Rebeca Grynspan: Promoting access to essential drugs at home and in the global South

20 Sep 2011

Associate Administrator
Opening remarks: Side Event entitled ‘Promoting Access to Essential Drugs at Home and in the Global South’
20 September 2011, 13:15-14:45

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Honourable Minister of Health of Mozambique, Dr Alexandre Manguele,
Honourable Vice Minister of Health of Brazil, Dr Helvecio Miranda Magalhaes Junior, and Additional Secretary of Minister of Health, Keshav Desiraju,
Excellencies, ladies and gentlemen, colleagues

On behalf of UNDP, I extend a warm welcome to all of you to this joint Brazil-UNDP side event on “Promoting Access to Essential Drugs at Home and in the Global South”.

For the next hour and a half we will have the chance to discuss, in some depth, the ways low and medium income countries are increasing access to pharmaceutical products- including medicines and health diagnostics.

Addressing the high cost of medicines for communicable diseases such as HIV and hepatitis has been at the forefront of global and national health policy discussions. The majority of people in low and medium income countries purchase medicine out of pocket, making affordability a key determinant of access. Studies carried out in several countries, and the case of Mexico in particular, have demonstrated that the out-of-pocket expense of medicines is a major reason people fall into poverty, and is therefore behind, to a great extent, the vulnerability and “volatility” of people who hover just below or above the poverty line.  

Just ten years ago, the annual cost of first generation treatment for HIV in both rich and in poor countries exceeded ten thousand US dollars per patient, per year. It was the countries and people who could least afford these costs, which bore the heaviest burden of HIV. The global community was rightly focused on the imperative of lowering the cost of treatment.

A number of important factors including:

  • competition from generics;
  • increasing economies of scale;
  • bold policy measures by key countries, some of who are represented here today; and
  • the bold and impressive leadership and advocacy of civil society groups, resulted in the annual cost of treatment falling to as little as one hundred and sixteen US dollars for WHO approved first generation antiretroviral therapy in low income countries.

As a result more than 6 million people receive HIV treatment, resulting in a 20% reduction in AIDS related deaths over the past 5 years. It has since become increasingly clear that the incidence and prevalence of non-communicable diseases, in particular, cancers, diabetes and cardiovascular diseases are increasing rapidly not just in developed but also in low and medium income countries.

The 2011 MDG Gap Report Task Force just released on Friday by the Secretary General notes that chronic diseases account for no less than 40% of deaths in low income countries. The AIDS response has taught us that efforts to address a pandemic are incremental and can take time.

Unless NCDs are addressed now, the lives of those living in developing countries will be saved from communicable diseases only to be lost prematurely from NCDs. Increasing prevalence of NCDs also has a large and growing impact on development outcomes.

The 2001 Report of the WHO Commission on Macroeconomics and Health found that extending the coverage of crucial health services to the world’s poor, including for a relatively small number of specific interventions, could save millions of lives each year, reduce poverty, spur economic development, and promote global security. The impact of AIDS on human development is a good example. In the most affected countries of sub-Saharan Africa, the AIDS epidemic has clearly had macro impact, slowing growth and decreasing life expectancy.

The burden of NCDs cannot be reduced without equitable and reliable access to essential pharmaceutical products.

All countries can and should begin to adopt and implement strategies to increase access to essential pharmaceutical products for the treatment of NCDs. In China, for example, over US$86 million could have been saved by switching to generics in just four types of medicine provided by public hospitals in 2008. This would have resulted in cost savings of 65 per cent on average.

The WTO Agreement on Trade Related Aspects of Intellectual Property rights requires all WTO Member States- except LDCs and countries negotiating their membership status - to protect and enforce intellectual property. Public health related flexibilities, however, have been successfully used to reduce the cost of treatment.

The TRIPS Agreement also specifies that “intellectual property rights should promote technological innovation, as well as the transfer and dissemination of technology, to the mutual advantage of producers and users of such technology, and in a manner conducive to social and economic welfare.”

In making new technologies work for human development, policies establishing intellectual property need to balance the legitimate need to incentivize innovation with the need to ensure the benefits of innovation are accessible to as many as possible. This was one of the messages of UNDP’s 2001 Human Development Report, “making new technologies work for human development”.

UNDP is a development agency, not a specialist health agency. But we believe that the relationship between health and development is mutually reinforcing – by strengthening one we strengthen the other. Health is also a goal in and of itself. Life expectancy is after all one of the ways we measure human development.

South-South cooperation across both health ministries and the private sector is emerging as an important modality for strengthening the voice of low and middle income countries. South-South cooperation is essential for enhancing learning and exchange lessons on how to strengthen institutional capabilities and facilitate technology transfer. Regulatory and policy options can also be used by governments to increase access to treatment. These may include price controls, encouraging the use of generic drug prescription, ensuring the availability of generic drugs in national markets, and new schemes to finance public health.

I look forward to hearing from our esteemed panellist how the public and private sector in their countries has worked to expand access to essential medicines. I likewise look forward to hearing the experiences from representatives in the audience here today. I hope we can use this event to help more countries advance the important cause of making treatment accessible to the people who need it the most.