UK, for failing to consider the needs of developing

“The German government’s opposition to this resolution is in sharp contrast
to its claim to act as a leader in global health. A true champion of global
health would vocally support this initiative,” said the open letter
to Jens Spahn, Minister of Health, and signed by 66 African NGOs based in
South Africa, Uganda, and Zimbabwe, including multiple cancer and
non-communicable disease advocacy groups. “We support maximum transparency
in the prices for medicines – transparency means our governments can
negotiate fair prices rather than negotiating blindly. We are requesting
the German government to stand in solidarity with people most at risk of
suffering and death because of lack of access to medicines by abandoning
your obstruction of this powerful resolution.” Identical letters were sent
to French Health Minister Agnès Buzyn
<http://bit.ly/OpenLetterFrance>, and Matthew
Secretary of State for Health and Social Care of the United Kingdom.

The resolution, introduced by Italy in February and revised in April, has
been the focus of enthusiastic support by a group of southern European
countries, as well as countries in Africa and Asia. Global humanitarian aid
groups, such as Doctors without Borders, have argued vociferously that a
strong resolution yielding more public data on prices for health products
could help bring down costs and increase access to desperately needed drugs
in developing countries.

While the debate had initially seemed to pit politically powerful northern
European countries such as Germany and the UK against a bloc of countries
in southern Europe, including not only Italy but Greece, Spain, Serbia,
Slovenia and Turkey, some Scandanavian countries were also showing signs of
support today for the resolution.

“Finland is in favour of a strong mandate of the WHO on this issue,” a
member of the Finnish delegation told *Health Policy Watch*, as tired
negotiators closed their session Friday evening. Norway, while not an
official sponsor, has also indicated support, observers said.

Negotiators for Switzerland along with the United States, have likewise
been positive about provisions calling for publication of list prices of
medicines sold and purchased in national markets. But representatives were
more reluctant about clauses asking national governments to require pharma
firms to disclose R&D and clinical trial costs for drugs at the time of
regulatory approval – even if funding comes from public sources.

Observers said that the United States along with Japan, also raised a
challenge today over a procedural matter, arguing that WHO should not have
released a comment-ridden version of the text
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_ACONF2-en.pdf> yesterday,
highlighting still vigorous debate over the transparency issue

One resolution co-sponsor told *Health Policy Watch* that the “drafting
group,” which swelled to several dozen countries at certain points today,
remained divided on the text’s publication. Some representatives said they
had no problem publicising their position, others defended a policy of

A WHO official, meanwhile, told *Health Policy Watch* that yet another
revised version of the resolution is expected to be published on Monday,
along with a expanded list of co-sponsors – as more countries are joining
the original group of 11 countries that initially supported the draft.

Delegates cooped up in Room XXVI of Geneva’s UN Headquarters, the Palais
des Nations, were otherwise reluctant to share any information on the
direction of the discussions, reflecting the sensitivity of the

As closed door sessions continued, today’s WHA plenary debate on the draft
resolution, originally scheduled for last Tuesday the 21st, the second day
of the World Health Assembly taking place from 20-28 May, was postponed
again. The item has now been scheduled to come to the floor on Monday,
according to the WHA daily journal schedule.

At the opening of the WHA, on Monday, U.S. Health and Human Services
Secretary Alex Azar said: “A top priority of the American people, and
therefore a top priority of mine, is the availability of affordable, safe,
and effective medicines. Over the last year, President Trump has introduced
more competition and negotiation to the way the United States pays for

“We proposed reference pricing for medications for the first time,
injecting competition into a large government-run program that previously
accepted any price manufacturers suggested…. under President Trump, the
United States will never be a bystander to abusive drug pricing practices,”
he said.

However, at another event on Monday, Azar also told journalists that he was
unsure if lifting the veil of corporate secrecy over costs for R&D would
pay off in terms of actually reducing drug prices.

“The question around R&D is: is that actually meaningful transparency, and
information that would go into the pricing and negotiation of products? We
suspect that is not necessarily the highest value area for our efforts, but
we continue to look at that. But our biggest concern is pricing
transparency as well as transparency of patents,” Azar said.

At the same time, critics point out that the costs of drug development
often include public subsidies and tax breaks. And they are a critical
component of final drug prices – whereby higher prices are justified with
the idea that an “innovation incentive” are required to stimulate further

Yet, in the absence of more hard data on R&D costs, the oft-cited reference
value of US$1 billion per product, which may be required to bring a
medicine from discovery phase to market, has no way of being verified.

*John Zarocostas contributed reporting to this story*.

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

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