Commentary: Making middle income countries pay full price for drugs is a big mistake

Middle income countries are home to nearly three quarters of the global population, 73% of the world’s impoverished people, and most of the world’s sick.1 Most cases of tuberculosis and vaccine preventable diseases occur there.2 As of 2012, about 60% of people living with HIV resided in middle income countries; by 2020, that proportion is expected to jump to 70%.3 Of the roughly 15 million people with HIV who do not have access to antiretrovirals, about two thirds live in middle income countries.4

Yet despite these statistics middle income countries are neglected by the international community. Many major donors and international aid programmes focus primarily on low income countries,5 a trend that is increasing.6 The same is true of drug companies, which routinely exclude middle income countries from “access programmes” that provide drugs free or at discounted prices,7 as well as voluntary licences, which allow for generic production of otherwise patented products.8 The World Health Organization notes that although the “vast majority” of people living with HIV reside in middle income countries, “international aid and assistance . . . still focuses on low income countries.”9

Middle income countries …