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Rapid Responses: Rapid Responses published:
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Which initiatives may reduce inequities?
- Florica Marian (3 June 2006)
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exerpts of e-drug discussion based on editorial
- Miriam A. Naarendorp (20 June 2006)
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Pricing is not the only concern
- Atieno Ojoo (20 June 2006)
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The Great Medicines Scandal: Next Steps?
- Warren A. Kaplan (21 June 2006)
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Access to medicines does not rely solely on pricing and affordability: WHO/HAI Report on Chronic Medicines sheds important light on issues of medicine availability
- Brenda J Waning (21 June 2006)
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Medicine prices scandal
- Andrew L Creese (21 June 2006)
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Broaden the debate for access
- Amitava Banerjee (22 June 2006)
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Availability and affordability of medicines is only one piece of the puzzle
- David Beran, John S. Yudkin (24 June 2006)
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What Counts Isn’t Always Counted
- Jeremiah Norris (27 June 2006)
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Florica Marian, Senior researcher Institute of Complementary Medicine, University of Bern
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Dear editor I share the grave concerns expressed in the editorial of Tessa Richards. The author addresses major sources of inequity concerning ill people in developing countries. For those suffering from neglected diseases, safe and effective drugs are lucking, whereas many of those suffering from chronic diseases cannot afford medical care. As pharmaceutical industry is controlling research priorities and prices, it is primarily responsible for these inequities. Richards highlights two solutions. Collecting data may contribute to increase the awareness of governments about the situation. Even more important, a resolution was recently adopted at the World Health Assembly aimed at prioritizing pharmaceutical industry based on needs defined by the member states. I support the author’s opinion that these are two important options. Nevertheless, I would like to mention some related problems and address some further issues which I consider being essential in this context. Collecting data does not implicate that these are going to be taken into consideration, as a recent example in Switzerland clearly shows [1]. “Is the society losing the control of medical research ?”[2] Recent articles express serious concerns about the increasing amount of profit- driven medical research and their influence in most fields of western medicine [3, 4]. Therefore, I doubt whether commercial driven research is able to contribute substantially to improve the access to health care in developing countries. As a medical anthropologist, I would like to mention the phenomenon of medical pluralism. Worldwide we can observe the use of different forms of health care. These include biomedicine as well as a multitude of medical and therapeutic healing cultures, which have been defined as complementary, alternative or non-conventional in the industrialized countries and as traditional in the developing countries. A considerable amount of literature show the worldwide increasing use of complementary and traditional medicines and the challenges related to their integration [5-7]. Many patients suffering from chronic conditions for which conventional treatments are not fully effective but for which some evidence for effective complementary treatments exists (the so-called “effectiveness gap) seek complementary therapies [8]. According to the WHO, the provision of safe and effective traditional and complementary therapies could become an important contribution to improve access to health care in low-income countries [9]. To conclude, we cannot reduce inequities in the access to health care in developing countries relying only on biomedicines: an approach integrating the best of conventional, traditional and complementary medicine is needed ![10] Yours sincerely 1. Walach, H., The Swiss Program for the Evaluation of Complementary Medicine (PEK). J Altern Complement Med 2006;(3): p. 231-2. 2. Delaney, B., Is society losing control of the medical research agenda? BMJ 2006;Volum(7549): p. 1063-1064. 3. Abramson, J. and B. Starfield, The Effect of Conflict of Interest on Biomedical Research and Clinical Practice Guidelines: Can We Trust the Evidence in Evidence-Based Medicine? J Am Board Fam Pract 2005;(5): p. 414 -418. 4. Gotzsche, P.C., Research integrity and pharmaceutical industry sponsorship. Trial registration, transparency and less reliance on industry trials are essential. Med J Aust 2005;(11): p. 549-50. 5. Eisenberg, D.M., R.B. Davis, S.L. Ettner et al., Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998;(18): p. 1569-75. 6. Bodeker, G. and R.R. Chaudhury, Lessons on integration from the developing world's experience Commentary: Challenges in using traditional systems of medicine BMJ 2001;(7279): p. 164-167. 7. Bodeker, G. and F. Kronenberg, A Public Health Agenda for Traditional, Complementary, and Alternative Medicine. Am J Public Health 2002;(10): p. 1582-1591. 8. Fisher, P., R. van Haselen, K. Hardy, S. Berkovitz, and R. McCarney, Effectiveness gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine. J Altern Complement Med 2004;(4): p. 627-32. 9. WHO Global Atlas of traditional, complementary and alternative medicine. 2005, WHO Centre of Health Development: Kobe, Japan. 10. Charles, Prince of Wales, The best of both worlds. BMJ 2001;(7279): p. 181. Competing interests: None declared |
