When it comes to treating diseases of the developing world, many doctors rely on tests or drugs that are either antiquated, ill-adapted or ineffective....that is, if they exist at all. The current method of financing health product development is often cited as a major barrier to the development of new, cheaper and more effective treatments. That 90% of the world’s spending on health research is still spent on the health problems affecting less than 10% of the world’s population is often cited. MSF (Doctors Without Borders) highlights this problem of medical innovation and other challenges in their Access to Essential Medicines campaign.If you have 5 minutes:
They highlight a number of reasons why health financing has stunted medical innovation:
1. Global spending on health research is skewed towards wealthy markets. Global spending on medical innovation has increased dramatically from US$ 30 billion in 1986 to US$ 105.9 billion today. A closer look shows how 90% of this money is spent on the health problems of less than 10% of the world’s population.
2. Diseases that take the heaviest toll do not attract the most investment into R&D. Between 1975 and 2004, 1,556 new chemical entities were marketed globally. Only 20 of these – a mere 1.3 per cent – were for tropical diseases and tuberculosis, which account for 12 per cent of the total disease burden.
3. Medical innovation is steered towards drugs that give commercial rewards, not the greatest therapeutic benefits. Pharmaceutical companies have more interest in developing a drug that will be lucrative, even if it doesn’t improve on medications that already exist rather than one that may represent a greater therapeutic breakthrough but for which there is no commercial market.
4. Funding for medical innovation that addresses diseases of the poor remains grossly insufficient. Governments are lagging behind philanthropic organisations such as the Bill & Melinda Gates Foundation, or even Médecins Sans Frontières . A recent report by the Treatment Action Group estimates at US$ 800 million the annual shortfall into funding for TB R&D.
5. This happens because in today’s R&D system, investments into R&D are paid for by charging higher prices for medicines. R&D relies on companies recouping their R&D investments through charging high prices, and protecting that price through patent monopolies. Not only does this mean that some drugs remain completely out of reach for many patients, it also means that diseases like TB or paediatric HIV that mostly affect the poor don’t get anywhere near the attention and investment into research as diseases that have bigger, more lucrative markets.
MSF also goes on to propose a number of alternative models:
1. Product Development Partnerships
2. Prize Model
3. R&D Treaty
4. Working with industry
If you have 15 minutes or more, check out the following sections of the MSF campaign:
- Introduction
- Current Challenges
- What is wrong with R&D today
- Looking for alternative models
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The following reading is another perspective on the 10/90 Gap. It's an interesting take, and stands in contrast to the MSF activist perspective on access to essential medicines.
If you have 5 minutes:
The author argues that the 10/90 gap is a misleading claim by activists. He suggests that the idea that 90% of the global pharmaceutical research budget is spent on diseases affecting only 10% of the world's population is false. He makes a number of arguments in defense of his thesis
1. Neglected Diseases represent a small percentage of mortality in the developing world. Tropical diseases that are widely touted as neglected often have preventive treatment or cures. He names only three tropical diseases that are truly neglected, according to the WHO.
2. Poverty is the real cause of disease. Diseases associated with poverty (such as TB, malaria, HIV/AIDS, treatable childhood illnesses and malnutrition) represent much more of the disease burden so called 'neglected' diseases. In addition, they are preventable.
3. Illness in low income countries is converging with high income country disease profiles. Conditions such as cancer, mental illness, and cardiovascular disease are more than 60% of the disease burden. Obesity is on the rise in the developing world. When research is done on these conditions, poor countries benefit.
The real issue, he argues, is access. The world's poor have limited access to treatments that are available for their health conditions. He posits that there are a number of issues that lead to poor access among the poor, and IP rights are not the most significant issues.
1. Intellectual property is not as big an issue as activists would have you believe. Most medicines on the 319 item list of the WHO essential medicines are not patented in the 65 poorest countries in the world.
2. In country taxes and tariffs can increase drug costs significantly. For example, in India duties add 55% to drug costs at the consumer level. Value Added Tax is another mechanism countries have of increasing revenue by up to 12%.
3. The way to increase access is to increase wealth. When people are better off, they can afford treatments, physicians and other health care workers can are more likely to stay in the country and deliver services.
If you have 15 minutes or more, check out the following sections of the full article: Diseases of Poverty and the 10/90 Gap
- Introduction
- Neglected diseases are a tiny fraction of total mortality
- Most Disease in lower income countries is caused by poverty
- Illness in high income countries and low income countries is converging
- Access is the real problem - not innovation
- Intellectual Property rights
- Taxes and Tariffs
- Table 3
- Wealth creation as a means to improve health
Article Details:
MSF Campaign for Access to Essential Medicines. What is Medical Innovation? Accessed July 2010.
Stevens, Phillip. Diseases of Poverty and the 10/90 Gap. November 2004.
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