Authoritative insights by 2014 GESPAM contributors added steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide

2014: A Year in Review through GESPAM Contributors’ Stands

by Daniele Dionisio*

PEAH – Policies for Equitable Access to Health

Now that 2014 is nearing its end, I wish to thank the top thinkers and academics who enthusiastically contributed articles over the year. Their authoritative insights meant a lot to our scope while adding steam to debate on how to settle the conflicting issues that still impair equitable access to health by discriminated population settings worldwide.

Find out below a list of summaries and links to the relevant articles:

Ole Petter Ottersen and Desmond McNeill, University of Oslo, pointed out that the root causes of health inequities are to be found in weaknesses at supranational political domains including democratic deficit, weak accountability, institutional stickiness, missing institutions and restricted policy space for health. The authors envisage that achieving health equity is not just a matter of coming up with technical solutions and providing the means to finance them. Rather, it is a matter of considering the political landscape and rectifying the dysfunctions in global governance that undermine health.

Relevantly, David Chiriboga former president of the UNASUR Health Council and former minister of health of Ecuador, reported that after setting up the public health infrastructure to fail, the World Bank and their allies are proposing a new solution: to create a publicly funded insurance package using the now expanded network of private providers, who will participate in the program, as long as they are guaranteed payment. As per Chiriboga terms, while reinforcing the notion that healthcare is a commodity and not a basic human right, this approach has several problems and side effects: fragmentation of care, higher cost, precedence of procedures over preventive medicine and further dismantling of the public healthcare system. At the same time, insurance packages divert attention and funds from a more comprehensive approach directed at modifying the root causes of disease, through socioeconomic interventions aimed at increasing equityâ.

In agreement, Natalie Van Gijsel, Medecine Pour le Tiers Monde, highlighted that the current privatization policies of the Philippine government do not provide an answer to the enormous health needs. The author contends that despite the name of the Philippine Universal Health Care program that claims to bring equity and access to critical health services to poor Philippinos, commercialisation of health services would do exactly the opposite. Inherently, Van Gijsel complained about the fact that “..the European Commission is supportive of these policies and formerly approved a contribution of €33 million in support of the Health Sector Reform Agenda of the Philippine government...”

In their article, Sadhana Srivastava and Kanikaram Satyanarayana, Indian Council od Medical Research and Ministry of Health & Family Welfare, New Delhi dealt with the major concerns of several patent offices all over the world in respect of providing access, including the growing prevalence of secondary patents (i.e., patents covering various ancillary features of existing medicines) and of a strategy called evergreening, that refers to patenting strategies to secure sequential and overlapping patents on a single object (qua invention) through trivial changes such as change in size, colour, dosage, delivery mechanism and composition of a patented drug. Inherently, the authors turn the spotlight on the recent developments India has achieved in the area of using TRIPS flexibilities and discuss the potential impact of effective implementation of these achievements for promoting access to health care.

On the same wavelength, Matthew Rimmer, Australian National University College of Law, Canberra, told about an independent “Pharmaceutical Patents Review Report”, published by the Australian Government on the 20^th March 2014, that recommended to shorten and reduce patent term extensions, to address the problems of evergreening and data protection, and to reverse Australia’s passive approach to the negotiation of intellectual property and international trade. As such, Rimmer emphasizes the need for Australia to protect its public health interests including in ongoing negotiations for the Trans-Pacific Partnership agreement.

From a similar point of view, Brook K. Baker, Northeastern University School of Law and Health GAP, maintained in his contribution that US business interests and government officials are trying to sell the idea that heightened intellectual property protections in India are essential to foreign investment, innovation, and achievement of public health goals. Instead, heightened intellectual property rights would make India consumers captive to Big Pharmaâs extortionate pricing at a time when there seems to be deference by the US and Indian governments to Big Pharmaâs pressure.

To the point, Carlos Passarelli, UNAIDS, stressed that the levels of enforcement of intellectual property rights (patents) may have critical impact in fostering or hindering access to medicines. He explained that UNAIDS vision of zero new infections, zero AIDS-related deaths, and zero stigma and discrimination is based on the recognition that medicines are public goods and, therefore, the proprietary/private right must not prevail over the public interest.

As regards these issues, Thomas Pogge, Yale University, stated that problems of innovation, access and delivery in the domain of pharmaceuticals still exclude billions of people from the health benefits that advanced medicines can provide. His article turned the spotlight on the Health Impact Fund as an initiative that could systematically and sustainably address these problems.

Inherently, Olasupo Owoeye, Tasmania University Faculty of Law, discussed how patent pools and regional integration can be deployed as mechanisms for assuaging the African access to medicines imbroglio.

Unfortunately, as reported by Moses Mulumba, CEHURD Uganda, the generic pharmaceutical manufacturers in the East African Community region still produce at a cost disadvantage compared to their large-scale Asian counterparts. Aside from this, Mulumba’s article also highlights some of the key areas where civil society there has engaged and can still engage with local pharmaceutical industries to address these challenges.

And this occurs at a time when, as written by Ella Weggen, Wemos Foundation, a study in Germany, France and the Netherlands has highlighted an alarming trend: the majority of medicines granted marketing authorisation has no added therapeutic value compared to medicines already on the market. In some cases the new medicine even did more harm than good.

