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It seems everyone is talking about inequality in 2014. President Barack Obama made income inequality the focus of his State of the Union Speech last week. It also featured prominently on the agenda of the World Economic Forum, the annual meeting in Davos, Switzerland, where political and business bigwigs discuss “the reshaping of the world”.
While many leaders were preparing their carefully crafted statements about saving the world’s poor, Marijn Dekkers, Chairman of the Board of Management of the pharmaceutical company Bayer, found himself at the centre of a media storm. A video from a panel discussion held in late 2013 called ‘Buffering the Pharma Brand: Restoring Reputation, Rebuilding Trust,’ showed Dekkers saying: “We did not develop this medicine for Indians. We developed it for Western patients who can afford it.” He was referring to Nexavar, a blockbuster cancer drug with more than US $1 billion in annual sales.
Médecins Sans Frontières and many other health advocates have criticised Dekkers for his remarks and his apparent ambivalence toward those in need around the world. What was made painfully clear by his statement, was how little has changed in the past two decades. Critics say many in the pharmaceutical industry continue to put shareholders ahead of public health.
During the 1980s and 1990s, AIDS spread across much of the world. As lifesaving drugs were developed, pharmaceutical companies restricted access to all but the wealthiest who could afford the combination of drugs that cost $10,000 to $15,000 a year in the West. In Africa, millions of people were infected with the virus and access to treatment was virtually non-existent.
The tide began to turn when generic manufacturers in India began offering the drugs at a fraction of the cost. However, access was still not a given. When South Africa attempted to provide generics to HIV-positive citizens, multinational companies stepped in to sue Nelson Mandela. The U.S. government even threatened South Africa with sanctions if it did not recognise the drug patents.
Strong civil society movements across the world stood up and demanded that generic drugs reach those who need them most. According to the World Health Organisation, 9.7 million people had access to treatment in 2012. There is still a long way to go, though -- only around one-third of those who are infected with the virus are on antiretroviral drugs.
Just as in the past, pharmaceutical companies today justify high prices by claiming that research and development costs are high. Innovation, the argument goes, will be curtailed if profit margins are diminished. However, according to an analysis published in the British Medical Journal, pharmaceutical companies spend only 1.3 percent of revenue on basic research to discover new drugs.
In essence, we do not need huge profits to develop new drug treatments. Rather, the real funders of innovation are taxpayers. More than 80 percent of funding for basic research to discover new drugs and vaccines stems from the public sector. Ensuring the right to life, as protected by article three of the United Declaration of Human Rights, means that when people cannot access life saving drugs, governments and civil society must be accountable for prioritising human life over patent laws.
In March 2012, the Indian controller general of patents did just that by authorising a local drug maker to produce generics of Nexavar because the cost of Bayer’s drug was too high for most Indians. Nexavar is given to patients to treat kidney, thyroid, and advanced liver cancers. The decision by the controller general reinforces India’s reputation as a country that puts healthcare patients first.
This is likely just the beginning. Yesterday, the World Health Organisation predicted that over the next two decades there will be a 70 percent increase in cancer cases, with the biggest burden in low- and middle-income countries. That pharmaceutical representatives continue to publicly argue that some medicines should be accessible only to Western patients, highlights the urgent need to fix a broken system.
After news of his remarks surfaced, Dekkers issued a clarification stating that his comments were a “quick response.” He said he would like “all people to share the fruits of medical progress regardless of their origins or income.”
Governments and civil society must again unite behind the simple idea that everyone has the right to health. That is, medicines must be affordable and accessible for all. With money for research and development coming largely from public sources, we must all hold pharmaceutical companies accountable and demand they serve people first.
As leaders meet to discuss inequality and how to reduce the gap between rich and poor, the development and distribution of medicines should be at the top of the agenda. Perhaps the next time the pharmaceutical industry speaks about restoring reputations and rebuilding trust, it should focus on ways for the world’s poorest to access lifesaving medicines.
John Butler has worked on public health issues on four continents over the last nine years. He specialises in policy and advocacy and has worked on a range of issues including HIV and AIDS, access to medicines, child health and universal health coverage. He is currently based in New Delhi and writes on health and human rights. You can follow him on twitter @atjohnbutler
Brian Wahl is a doctoral student studying epidemiology and disease control at Johns Hopkins Bloomberg School of Public Health. Prior to this, Brian was based in India and New York managing global health advocacy and policy research projects. He is interested in the right to health, access to medicines and specialises in epidemiology and biostatistics. He is currently based in Baltimore and writes on health and innovation. You can follow him on twitter @brianwahl