Manon Ress manonress at gmail.com
Wed Sep 25 10:38:49 PDT 2019


The British Labour Party’s platform on access to health, “MEDICINES FOR THE
MANY: Public Health before Private Profit,” is organized in five
well-written and powerful policy chapters. In 52 pages, the Labour Party
takes a strong stand defending patients instead of profits. It also
provides a clear explanation of a new set of needed health policies, fully
laying out rationale to implementation.

The first chapter covers the current United Kingdom (UK) health system
including the pricing of medicines. The second chapter deals with the many
problems that plague the existing health care system from the lack of
transparency to the pharmaceutical lobby.

The third chapter, titled “Policies,” is bold and is a must-read for anyone
who truly believes we can do better. Today, innovation incentives and
rewards are effectively the promise of huge monopoly-based profits, which
leads to expensive medicines. Chapter 3 addresses the issue in a decisive
manner. The chapter is about being practical, using the existing tools
available to force prices down and ensuring that publicly-funded drugs are
affordable to patients. It is also about being an innovator in the policy
space and creating new incentives for pharmaceutical innovation through
delinkage of the cost and risk of R&D from the price paid by the patients.

In “Medicines for the Many,” the delinkage model is clearly defined:

By changing the incentives that determine what kind of health innovation
happens, public health can come first, while rationing and denial of access
could end. Policy steps can be taken immediately to start the process of
changing incentives in the system, however the impact will be felt over a
longer-term period due to the development time required for drug discovery
and innovation.

Delinkage is an innovation model based on the premise that the costs and
risks associated with R&D should still be rewarded, but that the incentives
for R&D can be provided by means other than financial returns from high
product prices during the period of patent protection.

Innovation is instead supported through upfront grants or subsidies and
rewarded by a variety of prizes, including innovation inducement prizes,
market entry rewards, or open source dividends. These incentives, and the
kind of innovation they reward, can be focused on agreed health priorities
informed by multiple stakeholders rather than ceding this role entirely to
pharmaceutical companies, as is the case in the current system. By
replacing market incentives we can ensure that urgent public health needs
are prioritised, especially those that are currently ignored, like the ones
that affect poorer populations or represent low growth markets such as new
antibiotics. Furthermore, a much larger percentage of investment in
pharmaceutical products will go directly into R&D. Discoveries rewarded in
this model would then be openly licensed to facilitate generic manufacture
and competition, driving down prices close to the cost of production.

The fourth chapter is about “building a wider movement” that would include
trade unions, civil society, international allies, academics and experts,
political support and pharmaceutical industry representatives.

Also quite practically, Chapter 5 addresses the “Concerns and Challenges”
about how to fund these reforms, noting the Brexit context as well as the
common belief that reforms would slow down new discoveries.

The conclusions of the Labour Party progressive pledge are unequivocal:

Few injustices are as stark as the knowledge that a medicine exists to
treat or cure a family member, but that the unaccountable greed of a
corporation means they are denied it. With drug prices leaping from tens to
hundreds of thousands of pounds per patient, these injustices are only
going to become more common globally. Here in the UK this situation is
placing the egalitarian, collective ethos of the NHS under unbearable

Something has to change.

While this is a UK Labour Party policy document, it should serve as the
basis of reforms in many countries, including the US, which is still
struggling with denial of the need for transparency, the need to use
existing tools such as compulsory licensing, and the need for a real
discussion and decisions about publicly-funded drugs that are too expensive
for patients as well as payers. If the US Congress were serious about
dealing with the price of drugs, it would also examine how to achieve
delinkage of the price of drugs from the cost and risk of innovation. A
feasibility study would be a good start for a change.

A copy of the Labour Party pledge, “MEDICINES FOR THE MANY: Public Health
before Private Profit,” is available here.

Manon Ress
manon <manon.ress at keionline.org>ress at gmail.com
tel.: +1571 3316879

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