[Ip-health] Ellen 't Hoen in Spotlight: AIDS2018: Is cancer the new AIDS?

Thiru Balasubramaniam thiru at keionline.org
Wed Jul 25 06:58:37 PDT 2018


JULY 24, 2018
 BY SPOTLIGHT <https://www.spotlightnsp.co.za/author/nina/>
AIDS2018: Is cancer the new AIDS?

By Ellen ‘t Hoen

As the world gathers in Amsterdam for the 22nd International AIDS
Conference, high medicines prices are again making headlines across the
world. Ellen ‘t Hoen takes stock of where we are almost two decades after
HIV propelled these issues to the top of the international agenda.

High medicines prices are making headlines across the globe. Today, the
highest advertised price for blindness treatment Luxterna is set by the
company Spark Therapeutics at US$ 850,000. The rationing of essential
hepatitis C (HCV) medicines became common practice even in high-income
nations where they were deemed cost-effective but not affordable. People
living with HCV in several European countries are encouraged to seek
treatment through direct importation with the help of buyers clubs or
through medical tourism to countries where patents are absent and generic
treatments are available. The price of new cancer medicines and treatments
at US$ 100.000 a year is now common practice. Access to medicines has
become a global issue affecting even the wealthiest nations – and we need a
global response to find solutions.

It is therefore no surprise that people look to the successful efforts to
bring down the price of antiretroviral medicines to find answers to today’s
high drug price challenges in regard to other diseases. The key to the
successful lowering of ARV prices was a flexible approach to antiretroviral
medicines patents – for example, through the use of TRIPS flexibilities in
procurement, patent oppositions, licensing, in particular through the
Medicines Patent Pool – and the availability of global and local financing
for the procurement of those medicines that created a competitive market
for generic producers.

A decade ago one would not have expected the Dutch Minister of Health to
announce plans to examine how compulsory licensing of medicines patents may
serve as a strategy to decrease the prices of new patented medicines. Calls
for the use of compulsory licensing of patents of medicines can be heard in
France, Greece, Ireland, Romania, the UK, Spain, and the US. These calls
are mostly motivated by the urgency to lower the price of rationed (and in
some cases bankrupting) products for the treatment of HCV and cancer.

Based on the HIV experience, there is no doubt that addressing the barriers
to generic entry through the use of TRIPS flexibilities, such as compulsory
licensing, can be effective. The question is whether it will be politically
feasible, in light of the fierce opposition from the pharmaceutical
industry to such plans.  While the industry has shown flexibility
concerning HIV in low-income countries, it is unlikely that it will do so
in a country like the Netherlands.

So where do we go from here?

High medicines pricing have their roots in the financing model of
pharmaceutical research and development, which is predominantly based on
the granting of market exclusivities through patents or otherwise. This is
not a situation we can ‘compulsory license’ ourselves out of.

At the launch of the report by the Lancet Commission on Essential Medicines
Dutch Minister for Foreign Trade and Development Cooperation Liliane
Ploumen and Minister of Health Edith Schippers proclaimed the current
innovation system for pharmaceuticals to be broken. They wrote: “Patent and
intellectual property exclusivities are the only cornerstone of the current
model. Companies can ask the price they like. This will no longer do. We
need to develop alternative business models. And if public money is used
for the development of new medicines, agreement upfront is needed about
what this public investment will mean for the final price. We believe that
companies must provide full transparency regarding the costs of research
and development (R&D).”[2]

The development of new medicines is costly. The investment in innovation
needs to be protected and promoted, but not at the expense of access that
affects the most vulnerable. Considering the amount of money the world
spends on pharmaceuticals, it is time for some fresh thinking about how to
ensure the development of new essential medicines takes place while
assuring those medicines are affordable and accessible to all. Global
spending on pharmaceutical products is expected to reach US$ 1.4 trillion
by 2020 [i]
If even a small part of this money (raised through individuals and health
systems paying for the drugs), could be allocated to drug development
directly we could guarantee both innovation and access. After all, if the
R&D is already paid for there is no need for market exclusivities to recoup
the innovation cost. This is called the “delinkage” proposal. For example,
governments can create prize funds for the development of certain priority
health technologies. Such funds should ensure significant amounts of
financing for R&D are available and thereby create a ‘market’ for R&D.
Delinkage is not about taking money away from drug development. It is about
making sure needed R&D takes place and that the results of that R&D are
available to all.

For this to happen we will need a global movement based on solidarity.
That is perhaps the most important lesson we can learn from HIV.

   - *Ellen ‘t Hoen is a lawyer and public health advocate with more than
   30 years experience in health and intellectual property. She is the author
   of the book ‘Private Patents and Public Health’.*

 Wirtz, VJ, Hogerzeil, HV, Gray, AL et al. Essential medicines for
universal health coverage. (published online Nov 7.) The Lancet. 2016;

 Better life through medicine—let’s leave no one behind, Ploumen, Lilianne
et al.The Lancet , Volume 389 , Issue 10067 , 339 – 341

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

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