Prodi calls on stakeholders to 'take action' to ensure access to medicines in developing countries
'How is it possible that people in the developing world continue to die from diseases which have treatments, even cures?' asked Commission President Romano Prodi at the stakeholders round table on access to medicines, on 28 April. In his opening speech, President Prodi noted that more than two billion people worldwide do not have regular access to essential life saving drugs. AIDS, tuberculosis and malaria alone kill five million people each year mostly in developing countries. In view of this global health crisis, Mr Prodi called upon the high level representatives from developing and developed countries, international organisations, industry and non governmental organisations, to identify the task ahead and to ensure that progress towards sustainable access to medicines for poverty related diseases is achieved. 'This is a challenge which entails [...] reconciling needs, demand and supply at affordable prices. Hence, it means adapting, encouraging and it might even mean, sometimes, directing the market in a more socially responsible direction. Whichever of these applies, what is clear is that doing nothing is not an option,' argued Mr Prodi. During the first session, dealing with the contribution of research, stakeholders agreed that there are a number of obstacles preventing equal access to medicines for poverty related diseases. These include badly coordinated research efforts at global level, lack of dialogue and partnerships among stakeholders, as well as insufficient local political support and capacity building. However in the opinion of many stakeholders, the largest obstacle is the lack of private investment for the development and distribution of medicines for poverty related diseases. 'By fixing the economics, we can solve the issue,' argued Rino Rappuoli from the biopharmaceutical company Chiron. Part of the economic problem is caused by a research and development (R&D) industry which is not interested in investing in research into poverty related disease, simply because it is does not make 'business sense', noted Anarfi Asamoa-Baah, from the World Health Organisation (WHO). According to Grant Aldonas, US undersecretary for international trade, the only way around this obstacle is by tackling it head on. To 'harness the greed', governing bodies need to develop an effective political vehicle with broader incentives that will entice private companies to invest in R&D into diseases that are currently neglected or 'orphaned', explained Mr Aldonas. These may include giving better access to venture capital, low cost loans, tax credits, guaranteed markets and the extensions of patent rights or market exclusivity. But it is not just about incentives for private investment, according to Jean-Francois Girard, president of the French institute for research and development (IRD). Above all, the aim should be to develop a sustainable research partnership between Northern and Southern hemispheres. Within this partnership, Mr Girard underlined the importance of developing local resources so those concerned can take ownership of the knowledge and expertise, thus avoiding the danger of 'brain drain'. However, it is not partnership if all the decisions are taken in the Northern hemisphere, warned Dr Asamoa-Baah, adding that this type of solution would only be a short term objective. A new model for implementing equitable partnership between developing and developed countries, as well as public and private partnership, is already taking shape at EU level. As outlined by Commissioner for Research Philippe Busquin, also present at the roundtable, some 400 million euro has been set aside at EU and national level for 'The European and developing countries clinical trials programme' (EDCTP). This is a new five year research programme aimed at developing affordable drugs to treat AIDS, malaria and tuberculosis, through a new type of partnership between Europe and developing countries. 'Initiatives such as EDCTP could lead to other similar initiatives targeting, for example, other so called 'orphaned' illnesses,' explained Mr Busquin. Whilst stakeholders agreed that the EDCTP was good starting point for a much needed partnership between the Northern and Southern hemisphere, some stakeholders made recommendations to the Commission in relation to its design and implementation. With regard to finding the 200 million euro of private investment, as stipulated in the EDCTP budget, Danish MEP, Ulla Sandbaek suggested that it might be a good idea for the Commission to highlight examples of the programme in order to attract interest from pharmaceutical companies. However, according to Harvey Bale from the international federation of pharmaceutical manufacturers (IFPMA), the Commission should not think only in terms of attracting financial support when dealing with pharmaceutical companies. Instead it should think carefully about how to make use of the industries' expertise when developing local R&D capacity. In terms of setting priorities, Bruno Gryseels, from the institute of tropical medicine, asked whether the Commission had struck the right balance; allocating 200 million euro to EDCTP and only 50 million euro to research into tropical diseases under the Sixth Framework Programme (FP6). The right balance might include the development of a specific programme for poverty related medicines which would build on existing partnerships such as the international cooperation programme (INCO), he suggested. The starkest warning came from Dr Asamoa-Baah, who concluded that while the EDCTP had the right ingredients for 'true North-South partnership', the packaging was wrong. Although the EDCTP aims to provide training and the basis for a research infrastructure in developing countries, the fact that it is called 'clinical trials' will make it difficult to convince developing countries that their people are not going to be used as guinea pigs, he explained. The outcome of the discussions is expected to form the basis for possible intervention on the subject of a communicable diseases agenda during the G8 summit in June.