The high price of medicines in many high- and middle-income countries and ensuring medical supply chains during crises were  some of the issues discussed at the Fair Pricing Forum, which opened on Monday.

The three-day forum, hosted by the World Health Organization’s (WHO), brings member states and stakeholders together to  discuss how to ensure “optimal access to affordable health products”.

Judit Rius Sanjuan, director of the Pan-American Health Organization’s (PAHO) access to medicines department, told the opening plenary that the problem of access to medicines seems to be of “system design and therefore correctable”.

COVID-19 had a “devastating impact” on Latin America and the Caribbean, said Sanjuan.“Even though it is just 8.4% of the world’s population, it accounted for over 20% of global infections and 32% of deaths.”

The lack of equitable access to vaccines, shortages and overall lack of access to other medical tools including diagnostics and personal protective equipment (PPE), contributed to these statistics.

“The region is experiencing an epidemic of lack of access to high-cost technologies, or as we may dare to say, high-priced technologies,” said Sanjuan.

“The annual growth in pharmaceutical spending in Latin America and the Caribbean is 12% – four times more than in North America and six times the rate of Europe,” she said, adding that a recent study showed that some Latin American countries paid more for cancer drugs than many European countries.

Eight countries – Argentina, Brazil, Chile, Colombia, Dominican Republic, Ecuador, Uruguay and Venezuela – spend $3.2 billion every year on biological products including monoclonal antibodies.

In addition, over 1000 products in the US – also part of PAHO – had above inflation price increases in 2021, with the average increase being 31%.

Litigation as path to medicine access

“Due to the high cost of medicines, litigation has become a common pathway [for patients] to get access. In no other region is this trend as strong as in Latin America and the Caribbean. In just a decade, the number of health access litigation cases increased by 130% in Brazil and 119% in Colombia,” said Sanjuan.

“Most Latin American countries have to self-finance because they are not eligible for global financing. The current criteria for access and the pricing structure do not correspond with the needs of the region, where most countries are middle-income countries and some are high-income.”

For example, she said, hepatitis treatment costs $3000 in some countries in the region while the same treatment costs $200 in low-income countries.

“We shouldn’t punish economic development and progress with higher prices, especially as we are hurting, not only the health system, but the population in need. On average, households spend 34% of medical spending on medicines and out-of-pocket spending can be up to 60% in some countries, with the poorest people spending the biggest proportion of income on medicine.”

PAHO’s response to high prices include pooled procurement, increased regional production especially of high price technologies and expanded investment in vaccine and medicine research an development (R&D), Sanjuan concluded.

Antiretroviral price cut show what can be done

Meanwhile, Ellen ‘t Hoen, director of Medicines Law and Policy in the Netherlands, used the reduction in the price of antiretroviral (ARV) medicine for HIV treatment as an example of what could be done to bring down prices.

Initially costing $10-$15,000 per year although their production cost was “modest”, prices fell by 90% in the early 2000s once generic manufacturers entered the market, said ‘t Hoen.

“The following elements made this happen and I want to list those because they’re still very relevant today,” she added.

“First of all, the HIV medicines were added to the WHO Essential Medicines List despite their price. WHO pre-qualification was established and assured quality and the confidence in the [generic] products. As of 2003 , funding became available from the Global Fund, PEPFAR, other sources such as Unitaid,” said ‘t Hoen.

Additional factors include “extensive use of TRIPS flexibilities” after the World Trade Organisation adopted the Doha Declaration on TRIPS and public health in 2001. 

“And finally, there was transparency. The prices paid for these antiretroviral drugs were collected and made public almost in real time. As a result today, the Global Fund procures the three-in-one fixed dose combination for HIV treatment for under $40 per year.”

The high cost of cancer medicine, and the Medicines Patent Pool’s inability to secure licensing opportunities for oncology products – bar on one drug that was about to expire – “has to change”, she added.

“High medicines prices are sustained through monopolies, which are granted through both the patent system and the medicines regulatory system. Without addressing monopolies in medicine supply, it will remain difficult to reach fair pricing levels, in particular for newer medicines,” concluded ‘t Hoen, adding that it was unclear whether countries would address barriers before the next pandemic.

Voluntary licensing

However, Thomas Cueni, Director General of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), said that the best way to secure better access to medicines was via voluntary licensing agreements.

He added that the IFPMA supported more geographic diversity in manufacturing and wanted to have proposals in their Berlin Declaration embodied in the pandemic accord currently being negotiated at the WHO.

Adrian van den Hoven, chair of the International Generic and Biosimilar Medicines Association (IGBA), which aims to foster market access for generic medicines, said that the evergreening of patent agreements artificially stretches monopolies and harms access to medicines.

His association provides 70-90% of all prescription medication worldwide, said Van den Hoven. 

Key barriers to global access were related to regulation, intellectual property rules and sustainable off-patent markets to prevent medicine shortages.

Ensuring medicine in crises

Sierra Leone’s Deputy Minister of Health, Dr Charles Senessie, said that his country had to apply “out of the box thinking” to safeguard its medical supply chain during both conflict and health emergencies, such as the Ebola outbreak.

“We have developed a mobile app to monitor the supply chain even when there is no power,” said Senessie. “We also have protocols in place to ensure that services keep running in conflicts.”

Sierra Leone has turned to solar energy to power health facilities and is using hybrid vehicles to save fuel.

The Fair Pricing Forum ends on Thursday.