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Miriam A. Naarendorp, Pharmacy Policy Coordinator MOH Suriname, Henck Arronstraat Paramarobo
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Dear sir, An e-drug a discussion evolved, based on an Health Action International and the WHO report launched on 24 May at the World Health Assembly, on the price, availability and affordability of 14 chronic disease medicines for the treatment of asthma, diabetes, epilepsy, hypertension and psychiatric disorders. 'The report is an analysis of data from 30 surveys undertaken in all regions of the world using the WHO/HAI price measurement methodology. Key findings include:
In your your excellent editorial, same concerns were raised. A Kenyan based practicioner made reference to the fact that amongst other things, in developing countries we are creating an imbalance by neglecting the high costs associated with drugs used in chronic non-communicable diseases and narrowing our focus to HIV-AIDS, Malaria and TB. Find below an exerpt of my contribution to the remarks made by my Kenyan collegue: "In most of the Caribbean chronic non-communicable diseases are the leading cause of death. In Suriname, cardiovascular diseases, including cardiovascular accidents account for nearly 30% of mortality. Diabetes Mellitus accounts for about 5% (in Barbados the percentage is even higher), and they are on the rise, as is cancer. Treatment and management of these diseases presses hard on the budgets of our nations. Also we lack the human resources to incorporate chronic disease management in our health care delivery. At a WTO/TRIPS meeting in Antigua in 2005, representatives of the Ministries of Health of 4 Caribbean countries, expressed their concern about the price and accessibility for patients needing drugs for chronic non-communicable diseases, as it pertains to TRIPS. The letter can be seen at the following link http://crnm.org/documents/the_representatives_of_the_moh.pdf In Suriname we try to incorporate HIV and AIDS care in our regular healthcare delivery structures. Where deficiencies are noted, we try to strengthen our overall capacity for implementing disease prevention measures and disease management structures, however, when using donor funds, we sometimes have to admit that we are on the road to create an 'elite patient' for lack of better words. At the beginning of this month Surinamese pharmacists firmly expressed the view in a Caribbean Association of Pharmacist mid-term meeting that in the management of opportunistic infections in AIDS, we find it unethical to deliver earmarked medicines to AIDS patients alone, where other patients may benefit from the same treatment. We were however appraised by some colleagues that they find themselves hard pressed by donors to do exactly this. We need to convince both national policy makers and international donors of the importance of this issue. I can only hope that in the (near) future, more attention is being given to these matters and that we should find the middle road in applying the lessons learned in HIV, malaria and TB care to general healthcare delivery. Sharing experience in this matter will be a first step on this long but important road!" Miriam Naarendorp, RPh
Competing interests: None declared |
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Atieno Ojoo, Chief Pharmacist/Director of Pharmacy Kenyatta National Hospital, P O Box 13576, Nairobi 00800, Kenya
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It is quite a challenge to try and bring chronic diseases on the agenda when majority of deaths in developing countries is still infectious diseases! As a public health practictioner from a developing country, it is obvious to me that we can gain a lot more mileage dealing with infectious diseases, including respiratory infections, other than the well known HIV/AIDS,Malaria and TB. However,perhaps there is need right now to evaluate whether the attention given to HIV/TB/malaria is bearing fruitand how it is impacting on health expenditure for other illnesses. As a hospital pharmacist, I see the need not to ignore the matter of chronic illness management, as I am faced by these patients every day. However, the reality on the ground is that these patients with a chronic illness are much more likely to die from an infection, than the chronic illness itself. Of course access to proper treatment and care,for example in Asthma, remains a challenge. In many developing countries,we are still grappling with the basics of how to diagnose asthma, particularly in children. For example, in Kenya, we know that Asthma is prevalent, but,in real lifemedical practice, how does one differentiate asthma from chronic bronchitis or any other COPD? Is there need to split hairs? Who has peak flow meters in their budgets?Kenya has recently launched guidelines for the diagnosis and management of asthma. We wait to see if practice will change. When asthma diagnosis in the young is finally made, parental acceptance is still very poor. Once treatment is started, the transfer of knowledge on the various inhaler techniques is still a challenge. In the case of children, there is the added cost of the use of spacers, which are much more expensive than the inhalers themselves. Physicians