[Ip-health] WHO: Member States concerned over unaffordable prices of medicines

Mirza Alas mirzalas at gmail.com
Tue Jun 14 03:56:57 PDT 2016

*TWN Info Service on Health Issues (Jun16/07)11 June 2016Third World
Network *


*WHO: Member States concerned over unaffordable prices of medicines*

Geneva, 11 June (Mirza Alas and K M Gopakumar) – World Health Organization
Member States once again raised concerns over unaffordable prices of
medicines at the recent annual meeting of health ministers and high level

Many countries expressed the view that high prices of medicines will be a
barrier for the implementation of key global health strategies during their
interventions on the adoption of the three global health sector strategies
on HIV, viral hepatitis and sexually transmitted infections (STIs)
(Documents A69/31, A69/32 and A69/33) for the period 2016-2021 at the
69th World
Health Assembly (WHA) that took place in Geneva from 23 to 28 May.

These three different strategies pave the way for compressive actions in
prevention of, and treatment for, HIV, viral hepatitis and STIs.
Sustainable Development Goal (SDG) 3 sets specific targets on these
diseases along with other health conditions as part of the 2030 Agenda for
Sustainable Development adopted last year by Heads of States and

[SDG target 3.3: *By 2030, end the epidemics of AIDS, tuberculosis, malaria
and neglected tropical diseases and combat hepatitis, water-borne diseases
and other communicable diseases*.

SDG 3.7: *By 2030, ensure universal access to sexual and reproductive
health-care services, including for family planning, information and
education, and the integration of reproductive health into national
strategies and programs*.]

All three strategies aim to enhance access to treatment along with
prevention. For instance, the strategy on viral hepatitis states: “where
viral hepatitis transmissions is halted and everyone living with viral
hepatitis has access to safe, affordable and effective care and treatment.”
However, while the strategy identifies medicines and diagnostics as
unaffordable for most, it also identifies the main priority actions by WHO
as advocating for strategies to reduce prices and provide technical support
to countries for developing strategies to negotiate price reductions with

Access to treatment for hepatitis C is a tremendous challenge in both the
developed and developing countries due to the exorbitant high prices of
originator medicines. The challenges put forward by developing and
developed countries on access to affordable treatments resonates with a recent
Prices, Costs, and Affordability of New Medicines for Hepatitis C in 30
Countries: An Economic Analysis* published by the medical journal, PLOS
Medicine where the authors looked at the prices for hepatitis C and how
current prices will represent huge proportions on the health budgets and
therefore many countries have had to restricted access to treatment.

The study found that:  “The total cost of treating all patients with
hepatitis C would be equal to at least a tenth of the current annual cost
for all medicines in all of the countries studied. In some countries where
prices are high and the burden of disease is large, the total cost of
treating all infected patients would be more than the cost of all other
medicines put together” (see the full article in:

The WHO strategies stress the need for using the flexibilities in the Trade
-Related Aspects of Intellectual Property Rights Agreement (TRIPS) to
ensure access to affordable treatment.  The Viral Hepatitis Strategy states:

“The demand for affordable treatment for viral hepatitis B and C infection
requires comprehensive price reduction strategies for medicines,
diagnostics and health commodities, including for those medicines and
diagnostics in the development pipeline. Strategies include fostering
generic competition, including through voluntary licences, and using the
Agreement on Trade -Related Aspects of Intellectual Property Rights
regarding flexibilities to protect public health. That would include
compulsory licences and filing patent oppositions, differential pricing and
direct price negotiations with manufacturers, as well as local
manufacturing in accordance with the Global Strategy and Plan of Action on
Public Health, Innovation and Intellectual Property, *which also notes that
intellectual property rights are an important incentive for the development
of new health care products*”.  (Emphasis added.)

The last part of the sentence ‘intellectual property rights is an important
incentive for the development of new health care products’, clearly aims to
appease developed countries and the pharmaceutical transnational

While expressing unanimous support for the strategies many Member States
pointed out that the high price of medicines is one of the main barriers
against the successful achievement of the strategies.  They particularly
expressed their concern on the cost of hepatitis C treatment and requested
capacity building and technical assistance from WHO to overcome
price-related barriers. Concerns on high prices were not confined only to
medicines.  Member States also referred to prices on vaccines for hepatitis
B and for HPV (human papillomavirus that causes cervical cancer) during
their interventions on the global strategies.

