[Ip-health] MSF Op ed - Medicine is just for those who can afford it: why don't pharmaceutical companies develop drugs for the poor?

Joanna Keenan-Siciliano joanna.l.keenan at gmail.com
Fri Mar 14 04:29:02 PDT 2014

Al Jazeera Opinion
Medicine is just for those who can afford it
Why don't pharmaceutical companies develop drugs for the poor?
Last updated: 14 Mar 2014 09:08
Manica Balasegaram
Dr Manica Balasegaram is the Executive Director of Medecins Sans
Frontieres' Access Campaign.

Medicine is expensive, sure, but have you ever asked yourself why? The
pharmaceutical industry will have you believe that without high prices, we
don't get new drugs. The reality is, with high prices we don't always get
new drugs we need either. If a new drug is developed and nobody can afford
it, where is the benefit from it?

Limiting access to the products of pharmaceutical innovation is nothing new
to me. I've seen it for the last 15 years as a doctor with Medecins Sans
Frontieres. In one of my first field missions in Uganda, I watched young
children with malaria die because the best treatment to give them -
artemisinin - was not available and I was forced to use less effective
drugs. It was tragic to witness.

I was outraged at remarks made in December, but widely reported only in
late January, by the CEO of German pharmaceutical company Bayer, on one of
the company's cancer drugs. CEO Marijn Dekkers said that Bayer "didn't
develop this product for the Indian market; we developed it for Western
patients who could afford it." I was shocked at his candour: Dekkers'
comments sum up everything that is wrong with the pharmaceutical research
and development (R&D) industry today.

As it currently stands, patents create long monopolies, which allow
pharmaceutical companies to charge the maximum price they can without fear
of competition. Patients and health providers are put in a near-impossible
predicament: Either they pay the market rate, or they wait until the
maximum profits have been squeezed out of a drug and its patent expires.
Waiting in many cases means dying.

The current system also means some drugs just don't get developed at all;
there are some diseases for which there have been no new drugs developed
for half a century or more. It's because - while the need is there - these
drugs just aren't profitable for the pharmaceutical companies to do
research on them.

The reality of this was painfully illustrated in January, when British
pharmaceutical company AstraZeneca announced it was pulling out of R&D for
malaria, tuberculosis and neglected tropical diseases. They're all diseases
that occur, for the most part, in poor countries. Instead, they'll be
concentrating on drugs for typically rich country diseases: cancer,
diabetes, and high blood pressure.

But this lack of R&D into areas of need is beginning to hurt the developed
world, too. Just as we're facing superbugs that can't be killed with
existing antibiotics, there are no new ones in the development pipeline.
We're seeing people die of infections we can no longer treat with the
antibiotics we have. But the pharmaceutical companies don't want to pour
their R&D into a drug that people only take for a couple of weeks; they
want to develop drugs you need to take for a lifetime.

As taxpayers, we are in essence paying for drugs twice. First, a lot of the
R&D behind successful new drugs is heavily subsidised by the tax payer:
Globally, at least 40 percent of all R&D is paid for from the public purse
and by philanthropic organisations; for some diseases, such as
tuberculosis, it's over 80 percent. Then we have to pay again the high
prices for the patented medicines when they are produced. The only people
satisfied by this current system are the shareholders of pharmaceutical

It is critical that innovation is rewarded. But there are alternative
models than high drug prices and long monopolies for supporting useful
medical R&D. What we should have at the end of the R&D process, is medicine
which is effective, safe and - most critically - affordable for everyone
who needs it. The current system not only fails patients in India, it fails
the uninsured and underinsured worldwide.

We need to find new ways of paying for research that do not force a choice
between developing a drug and making it widely available. This idea is
nothing extraordinary; there are already alternative ideas out there -
models such as prize funds - that reward new discoveries through
substantial financial payouts, paid on the condition that the drug is
immediately open to price-lowering market competition.

There comes a time when we need to collectively look at a system and
realise that it is no longer fit for purpose. Current R&D models for new
medicines are not working; not for the world's poor, nor for you and I. It
is time to get angry, to demand change. The poor are no longer far away,
passive and prepared to die slowly of an illness we can cure. They demand
change and so should everyone.


Dr Manica Balasegaram is the Executive Director of Medecins Sans
Frontieres' Access Campaign; based in Geneva, he helps campaign for better
tools and access to medicines, particularly for the developing world. He
has worked as a doctor in MSF field projects in Uganda, Sudan, Republic of
Congo, Ethiopia, India and Bangladesh.

Joanna Keenan
Press Officer
Médecins Sans Frontières - Access Campaign
P: +41 22 849 87 45
M: +41 79 203 13 02
E: joanna.keenan[at]geneva.msf.org
T: @joanna_keenan


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