[Ip-health] sciencespeaksblog: Global Fund tiered pricing panel for ARVs, other health commodities raises questions

Thiru Balasubramaniam thiru at keionline.org
Tue Jan 7 10:20:17 PST 2014

Global Fund tiered pricing panel for ARVs, other health commodities raises

BY ANTIGONE BARTON <http://sciencespeaksblog.org/author/antigone-barton/>
 ON JANUARY 6, 2014<http://sciencespeaksblog.org/2014/01/06/global-fund-tiered-pricing-plan-for-arvs-other-health-commodities-raises-questions/>

Zambia didn’t look much different the day after the World Bank changed its
status from low-income to middle-income than it did the day before, Global
Fund Executive Director Mark
in his keynote address to a Georgetown University gathering in December.
Dybul, who was discussing the shift in development aid “from paternalism to
partnership,” in the midst of the replenishment conference for the Global
Fund to Fight AIDS, Tuberculosis, and Malaria, was pointing to long-term
challenges facing Zambia and other countries battling the epidemics.

A little more than a week later, though, according to this
 on* Intellectual Property Watch*, an activist from Zambia at the
International Conference on AIDS and STIs in Africa, expressed concern to
Dybul over a Global Fund initiative that could affect the country precisely
because of its economic reclassification. At issue was Dybul’s mention in
his Executive Director report for the Global Fund’s thirtieth board
meeting<http://www.theglobalfund.org/en/board/meetings/thirtieth/> of
a plan “to help expand access to essential health commodities through a
multi-tiered pricing framework.” The idea, according to the report would be
to “help ensure a sustainable marketplace and maximize availability across
countries of all income levels.”

The problem, according to this
by Dr. Suerie Moon of the Harvard Global Health Institute, is that tiered
pricing, setting different prices for the same drugs depending on the
economic status of the country they are going to, has been shown less
effective keeping medicines affordable than encouraging competition from
generic medicines. Putting the decision for pricing in the hands of
pharmaceutical companies, Moon writes, could put medicines out of reach in
middle income countries.

This, in turn, raises the question of exactly what a middle income country
is. While Dybul had a point that Zambia didn’t look any different the day
before its 2011 elevation to middle income than it did the day after, the
country had seen changes during the preceding year. The largest shopping
center in the capital city got its first escalator, for one thing. But
power failures still leave homes as well as clinics without electricity in
the capital city, and across the country on a daily basis. In addition
stock-outs of antiretroviral medicines and commodities that include HIV
testing kits have continued. And, as this
Medecins Sans Frontieres to the plan points out, most of the people living
in poverty across the planet reside in middle-income countries. The MSF
piece says that while generic competition dropped the price of HIV drugs
nearly 90 percent in the last decade, tiered pricing has led to middle
income countries paying in excess of 60 percent more for an antiretroviral
drug than low-income countries. It is a cost, MSF says, that can’t be
maintained by countries with large numbers of people living in poverty with

Moon, and MSF both indicate that a more meaningful task for the
“blue-ribbon task force” Dybul mentions would be to seek new ways to
improve drug access in middle-income countries. The *Intellectual Property
Watch* post quotes MSF Access Campaign HIV/TB advisor Sharonann Lynch
saying that Dybul met with activists at ICASA and indicated the Global Fund
would consider their concerns, making this an issue to watch in the next

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