still prescribe oral salbutamol,long term antihistamines and variants of cough mixtures for asthma management! The use of steroids is gaining ground, albeit slowly as the perceived fear of steroid side effects is huge. Perhaps this is because a lot of steroid use is still oral prednisolone. Can this area of chronic disease management be dealtwith like HIV/AIDs where there is some form of pre and post diagnosis counseling, followed by agressive adherence counseling and support? I agree however,that any disparities must be dealt with.At the moment, anyone diagnosed with a chronic illness in a developing country is prescribed a death sentence. As a tertiary referral hospital,we are unable to regularly make available anticancers, antidiabetics (except insulin at cost to the patient), and other medicines for chronic illnesses, as we cannot afford them in the government budgets. Patients are often very willing to raise funds and purchase the first course of therapy as they are desparate for a solution, but they soon are unable to continue. Private pharmacies do not regularly stock such expensive medicines as they remain "dead stock". In effect,even where individual patients could afford to buy the medicines, they might not get it easily. The other challenge with chronic disease management is the need for regular diagnostic support for follow up and maintenance of therapy. The diabetic patient needs ability to monitor blood glucose levels regulalry. the hypertensive needs to monitor blood pressure regularly, Peak flow meters for asthma patients etc. All these are vital, yet costly and are hardly remembered in any budget for health commodities. Atieno Ojoo, BPharm, MPH
Competing interests: None declared |
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Warren A. Kaplan, Assistant Professor of International Health Boston University School of Public Health, Boston MA 02118
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The recent World Health Organization/Health Action International, Europe report noted in this journal on disparities in price, availabilty and affordability of medicines for chronic diseases is important work. This entire subject matter as it relates to medicines for chronic diseases deserves wider appreciation and understanding. It should not be allowed to be filed away on shelves to gather dust- which is a rather roundabout way of asking the question "How can the contents of such a report be leveraged in effective ways?". I would suggest the following: 1. Teach and or otherwise disseminate the contents of this report to educational institutions with courses in chronic, non-communicable disease public health/disease management- both in -and outside- the United States. 2. Encourage a dialog between practitioners and the private sector at one or more regional/sub-regional meetings to further discuss the implications of this report. 3. Create "access to medicines" campaigns based on existing campaigns for infectious disease medicines. Quare: Perhaps medicines for chronic, non-communicable diseases requires a different model? Those in resource-poor countries who survive beyond their individual demographic and epidemiologic transitions are already facing epidemics of diabetes and heart disease. "Access" issues regarding medicines for chronic diseases lie well under the radar for most policy makers in developing countries but these issues cannot be ignored. Competing interests: None declared |
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Brenda J Waning, Assistant Professor International Health Boston University School of Public Health, Boston, MA, USA 02118
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The WHO/HAI report on pricing and availability of chronic medicines provides useful insight into the many challenges of treating chronic diseases in low resource settings. This report follows other landmark papers highlighting the growing prevalence and lack of treatment of chronic diseases in developing and transitional countries. The 2003 World Health Report describes a change in burden of disease in developing countries. These countries are now faced with an increasing burden of chronic diseases, specifically cardiovascular disease, unipolar depressive disorders, ischemic heart disease, diabetes mellitus, and chronic obstructive pulmonary disease (1). The authors state that in geographic regions with high mortality, noncommunicable diseases account for nearly half of the adult disease burden (1). Cardiovascular disease now accounts for one-third of all deaths in developing countries (1). Reddy et al reported that 53% of all deaths in India in 2005 were attributed to chronic diseases, with cardiovascular disease accounting for 36% of deaths (2). Still, there is no global movement to address the burden of chronic diseases in low resource settings. The WHO/HAI report provides important information on prices, pricing structure, and affordability of medicines to treat chronic diseases. Until recently, information on medicine prices was very difficult to find and only those in the business of selling medicines had true knowledge about prices and price components. The WHO/HAI campaign has certainly been successful in opening a dialogue and providing policy makers with global information on prices, price components, and affordability. In reaction, many policy makers have immediately acted to remove taxes placed on essential medicines. Given that medicines are sold in a market environment, follow-up WHO/HAI surveys will need to be conducted to assess the impact of tax removal