Environmental Engineering Reference
In-Depth Information
Health Organization [WHO] 2004b, 3). This figure rises to over half the population
in some low-income countries in africa and Asia. While these figures suggest a
gross inequity in drug access, it is notable that they refer only to essential medicines,
a category of medicines defined by the WHO (2007a) as 'those that satisfy the
priority health care needs of the population'. In the past, the wHo has selected
these medicines primarily on the basis of cost effectiveness and affordability. thus
drugs that effectively treat disease yet were expensive were excluded from the list as
a matter of course. this was the case with HIv/aIDS medicines (before the wHo
included them in response to activist pressures) and artemisinin-based anti-malarial
drugs, and remains the case for tuberculosis (tb) treatments and reserve antibiotics.
access to medicines to treat many priority healthcare needs such as HIv/aIDS or
malaria is considerably lower than even these figures suggest.
the impact of inaccessible medicines is exacerbated by the growing double
burden of communicable and non-communicable disease in developing countries
(commission on Intellectual Property rights, Innovation, and Public Health
[CIPIH] 2006, 15). Communicable diseases cause devastating rates of mortality in
these regions, led by HIv/aIDS in sub-Saharan africa as well as resurgent malaria
and tb. For example, 2 million people died from HIv/aIDS in 2007 (UnaIDS
2008, 15); more than 1 million people (mainly african children) die from malaria
each year and 1.7 million people died from tb in 2007 (mainly due to opportunistic
infections in people with HIv/aIDS) (wHo 2007b; wHo 2008).
this dearth of medicines is similarly illustrated by the skewed consumption
of medicines between rich and poor countries. In 2005, pharmaceutical sales in
latin america, southeast asia, the Indian subcontinent, africa, and the Middle
east combined amounted to only 12.1 percent of global sales (cIPIH 2006, 15). In
contrast, drug consumption in north america, europe, and Japan amounted to more
than 85 percent of the global pharmaceutical market. In other words, one fifth of the
world's population who are located in developing countries purchase almost two
thirds of the world's pharmaceuticals.
the persistent inaccessibility of many affordable medicines suggests that both
poverty and political neglect play key roles. Yet these factors provide insufficient
explanations for the global drug gap and, as the wHo's commission on Intellectual
Property rights, Innovation, and Public Health (2006, 16) indicates, drug pricing
and overall cost of treatment constitute a major problem in developing countries. In
developing countries, medicines can account for between 25 percent and 70 percent
of total healthcare expenditures, compared to under 15 percent in many high-income
countries (wHo 2004b, 14). Drugs also consume 50 percent to 90 percent of out-
of-pocket spending on health in developing countries (14). reducing drug prices is
therefore a critical strategy in ensuring broader access to medicines, and this is true
for HIv/aIDS and tb medicines as well as for drugs to treat non-communicable
diseases such as cancer and diabetes.
Several factors determine drug prices, including manufacturer's prices, transport
and storage costs, import tariffs and taxes, procurement practices, and dispensing
fees (Henry and lexchin 2002). However, patents are broadly recognised as the