During the discussions on the health sector strategies *Timor Leste, on
behalf of the South-East Asian Region (SEARO)*, observed that the cost of
medicines for the treatment of hepatitis C such as Sofosbuvir is extremely
high and that there is a lack of strategies to promote low cost generics in
all countries afflicted with a high level of hepatitis C incidence. Timor
Leste also noted that there is a need for scientific information for the
introduction of HPV programs as there are large budget implications and
that the national immunisation technical advisory groups should be
strengthened for evidence-based decision.

*China* supported the progress made and noted that HIV is not just a public
health issue but requires a multi-sectoral approach. It stressed that
improvements in technical and financial support were needed. China also
noted that there is a need to lower the prices of medicines.

*Thailand* pointed out that on viral hepatitis, a crucial challenge is the
availability of hepatitis vaccines and that there is a need for a
comprehensive package for treatment of viral hepatitis.

*Saudi Arabia *welcomed the strategy and emphasized their concerns
regarding access to medicines especially vaccines.  It also noted that
steps to ensure access to generic medicines were not yet sufficient and
called for the production of high quality of generics for hepatitis
infections as was with the case of AIDS.

*Malaysia* voiced its support for the strategies but pointed out that
coverage cannot be reached if the medicines are very expensive and
requested WHO to work on reducing prices with pharmaceutical companies.

*Brazil* also stressed that the high costs of medicines are threating the
fight against STIs and hepatitis, emphasizing the importance of the use of
TRIPS flexibilities.

*India* commended the Secretariat for the strategies and pointed out the
importance of affordable HIV medicines and how India has played a key role
at the global level. India also remarked on the importance of working on
prevention and that the main challenge for the implementation of the
strategies will be how to finance them.

Issues regarding prices of medicines were not only raised by developing
countries, where this has been a long struggle, but they were also
mentioned by developed countries such as Australia, the United Kingdom and

*Australia* welcomed the three strategies and highlighted that progress
remains uneven. Further, Australia acknowledged that the challenges require
Member States collaboration and welcomed the hepatitis strategy which
recognizes the challenge of affordable access.

The *United Kingdom* emphasized the importance of country investment and
called on the WHO to scale up country support to ensure universal coverage.
Moreover, it noted that aiming to eliminate hepatitis by 2021 is an
ambitious objective for countries to achieve considering the high cost of
addressing the problem.

*Greece* remarked on its national efforts to develop a national hepatitis C
plan and its commitment to ending viral hepatitis. However, Greece pointed
out the moral dilemma it faced given the country’s resource constrains, and
how that will be an obstacle for implementation. It noted that it will be
important to have negotiations on the price of medicines according to
national plans and to encourage tools like joint procurement and exchange
of experiences across countries.

However, the *United States* noted that there is a need for more efficient
delivery models and about information of how Member States will reach
vulnerable groups. The US also noted that providing access to medicines is
crucial but expressed concerns about WHO having an advocacy role to
increase affordable access to medicines and the focus on prices and
intellectual property in the strategies to increase access to hepatitis

At the adoption of the strategies by Member States the WHO Secretariat said
that actions are now required for implementation and that there are major
opportunities for comprehensive price reductions. It said further that even
though price is a challenge the introduction of generics is crucial for low
and middle income countries and that now hepatitis C treatment has been
produced for less than USD 300.

Discussions on challenges related to prices were also present at the
adoption of the report of the Global Vaccines Action Plan (Document A69/34
<http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_34-en.pdf>)where many
Member States again expressed their concerns on the high prices of
vaccines.  Developing countries emphasized the difficulties in producing
their own vaccines and the support needed from WHO to enhance capacity in
vaccine manufacturing for countries to be able to keep high vaccination

Member States stressed that WHO should promote collective purchasing of
vaccines and an emphasis was made on the need to use TRIPS flexibilities.
Moreover, Member States raised important challenges in maintaining the
immunization programs particularly for countries that are graduating or are
not eligible for the Vaccine Alliance (GAVI) support. They highlighted the
need to discuss a plan to reduce high vaccine prices and ensure the
affordability of new vaccines.

**With inputs from the WHO Watch team of the People’s Health Movement*

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