policies on medicine prices. In addition to important information on pricing, the WHO/HAI report provides vital information on the availability of medicines in low resource settings. The authors report alarmingly low availability of key medicines to treat chronic diseases in both public and private pharmacies across most regions. For example, hydrochlorothiazide (HCTZ), considered a first line anti -hypertensive in many countries, had very low availability. In the private sector, median availability for HCTZ originator product and HCTZ generic product was 0% and 41%, respectively (3). In the public sector, median availability for both HCTZ originator product and HCTZ generic product was 0% (3). Hydrochlorothiazide remains one of the most cost- effective means of controlling hypertension; but, if it is not available, it can not be used. While price campaigns to reduce prices are important, they will not address the issue of availability. In the same regard, the availability of beclomethasone inhalers to control asthma was far below acceptable levels. The WHO/HAI report reveals that no country had 100% availability of beclomethasone inhalers in private sector pharmacies (3). And only 5 countries showed availability >30% for originator and generic beclomethasone inhaler (3). In contrast, availability of salbutamol inhalers was relatively high across most countries (3). These findings suggest that while salbutamol rescue therapy is widely used, there is very little use of beclomethasone inhaler to prevent asthma attacks. This practice has implications on both outcomes and affordability. It is likely that this practice leads to excessive use of salbutamol inhalers, adverse effects associated with beta-agonist overuse, and excess visits to hospitals and clinics for treatment of asthma attacks that do not respond to salbutamol. Many people suggest salbutamol is more widely used than beclomethasone because it is usually much cheaper. However, it is likely that the overall household and system costs of treating patients with only salbutamol are far greater than an approach that combines both steroid and beta-agonist inhalers. As mentioned earlier, policies on pricing will not address the insufficient availability of chronic disease medicines. Additional qualitative and quantitative research needs to be conducted to better understand why these key medicines are not available in public and private pharmacies. Only then can interventions be designed and implemented to address availability of medicines for chronic diseases in low resource settings. References 1. The World Health Report 2003; Shaping the future. World Health Organization. 2. Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005:366 (9498):1747-1749. 3. Gelders S, Ewen M, Noguchi N, Laing R. Price, availability and affordability; An international comparison of chronic disease medicines. 2006. World Health Organization and Health Action International. WHO- EM/EDB/068/E/05.06/3000 Competing interests: None declared |
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Andrew L Creese, Health economist Formerly WHO
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Tessa Richards draws attention to the high price and low availability of essential drugs in her editorial of 19 June. Another factor makes the contrast between richer and poorer peoples more dramatic - the absence of insurance cover in less organised health systems. Medicine prices are simply not an issue to most patients in wealthier countries. Few people in western Europe, for instance, are aware of what their medicines actually cost. The NHS in Britain and other forms of health insurance elsewhere cushion people against the "true" cost of the medicines they need and get. Such systems are an integral part of "economic development". So we seldom pay out-of-pocket for the full cost of our medicines. People in poorer countries are hit, as it were, twice: once by the high price of medicines, and again by the lack of social protection in the form of widespread health insurance or effective national health systems. In poor countries the price really matters! Thank you for drawing attention to this problem of the less-developed parts of the world. Competing interests: None declared |
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Amitava Banerjee, Senior House Officer, General Medicine John Radcliffe Hospital, Oxford
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In an evaluation of WHO activities in the Lancet, Horton (2002) stated that "..access to medicines has become the test above all others by which the rich world will be judged in its dealings with the poor" (1). Tessa Richards’ editorial highlights the great importance of the recent report on pricing of drugs in developing countries (2). Essential drugs which are cost-effective and evidence-based (e.g. aspirin and bendroflumethiazide) are not reaching the patients that need them. As already stated by other responders, access is much more than pricing or affordability. Essential drugs save lives and improve health, but only when they are available, affordable, of good quality and properly used. The debate for improving access to essential drugs for chronic diseases, but also all diseases constituting the major disease burden, must be broadened. There are three reasons for improving access to drugs for chronic diseases: 1. Evidence for the burden of chronic diseases and their treatments Since 1990, more people have died from coronary heart disease (CHD) than any other cause and two-thirds of all cardiovascular fatalities occurred in developing countries (3). Globally, deaths from CHD constitute the second biggest killer in 15 to 59 year olds after HIV/AIDS (4). More large-scale clinical trials have been concerned with treatment and prevention of CHD than any other disease. There is an excellent evidence base from the last 30 years for simple treatments, such as aspirin and statins, in both primary and secondary prevention of CHD. This new report for pricing of drugs for chronic diseases shows that evidence is not being put into practice in the poorest areas of the world (where most of the CHD is occurring) with very poor access to aspirin and anti- hypertensives (2). 