On her part, Raffaella Ravinetto, Antwerp Institute of Tropical Medicine, pointed out that the issue of post-trial equitable access to essential medicines for treating non-communicable diseases in low and middle-income countries is raising increasing concerns. Her article suggests some short-term measures to fill in the relevant gaps.

Additionally, Karyn Kaplan, Treatment Action Group (TAG) reported that, while hepatitis C virus (HCV) infection can be cured now thanks to highly effective oral direct-acting antivirals (DAAs), that remains, however, only a distant dream for most who need it worldwide. Hence, her article urged to fight HCV DAA bank-busting price tags, and the intellectual property regime and the industry behind it, that collude to undermine public health.

In unison, William F. Haddad, Biogenerics, New York, blamed that hiding behind patents, Pharma has become immune to criticism and has developed a powerful constituency among politicians who often use prepared cliches to equate challenges to high prices as a threat to democracy.

In this environment, the article by Shubha Ghosh, University of Wisconsin Law School, is one entry into the cottage industry of patent law analysis that was generated by Court’s unanimous decision in Association for American Pathologists v. Myriad Genetics as regards the patentability of DNA sequences. The author analyzes the decision and puts it in context, both present and the near future. He states that, although some found the decision devastating for the pharmaceutical and biotechnological industries, the ruling was not as fatal as some claimed, while setting the right course for the future of synthetic genetics.

The article by Lawrence C. Loh, University of Toronto and The 53rd Week , took recent backlash cases against vaccinator staffs as a starting point and maintained that effective immunization programs protect our communities and our way of life from innumerable communicable diseases, while encouraging development efforts abroad. ….Eradication is a laudable goal that can only mean better health for all. Thus, it matters not if anti-vaccinators are radical militants or Hollywood celebrities; they stand with each other, and with these preventable diseases….

Priya Shetty, Danny Edwards and Carel IJsselmuiden, COHRED and KwaZulu-Natal University, South Africa, remind us in their article that many low and middle-income countries (LMICs) are still struggling to finance indigenous research and development (R&D), that several are failing to meet continental declarations of intent such as the African Union target of 1% of GDP on R&D, and that in the next two years, LMICs may make significant strides in pushing their own R&D models, although it is clear that a radical re-think of how to fund, and how to incentivise R&D is needed if they are to get drug development for diseases of poverty resourced. As such, the authors assert that a bold new strategy requires perspectives including the voice of NGOs and civil society, if progress in R&D is to result in greater access and health equity. This is why LMICs should take the lead and not rely on external aid nor wait for international treaties to arrange what they can start and fund at home.

To the point, Claire Wingfield, PATH, wrote about a new paper exploring why R&D of high-priority health tools for diseases and conditions affecting LMICs should be a critical component of the post-2015 development agenda.

From a complementary perspective, Laura L. Nervi, University of New Mexico, pointed out that more attention should be paid to the consequences that the increasingly intricate panorama of international cooperation in health (ICH) has on LMICs, and to the complex set of connections of decision-making processes, power relations, and global/local articulations involved in planning, channelizing, and executing international aid. As such, the author aimed to give a glimpse at some of the (nonfinancial) issues that the governments of LMICs confront in the process of incorporating technical and financial ICH in their national health agendas.

Inherently, the paper by Sara Gorman, Columbia University Mailman School of Public Health, suggested that while individual donations cannot operate in lieu of government or multilateral funding, engaging the general public in global health issues and providing them with easy ways to donate could be extremely effective.

A couple of articles dealt with Chagas disease:

Alessandro Bartoloni and Lorenzo Zammarchi, University of Florence, Italy, regretted that even though Chagas disease has emerged as a potentially chronic or lethal illness in many non-endemic areas such as USA, Canada, Japan, Australia and several European countries, unfortunately only few governments in non-endemic countries have implemented adequate public health measures to avoid autochthonous transmission and provide appropriate care to subjects that are affected.

Moreover, Mabel Lenardon and co-Authors, Municipality of La Plata and Mundo Sano Foundation, Argentina, told about the experience carried out by the Secretariat of Health and Social Medicine of the Municipality of La Plata and Mundo Sano Foundation from July 2010 to December 2013 at school institutions of the Buenos Aires province and primary health care centers of the municipality. The partnership aimed to address the situation of people affected by Chagas disease from a comprehensive perspective, carrying out early diagnosis and timely treatment in a specific non-endemic geographic area.

From a different viewpoint, Cinzia Chighine, Tuscany Region, Italy, contributed an analysis drawing from her field experience in Lebanon. As such, while regretting that the Lebanese health care system is very fragmented due to the lack of a public health policy, strategic planning of services and their organizational structures, the author focuses on a recent process of decentralization whereby South Beirut Municipalities are improving primary healthcare services and integrated local welfare.

Last but not least, Iris Borowy, Aachen University, Germany, tackled challenges to global health from a multi-pronged, entwining perspective. She alerted that if the present trend continues, road traffic injuries (RTIs) are expected to kill approximately 1.9 million people per year by 2020, which would raise them to rank three of the leading causes of death. Borowy reported that over ninety percent of RTIs fatalities occur in low- or middle income countries, while being the most important cause of death among young people between 15 and 29 years of age. As such, the author stressed that promoting non-motorized forms of transport, notably walking and cycling, would come with the double benefit of both mitigating the triple health burdens of RTIs, climate change and air pollution and of providing the positive health benefits of increased physical activity. This double advantage would appear true both for cities in high-income industrialized and in middle-income industrializing countries.

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DanieleDionisio