The Lancet: Monthly cost of $1-2 per person could ensure access to basic package of 201 essential medicines
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The cost of providing a basic set of 201 essential medicines to all people in low- and middle-income countries could be as little as
However, one in five countries worldwide spend less than this per person per year on medicines, demonstrating the urgent need for additional financing to meet basic health care needs. At the same time, the world as a whole spends at least 8 times this amount on medicines, highlighting massive inequities and inefficiencies in financing and governance that restrict access to medicines for many people worldwide.
Essential medicines are defined as a core set of medicines to meet the priority health needs of populations, and include analgesics such as morphine, tuberculosis, HIV or malaria drugs, medicines for chronic diseases such as insulin or cancer medicines as well as vaccines and contraceptives. The Commission argues that access to affordable and quality-assured essential medicines is central to the Sustainable Development Goal target of achieving universal health coverage by 2030, and that strong government and international leadership is needed to effectively implement essential medicines policies and create accountability.
The Commission brings together a group of 21 international experts and makes recommendations to governments, civil society, national health institutions, national medicines regulatory agencies, and the pharmaceutical industry. The report will be launched in
"Countries around the world, regardless of income level, face enormous challenges ensuring equitable access to affordable, quality-assured essential medicines," says co-chair of the Commission
Based on disease prevalence, consumption of medicines and medicine prices, the Commission estimates that the cost of providing 201 medicines (378 different products) from WHO's Model list of Essential Medicines [3] to the total populations of low- and middle-income countries (LMICs) is between
Recent estimates suggest that the average total spend on medicines in low-income countries (LICs) is
The Commission highlights national and global policies (e.g. promoting generic medicines use, price transparency, pooled procurement) that, when implemented effectively, can make essential medicines affordable and translate into sustainable access for all. Related to this, the Commission warns that flexibilities included in the
Despite some progress, serious problems with medicine quality and safety persist in many low- and middle-income countries. At their most benign, poor quality medicines have no treatment effect, and at their worst cause human disasters. For instance, over 120,000 children in sub-Saharan Africa are estimated to have died in 2013 because of substandard antimalarial medicines.
In many cases, poor quality or unsafe medicines are the result of serious negligence in manufacturing (whether by accident or intent), followed by failures of the quality assurance process. In most high-income countries, National Medicines Regulatory Agencies provide quality assurance, but in the face of weak national regulatory systems in LMICs, many procurement agencies rely on WHO's prequalification programme. Good procurement methods can greatly improve the quality and safety of drugs (see figure 9,
The Commission also warns of inappropriate use of medicines, such as over or underuse (eg, overuse of opioids in the
The current system, in which market exclusivity and patents are the main drivers of innovation, fails to incentivise research and development into essential medicines. The Commission says that pharmaceutical research must be re-focused on developing affordable new essential medicines to address high priority diseases, by adopting a new global R&D framework, including a
Following the success of patent pools for HIV medicines, the Commission calls on the international community to create a general essential medicines patent pool, to licence patents to other companies in order to create a competitive generics market and improve access to medicines in LMICs.
Initiatives to address the lack of R&D on missing essential medicines are largely dependent on charitable donations, and have helped address some of these problems (eg, new medicines for HIV or tuberculosis), but they do not provide a long-term solution.
"Often, the public pay for medicines twice - first through government funded research, and then through high prices. The current system of developing new medicines is in crisis, as it largely fails to produce much-needed products to address the health needs of millions of people. When new essential medicines are developed, market exclusivity, through patents or other mechanisms, allows for pricing that potentially makes them unaffordable, even in high income countries," says co-chair Professor Hans Hogerzeil,
Finally, the Commission warns that lack of transparency and access to data on essential medicines is a general obstacle to the effective implementation and evaluation of essential medicines strategies, and propose a set of 24 indicators to measure progress.
"We believe that our recommendations can substantially improve access to essential medicines in high- and low-income areas alike," says co-chair Professor
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Keywords for this news article include: Vaccines, Virology, The
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