2. Ethical responsibility and the human rights framework The health of the public is a social good, valued as a worthy goal beyond our preference for it or the satisfaction we may get in achieving it and improving access to drugs is part of this social good. Therefore, society has an obligation to facilitate access to drugs. Medicine is governed by the ethical principles of autonomy, beneficence, non- maleficence and justice. This professional responsibility puts health professionals apart from other professions. Therefore, to broaden the frontiers of human knowledge like other scientific disciplines is, in itself, an inadequate goal. If resources allow, then less urgent projects can be undertaken. In a world of limited resources, existing resources must be used for maximum benefit of the population, whether judged on cost -effectiveness, disability-adjusted life-year (DALYs), morbidity or mortality. The highest attainable standard of health is one of the fundamental rights of every human being (5). Health and well-being are nearly impossible to achieve when other fundamental rights are neglected or violated. The health and human rights movement gained momentum largely due to the global HIV/AIDS pandemic. Chronic diseases and their risk factors must be viewed in the same way as HIV/AIDS and the same human rights frameworks are applicable, particularly since they pose the same threats to security, disease burden and global economy. 3. Linking chronic diseases to development The Millennium Development Goals (MDGs) have focused developed world governments on major areas for development assistance. MDG number 8, "Developing a global partnership for development" includes the objective, "In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries" (6). Since spending on pharmaceuticals represents up to 66% of health spending in developing countries (WHO), access to essential medicines is a key issue (7). As the burden of chronic diseases increases with epidemiological transitions in low-income countries, their potential impact on the workforce and economic development is huge. In conclusion, the scientific evidence unquestionably supports the link between chronic diseases, poverty and development. The problem, however, lies in convincing the scientific community and the policymakers of the urgency and the scale of the problem. As chronic diseases are elevated on the global health agenda, emphasis must be put on proper access to drugs. Access to medicines is a complex, multi-factorial issue which depends on more than drug pricing. References 1. Horton R. WHO: the casualties and compromises of renewal. Lancet, 2002, 359; 1605-1611. 2. Gelders S, Ewen M, Noguchi N, Laing R. Price, availability and affordability; An international comparison of chronic disease medicines. 2006. World Health Organization and Health Action International. WHO- EM/EDB/068/E/05.06/3000 3. Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005:366 (9498):1747-1749. 4. Chronic Diseases Report 2005. World Health Organization. Chapter 2: Chronic Diseases and Poverty. 5. International Covenant on Economic, Social and Cultural Rights (CESCR), Article 14. 6. United Nations Millennium Development Goals. http://www.un.org/millenniumgoals/ 7. WHO. The world drug situation, World Health Organization, Geneva (1988). Competing interests: I spent a summer internship at WHO in 2005, working on access to medicines for chronic diseases. |
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David Beran, Project Coordinator International Insulin Foundation UCL Archway Campus 2-10 Highgate Hill N19 5LW London, John S. Yudkin
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Editor –The editorial by Richards1 and the report of Gelders et al for WHO2 highlight the problem of price barriers in access to medicines. The International Insulin Foundation (IIF, www.access2insulin.org) has collected data on the problems faced by patients in 3 countries in Africa in accessing diabetes care and insulin. A Rapid Assessment Protocol (RAPIA) enabled data to be collected at all levels of the system from the Ministry of Health down to individual patients.3 The results from Mozambique and Zambia highlight the high cost of insulin to the health system and individual patients.4 In Mozambique, for example, the average price of insulin purchased by Central Medical Stores was $4.10 but this was then ssold on to public hospitals at an average price of $5.66. When available, the average (subsidised) insulin price to the patient was $1.13 per vial in these hospitals, but in the private sector the average cost was $10.21 per vial. The availability and affordability of medicines is only one piece of the puzzle needed to address chronic conditions in such countries. Diagnostic tools, basic infrastructure and trained healthcare workers are also needed. Only 6% of health facilities surveyed in Mozambique had blood glucose testing strips in comparison to 25% in Zambia.4 These problems with supplies were combined with a paucity of trained healthcare workers. All chronic conditions require the health system to have facilities for prompt diagnosis, for which are needed both diagnostic tools and qualified personnel. These healthcare workers need to be able to start and adapt treatment regimens. In addition an effective referral systemis needed for patients with complications. A system to provide a constant supply of medicines throughout the country, at affordable prices, is necessary but not sufficient for good clinical care. 1. Richards T. The great medicines scandal. BMJ 2006; 332:1345-6. 