A prescription for a more just access to treatment?

Manuel Martin, Medical Innovation & Access Policy Adviser, MSF Access Campaign

Whenever the topic of high medicine prices comes up, discussions often get very technical — buzzwords like ‘R&D costs’, ‘fair return on investment’ and ‘incentives’ are immediately thrown around. While these terms come naturally to self-identifying policy geeks like me and we know the importance of these discussions, they risk blocking out the far bigger picture: the lives of patients.

Thankfully, every once in a while, a patient comes along to remind us and decision makers that while we debate the details of the perfect way to pay for medicines and conduct research and development, the status quo kills.

Most recently it was a boy named Luis. Luis is just nine years old and suffers from cystic fibrosis, a disease which slowly fills his lungs with mucus. He was not able to access a life-changing medicine called Orkambi because Vertex Pharmaceuticals had refused all offers the UK’s National Health Service made over four years of negotiations.

This week the Health and Social Care Secretary, Matt Hancock, announced a deal has finally been struck with Vertex. Although the price of the drug will remain confidential, hampering the ability of other countries to negotiate lower prices, this can and should be chalked up as huge win for Luis and all other cystic fibrosis sufferers.

But this wasn’t Luis’ only win. About a month ago, the UK Labour Party’s leader Jeremy Corbyn met Luis and listened to his story after a public campaign by the civil society organisation, Just Treatment. Following this meeting, the party announced a new policy commitment on medicines, ‘Medicines for the Many’. These events have brought debates about exorbitant medicine prices and the way the UK government finances research and development back to the forefront and into the public eye.

Labour’s new policy is ground breaking in that it reflects many of the arguments of that have been made by UN bodies, civil society (including MSF*) and patient groups for years. It sets out the principles for an improved pharmaceutical innovation system — a system that would prioritise patient benefit over short-term company profits. It would bring medicine prices down and direct medical innovation according to patient need not shareholder profits.

This hasn’t stopped the pharmaceutical lobby from pretending like it would break the ground underneath their feet. The Executive Director of the Association of the British Pharmaceutical Industry immediately warned that the policy, if implemented, would harm innovation and discourage research, a familiar and jaded response that is pulled out by the industry whenever action on medicine prices are proposed.

But while civil society has always been quick to point out the intellectual laziness behind this argument, they are no longer alone. Just last year the former pharma executive turned US Secretary of Health and Human Services, Alex Azar, said “I’ve been a drug company executive — I know the tired talking points: the idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt. I’m not interested in hearing those talking points anymore, and neither is the President.” While this statement has not translated into reality in the US, it reveals that even industry insiders don’t believe the scaremongering.

The idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt — I’m not interested in hearing those talking points anymore.”

US Secretary of Health and Human Services, Alex Azar

To get into the detail, one of the proposals in the policy to bring prices down is the use of ‘compulsory licenses’. Here is where being geeky helps to cut through the narrative put forward by the pharma industry that these licenses disincentivise important future research.

Compulsory licenses, or ‘crown use’ licenses as they are called in the UK, are an old tool made available to governments to combat all sorts of monopoly abuse, including exorbitant prices. For instance, in 1965, the UK government used a crown license to import the essential antibiotic tetracycline from a generic drug company in Italy, offering the medicine at one tenth of the price of the pharmaceutical giant, Pfizer.

Since 2001, about 100 compulsory or public non-commercial use licenses have been threatened or used around the world in order to reduce prices of lifesaving medicines, mostly in the area of HIV. And guess what — surprise, surprise — the development pipeline for antiretrovirals is still going strong with over 15 new medicines against HIV approved in the last ten years.

The importance of maintaining compulsory licensing as a tool to combat abusive pricing was also hinted at by the junior health minister from the Conservative Party in the UK, Seema Kennedy, when she said she had the ‘moral obligation to look at these other options’ if Vertex didn’t change their approach to Orkambi.

The creation of a publicly owned manufacturer of generic medicines is the second seemingly radical proposal from Labour — until one discovers that Sweden’s state-owned pharmaceutical manufacturer, APL, is one of the largest in Europe and has been producing specialty medicines for over 40 years. And in Poland, the state-owned ‘Polfa Tarchomin’ is one of the country’s main producers of medicines — offering for instance human insulins at prices that are affordable to the Polish healthcare system. In fact, during the turn of the millennium, publicly owned generic manufacturers in Brazil and Thailand produced first-line HIV treatments, saving the lives of millions who would have otherwise not been able to afford treatments.

For me, the most exciting and potentially transformative idea is the proposal to explore what we geeks call the principle of ‘de-linkage’ in medical innovation. Simply put, it means that governments stop incentivising research through high medicine prices — which is not only unjust but also extremely inefficient — and use other mechanisms instead. This means that action by governments to reduce medicine prices would not impact innovation — quite to the contrary — it would generate savings that could finance and set research priorities aligned with urgent public health needs, not (just) profits.

This could impact the lives of many people in developing countries where our own medical teams work and whose medical needs are not met by the present innovation system. Think back to the Ebola outbreak in 2014 in West Africa — our teams simply didn’t have the medical tools to fight the disease because vaccines and medicines had not been developed. If we didn’t solely rely on high prices to incentivise innovation, we could have filled that gap before the outbreak happened while maintaining collective control over access and availability over the products.

Medicines for the Many’ is a call to action that should be heard. While in the US the Trump administration has blamed other countries for their high prices and for ‘freeloading’ off US research, a policy like “Medicines for the Many” in the UK extends solidarity to other countries facing high drug prices and commits to not only opposing harmful trade agreements that would limit access to affordable medicines but ensuring that UK funded research results in affordable medicines elsewhere, a commitment that has the potential to significantly improve access to treatments MSF requires on a day-to-day basis.

At a time when so much of the political discourse is about an ‘Us and Them’, exclusive and ever-narrowing vision of humanity, this policy is one of many encouraging signs that lets us hope that, at least where medicines are concerned, we can still envision a fairer more inclusive world where everyone can get the lifesaving medicines they need.

*See page 30 in our report, ‘Lives on the Edge: Time to align medical research and development with people’s health needs.’

This blog is a place to reflect on our experiences working for access to medicines. For the official MSF Access Campaign website please visit msfaccess.org.