[Ip-health] Health Policy Watch: Medicine Prices – Delegates Near Agreement On Softer Resolution For Disclosure

Thiru Balasubramaniam thiru at keionline.org
Sat May 25 22:03:00 PDT 2019


Medicine Prices – Delegates Near Agreement On Softer Resolution For

26/05/2019 by Elaine Ruth Fletcher

After a grueling 34 hours of nearly non-stop negotiations, World Health
Assembly delegates appeared to be near agreement Saturday evening on a
resolution supporting more systematic disclosure of prices for medicines
purchased and sold on national and global markets.

But language suggesting that countries require pharmaceutical manufacturers
to publish data on the costs of research and development – costs that are
often used to justify high end-user medicines prices – appeared likely to
be muted in the final text.

The clause in the original draft resolution, as proposed by Italy in April,
had recommended that countries require industry disclosure of such costs at
the time of national drug registration.

But after widespread opposition from countries including the USA, United
Kingdom, Germany and others, delegates said that support was building for
voluntary disclosure of “inputs across the value chain,” as per a phrase
proposed by India.

“There will be a resolution,” a delegate from one of the countries
co-sponsoring the resolution told *Health Policy Watch* as a weary group of
about a dozen negotiators emerged from a 10-hour drafting session Saturday
evening at Room 24 of Geneva’s UN Headquarters, the Palais Des Nations.

“It is a compromise but that is the nature of negotiation. It is better
than no resolution at all,” he said.

Delegates had been closeted away since 9 a.m. Saturday morning as the
loosely organised “drafting group” struggled to come up with a consensus
draft in order to get the proposal to the floor by Monday so that it could
be assured of approval by Tuesday 28 May, the closing day of the 72nd World
Health Assembly.

At noon on Saturday, that drafting group had counted over 50 delegates, and
some participants complained that the text had swelled almost as much to
include too many lofty-sounding, but possibly extraneous clauses about
technology transfer and local production of medicines.

However important, critics said that loading too many “asks” onto the text
could potentially weaken the core purpose of the resolution, which was
supposed to be about more transparent disclosure of prices for medicines,
which advocates argue can help countries negotiate better drug purchases,
and thus drive down costs for hundreds of millions of people worldwide who
currently cannot access critical drug treatments for cancers and other
noncommunicable diseases.

Then, as numbers of negotiators dwindled throughout the long afternoon,
progress advanced. By evening, only about a dozen members of the drafting
group remained, including the USA, India, Switzerland, and France, as well
as representatives from other key regional blocs in Latin America, Africa
and Asia.

But those delegates were smiling as they finally emerged from the room, in
near agreement on a final text, they said. While that text was only to be
published on Monday, they said it was almost clean of the nearly 100
caveats and comments that had been added to last week’s draft

“Lots of compromises were made to accommodate countries that are protecting
drug companies, so one should wait to see the actual agreement before
making too many judgments,” said Jamie Love, Director of Knowledge Ecology
International –  one of the activist groups that waged a heated battle over
the resolution in past weeks – in the KEI newsletter posted just after
negotiations ended.

Love predicted that the final, agreed-upon text would make “considerable
progress in some areas, including but not limited to [market] price
transparency.” But he also anticipated that the text about disclosure of
the costs of clinical trials would be “pretty disappointing, on a very
important topic.”

“Pretty shocking that some countries, like US, Switzerland, Germany, the
UK, Japan, Denmark, Sweden, the Netherlands, Australia, sought to block
language that would ‘urge’ countries to require disclosure of clinical
trial costs, and I am waiting to see what if anything was done on
disclosure and reporting of government R&D subsidies,” he noted.

“If governments like the US, the UK and the Netherlands are complaining
about high prices on drugs for cancer and rare diseases, why not have the
cost of trials data that would greatly improve their bargaining power?” he

Some countries, however, also cried foul over the tone of the campaign that
had been waged by activist groups, led by KEI, and Médecins Sans Frontières
(MSF/Doctors Without Borders), but also involving NGOs in France, Germany,
the UK, and Africa.

The campaign had initially included an open letter
<https://www.keionline.org/30830> addressed to all WHO member states, as
well as press briefings and press releases. Last week, letters targeted the
health ministers of Germany, the UK, and France, perceived as leaders in
opposing the measure. Over the weekend, feelings climaxed in a vigorous
campaign on Twitter and other social media, including some targeted
personal attacks on specific delegates, including in a French satirical

Countries such as Switzerland and Canada, which often play the role of
mediators between polarized groups of countries in the WHA, also came in
for a pummelling. In one CBC news story
where Love was quoted complaining about Ottawa’s efforts to soften language
about R&D disclosure, he said:

“You disappointed us this week, Canada, you guys are supposed to be the
good guys, right?”

Even the US Senator and presidential hopeful Bernie Sanders got into the
act, saying in a tweet
<https://twitter.com/SenSanders/status/1132054320063614976> on Friday: “I
understand President Trump is blocking a resolution at the @WHO that would
require drug companies to disclose actual R&D costs for pharmaceutical
drugs. Nobody should believe Mr. Trump when he talks about taking on Big

The international press attention and social media uproar was clearly
unsettling to health delegations unaccustomed to having technical debates
around WHA resolutions be the focus of close scrutiny and aggressive

“It doesn’t help advance a solution,” said one European representative.

Another delegate from Zimbabwe, said that members of the drafting group had
been asked to clamp down on their public discussion of the text, which
could even foul the waters of an agreement.

Other delegates voiced concerns that they had lacked sufficient time to
review the nuances of the resolution, which was only floated by lead
sponsor Italy in February, prior to being formally tabled in April
and then revised later in May
<http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_ACONF2-en.pdf>, following
two country consultations.

That broke with the usual precedent whereby resolutions are typically
reviewed first by the WHO Executive Board at their regular meeting in
January, prior to being aired at the World Health Assembly.

Yet despite the brouhaha, the resolution was clearly gaining support. Over
the weekend, at least another six countries reportedly joined the
resolution as co-sponsors, including Asian and African heavyweights such as
India and Kenya, as well as Andorra, Luxembourg, and Sri Lanka.

This was in addition to the 10 previously declared co-sponsors, Egypt,
Greece, Italy, Malaysia, Portugal, Serbia, Slovenia, South Africa, Spain,
and Turkey.

The move by Kenya to join with South Africa was significant, one delegate
from another East African country noted. “Particularly on issues like this
one, we have to vote as a bloc to make our voices heard.”

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

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