The common saying attributed to Benjamin Franklin goes, an ounce of prevention is worth a pound of cure. And in public health, an area commonly short on funding, that is something I can say most people probably agree with. However, in many instances preventing an infectious disease is just not feasible. This could be because the disease is endemic in the population, the vectors or way it’s transmitted is incredibly complicated and hard to control, we don’t have good enough solutions to make prevention effective, etc. So in these situations, the cure/treatment is the only weapon we have against the diseases. But the one problem here is that drug development is based on profit and the highest infectious disease burden is commonly felt by lower income people and countries.
I am by no means an expert on trade agreements and the like, which make it easier/harder for middle and lower income countries to get access to affordable medicines so if there are people out there who’d like to add more info through the comments section, please do so. Also, This Week in Global Health (TWiGH) did a 4 part video series discussing access to medicines. (full disclosure, I contribute blog posts for TWiGH as well)
According to the WHO, money spent on medicines accounts for the majority of healthcare costs in middle and lower income countries. While trade in medicines is increasing, it’s only really happening between wealthy countries. It’s estimated that 1/3 of the developing world’s people are unable to receive or purchase essential medicines on a regular basis. The lack of access to medicines in poorer parts of the world does not just impact the health systems native to that country. MSF’s efforts in these countries without suitable access to medicines is also hampered because they can’t get the medicines they need. So to combat this growing problem, MSF has created an Access to Medicines Campaign. So for those of you interested in joining the campaign to provide affordable medicines to those who need it, I highly recommend checking out MSF’s work. They are doing a lot of advocacy and provide multiple ways for interested people to get involved in combating trade agreements which don’t allow for the production and sale of affordable medicines to those countries that need it most.
So if you’re interested in how pharmaceutical companies are doing in regards to access to medicines in developing countries here’s a little chart provided by the folks at Access to Medicine Index:
For a specific example of the problems with access to medicines, according to a 2015 report by MSF on affordable vaccinations, the cost of fully immunizing a child has skyrocketed, even with the help of Gavi, the Vaccine Alliance. Middle-income countries are hit the hardest as they’ve never been eligible for Gavi’s financial assistance or had access to Gavi’s prices, because their gross national income is too high to qualify but not high enough to afford the high medicine prices. “Vaccine ‘affordability’ is currently defined by what countries and donors are willing to pay, and not according to public health need. ” The vaccine market is pretty insulated, making it harder for new manufacturers to break in, and less competition means the ability to keep prices high because countries have no other alternative from which to purchase vaccines.
Until more manufacturers start making/pricing vaccines for infectious diseases affecting people living in middle and lower income countries, costs will continue to spiral out of control, leading to a generation of people not fully vaccinated and the rise of vaccine preventable diseases around the world. The need for more affordable vaccines doesn’t even consider the millions of people who need medicines for chronic conditions like diabetes, heart disease, HIV/AIDS, TB, etc. who will continue to lead poorer quality lives without the regular access to medicines they desperately need.
Increasing access to medicines really is a life or death decision.