Editorials

Poor world health and rich world wealth

Commercial companies alone can't solve the health problems of developing countries

News p 635

Oxfam and allied aid organisations have recently accused the international pharmaceutical industry of using its influence to maintain a worldwide system of intellectual property law and enforcement that is now denying the world's poor access to essential medicines and blocking progress towards health for all.¹ Enabling all sections of the global population to gain the extended life expectancy enjoyed in developed countries is one of the world's fundamental challenges.² But it is not clear that doing away with legitimate intellectual property rights will aid this process in the long term, or that individual companies can carry a responsibility that properly belongs to governments and peoples.

The concern of Oxfam and others has been made acute by the HIV-AIDS pandemic in regions where the price of patent protected antiretroviral drugs and drugs for opportunistic infections makes them unaffordable to all but a privileged few. Health gains made in previous decades are being lost. The pharmaceutical industry's critics also blame it for inadequate research investment in diseases relevant to the health of the world's poor. Oxfam's report Dare to Lead urges the newly formed Anglo-US company GlaxoSmithKline to play a central role in reforming this situation.³ It argues that GlaxoSmithKline has a moral duty "to forgo [intellectual property] privileges in developing countries, if [these] are likely to lead to an increase in prices" and should donate to an international research fund controlled by the World Health Organization. Oxfam criticises current industry programmes to give low cost and free medicines to developing countries for being too small scale and perpetuating the system of intellectual property protection enshrined in the World Trade Organisation's current rules (the trade related aspects of property rights (TRIPS) agreement).

Those defending the industry's position on issues such as the supply of generic versions of patented AIDS treatments in South Africa and Brazil⁴ argue that intellectual property law exists to generate global public benefits. They emphasise that intellectual property legislation and the TRIPS agreement were created to defend the interests of the entire world community in continuing investment in research and innovation.⁵ Most economists would accept that intellectual property needs protecting in market economies. Without patents, medicines such as today's AIDS treatments would not have been developed by privately financed organisations. However, it is also true that in the immediate future rich world citizens have more to gain from intellectual property protection than those of the poorest nations. The important issue is to find ways of providing very poor populations with cheap access to patented essential medicines in ways that do not permit "leak back" sales of such products to richer countries and so undermine research for the future.

Suggestions that pharmaceutical company managers responsible for protecting pension fund and other shareholder interests should invest in areas likely to yield low returns are also questionable economically. It would be more logical to argue that if medicines like antiretrovirals canif supplied free or at marginal costcontribute to the control of AIDS in areas such as subSaharan Africa⁶ then governments and electorates of the rich world (who are key stakeholders in the modern pharmaceutical industry) share a common moral responsibility to meet their price.

Some campaigners may have despaired of winning support for this good cause through direct appeals to the voting public and leaders of North America, Europe, and Japan. Attacks on relatively enlightened companies such as GlaxoSmithKline may be seen as a tactic designed to achieve by threat what cannot be gained by calls for compassion and international solidarity. One danger is that this could help to reinforce a blame oriented global political culture which has little underlying respect for truth or genuine humanitarian values.

It could also needlessly harm pharmaceutical companies, which are valuable national and international assets and have played a vital part in creating the medicines at the centre of the current debate. However, to the extent that Oxfam's latest intervention will help to promote more committed approaches to improving poor world health it is welcome. All sides in what might otherwise prove to be merely another phase of a sterile, decades long⁷ debate need to accept that the way forward demands mutual respect and a pragmatic willingness to work together for better world health.

GlaxoSmithKline publicly reacted to Oxfam's criticisms by accepting a responsibility to do more to improve the supply of medicines to the poor world.⁸ It is also encouraging that Britain's chancellor of the exchequer announced in last week's budget the introduction of tax credits to encourage UK based pharmaceutical research into diseases prevalent in developing countries. This measure, which stems in part from the work of the prime minister's task force on the pharmaceutical sector, is an important step. The chancellor also repeated his support for the creation of a new international fund for purchasing drugs and vaccines for the world's most vulnerable children and adults.

No commercial company can act as a charity without running the risk that it would soon have no more than good intentions to offer either its customers or its owners. But if policymakers can create purchasing funds, ensure that patented medicines supplied at low cost to poor populations do not "leak back" to rich world markets, and restrain medicine price negotiators in prosperous countries from demanding savings to match those offered to the poorest, progress could and should be made. Given appropriate incentives, the profit motivated pharmaceutical industry provides a powerful force for improving both public health and private wealth throughout the global community.

David Taylor, professor of pharmaceutical and public health policy. 

School of Pharmacy, University of London, London WC1N 1AX

Acknowledgments

DT worked with the Office for Health Economics (funded by the pharmaceutical industry) and the Association of the British Pharmaceutical Industry in the 1980s. He has received consultancy fees from several pharmaceutical companies in the past five years, though none related to the subject of this editorial. He acted as a consultant to Unicef in 2000.