Ensuring access to medicines is good for everyone – pharma included

Because its publicity that money just can’t buy, because it will attract a new breed of investors – and quite simply because it’s the right thing to do.

These are some of the reasons pharmaceutical companies need to ensure their lifesaving medicines are affordable in low- and middle-income countries (LMICs).

After working with industry to make expensive HIV, hepatitis C and tuberculosis medicines more accessible to people in the developing world, the Medicines Patent Pool (MPP) is expanding its remit.

The organisation is about to deploy its unique modus operandi to the World Health Organisation’s (WHO) Essential Medicines List (EML) in a bid to further fight health disparity.

MPP’s Executive Director Charles Gore said it was an exciting time for the organisation, which acquires licenses from major pharmaceutical companies and then sub-licences generic manufacturers in selected LMICs.

“By licensing a number of generic manufacturers, this promotes intense competition and drives the prices down,” he explained.

“A lot of the price of a medicine is caught up in the patent, in the research and development. When you are just thinking about the production of the pills, the price drops can be dramatic, and this makes the medicine affordable.”

HIV outcry

The MPP was set up with the backing of Unitaid in 2010 as a response to the inequity of access to the HIV medicines that were coming onto the market.

“There were companies in the HIV space who realised that they had these lifesaving drugs, but a lot of the people who needed them were in LMICs and not in a position to pay.

“There was a huge societal pressure to make these drugs available, and we were able to negotiate with the industry,” said Charles.

The MPP extended its remit to hepatis C and tuberculosis in 2015, and found, in some cases, that discussions were more difficult without the backing of public outrage.

But attitudes are starting to shift throughout society, and the mainstay of the pharma industry needs to catch up, said Charles.

“Access is becoming more and more of an issue, and affordable drugs are essential to the expansion of universal health coverage. It will become unacceptable to have a first world and a third world when a drug is launched,” he said.

“I think some parts of the pharma industry may be a little behind on that.”

Compulsory access schemes

The MPP believes that by 2040, all new drugs will be required to have an access scheme at launch, and while some companies are actively embracing that, others need a little help.

Charles said: “I went to see one company whose new CEO has said they want an access programme to go with every launch from now on.

“All companies need to understand that this is going to happen anyway, and that there is no getting away from it. It’s good PR to embrace it now, but it’s really, really bad PR to be dragged into it reluctantly.”

While some companies have a model of simply giving their drugs away in the developing world, MPP offers something different.

It has been replicated by Gilead, which has expanded access to its game-changing hepatitis C treatment, launched before MPP had a remit within the virus, by working with generic manufacturers.

Sustainable model

Charles said: “We are not the only answer, but we are one answer. Because our model is one of licensing, everyone gets something out if it. It is sustainable.

“People who need them get the drugs, the generic manufacturers get the business, and the pharmaceutical companies get the kudos,” said Charles, highlighting the potential gains on the Access to Medicines Index.

And that kudos has serious weight in terms of opportunity, as we witness an increase in socially motivated investment across the developed world.

Said Charles: “This is becoming more important to investors as well as to governments, and the industry needs to be ahead of the curve on this.”

Most importantly, though, eradicating health inequalities is everyone’s responsibility – and most people who dedicate their lives to advancing medicine want the drugs they create to benefit as many people as possible.

The right thing to do

“A first and a third world exists in medicine. We do not want any third-class citizens in this world. We want medicines, particularly lifesaving ones, to be available to everyone in an affordable way,” said Charles, adding that a healthy population was critical to a country’s wellbeing and economic prosperity.

“If there are areas where there is a big public health need where we could be making a difference, then that’s what we should be doing.  It boils down to ethics. If you want to work towards a world of fairness, making medicines available to everyone is a key part of that.”

Getting there is possible, but not without its challenges, he said, adding that the pharmaceutical industry is a crucial partner on that journey.

About the Medicines Patent Pool (MPP)

Charles Gore is Executive Director of the Medicines Patent Pool (MPP), a United Nations-backed public health organisation working to increase access to HIV, viral hepatitis C and tuberculosis treatments in low- and middle-income countries.

It partners with international organisations, civil society, patient groups, industry and other stakeholders to prioritise, forecast and license needed medicines and pool intellectual property to encourage generic manufacture and the development of new formulations.

To date, the MPP has signed agreements with nine patent holders for thirteen HIV medicines, one HIV technology platform, two hepatitis C direct-acting antivirals and one tuberculosis treatment. The organisation was founded and remains funded by Unitaid.