Ladies
and Gentlemen,In
my view this has been an extraordinary meeting.
Extraordinary in the sense of the complexity of the
issues we have been discussing. Extraordinary, too, in
the wide range of views that we have heard expressed. I
believe we have achieved a great deal.
Over
the last three days we have come a long way in clarifying
what it will take to make a real difference in ensuring
that poor people in low income countries have access to
the vital medicines they need.
As
I said at the outset, our purpose was not to make
decisions or to prepare detailed plans. Nevertheless, I
believe that the discussions here in Hosbjor have laid
the groundwork for positive actions in the future. By
focusing both on innovation for the future and increasing
access in the present, they build on foundations laid at
the recent meeting convened by the UN Secretary General.
The
problems we are discussing are urgent. Reaching the
targets set by both the leaders of developed and
developing countries alike, for reducing the burden of
disease caused by HIV/AIDS, malaria, TB and the other
health conditions that create and perpetuate poverty will
not be easy. I am convinced that it will not be possible
without a massive increase in the scale of the national
and international response. And access to essential drugs
is a critical component of that response.
What
have we learnt?
We
have heard quite clearly that the price of drugs
matters — it matters to poor people, and it
matters to poor countries. But little progress will be
possible without a significant investment in building
effective health systems. We have heard too that even
with lower prices — particularly in the case of
anti-retrovirals — additional finance will be
essential.
We
have heard that the protection of intellectual
property is a necessary factor in stimulating
the innovation needed to produce new drugs, vaccines and
diagnostics. It is equally clear, as we have heard this
morning, that effective protection of intellectual
property needs to be combined with incentives that will
drive research and development in the direction of the
health conditions that disproportionately affect the
poor.
The
present regime of international trade agreements has
been designed to strike a balance between the rights of
patent holders and the rights of patients. The TRIPS
agreement contains important public health safeguards. It
has been argued here that we do not yet have sufficient
experience to judge their real effectiveness. But we have
also heard at this meeting some important reassurances
that countries’ rights to exercise these safeguards
must be respected.
When
it comes to increasing access to drugs through lower
prices, we cannot rely on one single solution.
As one presenter put it: we need a mix of mutually
supportive strategies. Such a mix of strategies needs to
be geared to the circumstances of individual countries.
We
have focussed particularly at this meeting on differential
pricing. And here we have an important body of
experience on which we can draw. The presentations we
heard yesterday show that differential pricing is
feasible. It can result in prices that are between 1% and
10% of those charged in high income markets. This has
happened through a combination of high volume purchasing
by governments and international agencies, adequate and
reliable levels of finance, advocacy, corporate
responsibility and market forces.
For
differential pricing to work on a large scale, I think we
can all agree that there must be watertight ways of
preventing lower priced drugs from finding their way back
into rich country markets. We have heard suggestions as
to how this can be achieved. These ideas now need to be
tested to show that strategies to prevent
diversion can really work in practice.
There
were other important lessons that came out of our review
of current experience. It reinforced the point that just
making drugs available — even at no cost — does
not guarantee that they will be utilised. All the other
pieces of the picture have to be in place as well: the
distribution systems; the partnerships between public and
private providers; the agreements between governments and
development agencies; and — as several of the
presenters stressed — clear and explicit goals and
objectives. There are lessons from the experience of the
onchocerciasis control programme, for example, that could
benefit countries seeking to take up the offer of drugs
to prevent mother-to-child transmission of HIV.
The
need for significant increases in international
financial assistance has been a recurrent theme.
We in WHO believe there is a strong case for the
establishment of a new international health fund. It will
give political prominence to priority health issues
including HIV/AIDS — and is a tangible response to
earlier commitments on the part of the international
community to mobilise more money. It offers the
opportunity to capture resources from new partners,
particularly those who do not have a strong country
presence. It is also a means of ensuring more resources
to those countries without a strong donor presence.
The
issue that has struck me in this discussion is not just
that we need an absolute increases in the level of
resources, but that we need to think carefully about how
these resources are provided. We need mechanisms that
transfer money rapidly to countries. We need to combine
speed with transparency and accountability. We need
mechanisms that ensure that decision making and priority
setting remains, where it belongs, at national level.
Moreover, if funds are to be used to procure commodities,
we need to build on what exists — both nationally
and internationally. No reinvention of wheels, and most
important, no undermining of existing capacities and
systems.
Colleagues,
We
knew at the start of this meeting that there would be
tensions and areas where it would be difficult to agree.
This is inevitable. But our task here is to think through
the implications of different options — even if we
do not always reach a consensus on their viability.
One
of the issues that remains unresolved concerns the extent
to which price reductions can or should be achieved by
relying only on negotiation with producers. Much of the
discussion about differential pricing is based on the
assumption that it is possible to agree on a fair price
— based, for example, on the marginal cost of
production.
At
the same time, we have seen the effect of competition on
the prices of drugs.
We
have heard arguments both for and against voluntary
licensing of patented drugs. On one hand it is
said there is no economic justification for this
strategy. On the other hand it has been suggested —
not just as a means of introducing competition and thus
lower prices, but also as a way of ensuring that lower
cost drugs produced by the licensee are easily
distinguished from those produced by the patent holder
for high cost markets.
Of
course, voluntary must really mean voluntary. But the
question we need to ask ourselves is: what conditions or
incentives would be necessary to introduce greater
competition through voluntary licensing — in ways
which are consistent with international trade agreements
— on a larger scale?
There
are other issues too that merit our further attention.
I
will just take three examples — but there are others
that are set out in our background paper. First, we have
touched several times on the issue of how to handle
differential pricing in the context of middle
income countries. In addition, these countries
represent a potential market for the diversion of cheaper
drugs.
Second,
we need greater clarity around the issues of parallel
trade. And as we heard yesterday, those directly
involved — both trade and health officials —
need better and more accessible information on what is
and is not legal.
Lastly,
for any strategy designed to lower prices and increase
access, predictability and sustainability must remain the
watchword.
Colleagues,
In
closing let me say a few words about next steps.
The
issues we have been discussing are essentially political.
And as such require political solutions, through
political processes. We need to be sure we have all the
evidence that is available, but there are no technical
right answers to most of the things we have been
discussing.
For
us in WHO, the next step is to report on this meeting to
our Member States when they debate the follow up to the
Revised Drug Strategy at the World Health Assembly next
month.
The
test of a meeting like this is not the production of a
plan. Nor is it the quality of the report — although
I am sure in this case, it will be a good one. The test
is whether better understanding — of the issues and
of each other’s position — can be translated
into positive action within our own areas of influence.
Thank
you.
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