Many medicines are increasingly becoming unaffordable. Many ‘new’ medicines turn out to be no more effective than those already being used. Global health needs are not driving medical research and development. Today, access to medicines has become a global concern which not only affects low and middle income countries.

On 8th November 2016 the Lancet Commission on Essential Medicines Policies launched its report “Essential Medicines for Universal Health Coverage” identifying lessons learnt from 30 years of implementing essential medicines policies.

“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 Andy Gray, University of KwaZulu‐Natal, Durban, South Africa, who was one of 21 international health policy experts gathered by The Lancet to study the problem. “Recent examples such as the EpiPen scandal in the USA, the high cost of Hepatitis C drugs or the failure to develop new antibiotics to treat resistant infections demonstrate that access to safe, quality and affordable medicines is a global issue, at the heart of advancing access to universal health coverage.”

The Commission identified five crucial areas: the role of governments and national health systems in paying for a basket of essential medicines; making essential medicines affordable; assuring the quality and safety of medicines; promoting quality use of medicines; and developing missing essential medicines. Three cross-cutting themes:  equity of access; strengthening institutions; and promoting accountability also underpin the report.

The report is rich in data and evidence-based recommendations to governments, civil society, national health institutions, regulatory agencies and the pharmaceutical industry. Their joint efforts are needed to improve access and affordability.

Increased transparency  of health and medicines information (on, for example, drug pricing, clinical trials, public funding and R&D costs), by governments, national health systems and the pharmaceutical industry; monitoring systems for affordability, price and access; pooled procurement (when multiple payers within a country or across countries negotiate prices together); delinking price from R&D costs (to provide incentives for research and development of new drugs by other ways than product pricing; implementation of current flexibilities allowed under the World Trade Organisation’s agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) where governments can limit IPR legislation for public health purposes; avoiding misuse and improving the quality of medicines: these are some of the recommendations suggested by the Commission to close the gap “between the current situation of access to affordable and quality-assured essential medicines and the idea of equitable access to essential medicines for all”. Many of the recommendations might sound familiar, but the Lancet Commission also adds a set of 24 core indicators to measure progress and hold all stakeholders accountable.

“We believe that our recommendations can substantially improve access to essential medicines in high‐ and low‐income areas alike,” says co‐chair Professor Veronika J. Wirtz, Boston University School of Public Health, USA. “(…) Promoting accountability for improving essential medicines policies will require drastic changes in our approaches to transparency and implementing corrective actions across both sectors, public and private.”

Commenting on the recommendations, the Dutch Minister for Foreign Affairs Lilianne Ploumen and the Minister for Health Edith Schippers stated: “The system is broken but change is underway to fix it. Governments cannot do this alone. We need meaningful efforts by both the pharmaceutical industry and governments to invest in new medicines, provide full transparency on costs, prices, and who pays what beforehand, and respect the legal space for governments to protect public health. If we don’t succeed in these efforts, we cannot guarantee people’s access to innovative and affordable medicines. Without fixing this broken system we will not reach the Sustainable Development Goal to ensure healthy lives and wellbeing for all, at all ages. “Leave no one behind”, the UN’s slogan, will prove to be empty words.”

Viviana Galli

Coordinator European Alliance for Responsible R&D and Affordable Medicines

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