2. Gelders S, Ewen M, Noguchi N, Laing R. Price availability and affordability. An internal comparison of chronic disease medicines. Geneva: WHO, Health Action International, 2006. 3. Beran D, Yudkin JS, de Courten M. Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'. BMC Health Serv Res. 2006;6(1):17. 4. Beran D, Yudkin JS, de Courten M. Access to Care for Patients With Insulin-Requiring Diabetes in Developing Countries: Case studies of Mozambique and Zambia. Diabetes Care, 2005; 28; 9: 2136-40. Competing interests: None declared |
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Jeremiah Norris, Director, Center for Science in Public Policy Hudson Institute, 1015 15th street NW, Washington DC, 20005
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There can be no doubt that “sick people in poor countries are deeply disadvantaged,” and the author clearly demonstrates compassion on their behalf. Yet, the data presented overstates the case for neglected diseases in the developing world. The WHO classifies ten diseases as ‘neglected.’ They include the six tropical diseases, plus HIV/AIDS, TB, Malaria, and Diarrhoeal Diseases. Taken together, WHO records a mortality of 5.4 million in 2004, or slightly less than 5% of the global total. (1) The author ignores the substantial progress made on the reduction of tropical diseases over the past decade or so. WHO records that 200,000 died of schistosomiasis in 1993; that number was reduced to 0% by 2004. (2) In that same year, WHO documents that of the six tropical diseases, total mortality fell from 171,000 in 2000 to 129,000 in 2004, and that for four of them, the mortality rate was 0%. Moreover, the work on the part of the WHO and other organizations on tropical diseases has been significant. WHO’s Tropical Disease Research Programme has invested some $900 million since 1977 and has successfully developed several new therapies. The Gates Foundation has a $400 million program in malaria research, and USAID is currently conducting a $1.2 billion malaria program in Africa. The Global Fund for HIV/AIDS, TB and Malaria, and the PEPFAR effort has invested billions in these diseases over the past four years. Placing blame on the pharmaceutical companies for their failure to invest in research and development of medicine for neglected diseases contravenes this fact: in the 21 years since the AIDS virus was identified, these same companies developed 86 new drugs for treatment, at an estimated investment of $69 billion. In the annals of science, seldom—if ever, has a single industry been able to respond to a global crisis in this same expeditious manner. In WHO’s Progress Report on the ‘3 by 5’ plan, it states that between 250,000 – 350,000 deaths were averted as a result of this R&D investment. (3) The author is correct in stating that taxes, duties and mark-ups for drugs result in high prices to patients. However, the exact quote from this WHO study is even more telling: “One major finding of the surveys was that taxes and duties levied on medicines, as well as the mark-ups applied, frequently contribute more to the final price than the actual manufacturers’ price.” (4) More importantly, however, the greatest health problems in the developing world—and the costliest to societies, no longer stem from tropical or neglected diseases. In October 2005, WHO published a report detailing how 388 million people will die by 2015 from chronic diseases. Of this total, 80% of the mortality will fall on the developing world. In China alone, WHO estimates that it will forego $558 billion in national income over the next ten years as a result of premature deaths caused by heart disease, stroke and diabetes. (5) As a matter of public health policy, we ought to encourage the pharmaceutical companies to keep their engines of innovation running at fever pitch. In this manner, their R&D outputs can continue to provide a steady infusion of contemporary therapeutic products to those most in need of medical treatments. This month, the U. S. Food and Drug Administration approved the world’s first vaccine for a cancer. After cardiovascular disease as the leading killer on a global basis, cancer is rated by WHO as the 2nd leading cause of death. Now, with a vaccine for cervical cancer, one of the primary causes of mortality for women in the developing world, they may need never to face the specter of this dread disease. End Notes The World Health Report 2004, WHO, Geneva, p. 120. The World Health Report 1995, WHO, Geneva, Table 1, p. 3. Progress Report on ‘3 by 5’, WHO, Geneva, March 2006. Price, Availability and Affordability: An International Comparison of Chronic Disease Medicines, WHO and Health Action International, May 2006, p. viii. Preventing Chronic Diseases: A Vital Investment (Overview), WHO, Geneva, October 2005, pp. 4 &5. Competing interests: None declared |
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