UK government pushes for equity pricing of AIDS, TB and malaria treatments

A working group chaired by UK International Development Secretary Clare Short has reported to the Prime Minister, Tony Blair, proposing a series of measures to increase access to treatments for AIDS, TB and malaria in the least developed countries and throughout Africa. Differential pricing, so that costs are kept as close as possible to actual production costs, is seen as the basis for a partnership between industry and international development agencies to provide treatments to all who need them. The report also addresses the need for additional research and development of new treatments and means of prevention, building on previous work by the UK Government's Performance and Innovation Unit.

The report has been welcomed by WHO's Director-General, Dr Gro Harlem Brundtland, who joined members of the working group at 10 Downing Street this morning to discuss how to take the proposals forwards. WHO has agreed to help in monitoring the impact of measures taken, "in cooperation with industry and other stakeholders".

The report "supports specific action on the R&D agenda, and outlines an ambitious international agenda to facilitate a framework for voluntary, widespread, sustainable and predictable differential pricing as the operational norm."

While the proposals have been broadly welcomed by GlaxoSmithKline and AstraZeneca, which were both represented on the working group, support from other major companies such as BMS, Merck and Abbott would clearly be needed for the strategy to succeed.

"Working with the US Government and gaining their support will be particularly critical given the importance and size of the US Industry. Continued dialogue directly with US Industry may be a promising way forward," says the report. Efforts will be focussed on the G8 Summit due to be held in France in June 2003, with the goal of securing public commitments to the principles identified as critical for improving access to treatments.

The report recognises the need and opportunity for the same principles to apply to diseases beyond AIDS, TB and malaria, but asserts that the priority is to show that they can be made to work in these areas, without stopping anyone from applying them to other conditions and treatments. It proposes that independent confidential audits should be undertaken to check that companies are, in fact, offering treatments at prices close to production costs. "Calculating price and costs is complex, and this objective could be achieved in a number of ways, but by definition would exclude R&D, marketing and sales and corporate administration costs."

Assurances would be needed from wealthier countries, such as the European Union, that they would act to prevent low cost medicines being diverted into their own markets, as has been reported in the case of GSK medicines intended for several African countries. An EU regulation is due to be enacted shortly, and the UK government has also pledged not to use preferential prices as a basis for demanding lower prices for the NHS.

At the same time, greater commitment is needed from the governments of developing countries and from development agencies, to strengthen health systems to deliver treatments and to remove barriers, such as tariffs, which get in the way of providing them. A range of additional measures, including bulk purchasing agreements, support for appropriate drug donations that support national health priorities, and development of national policies to determine what medicines are needed and how they should be used, are included in this framework.

In addition to providing tax incentives to invest in research and development into diseases affecting people in developing countries, the report proposes "rigorous independent monitoring" of the extent to which this is actually happening, to identify obstacles and propose ways of overcoming them.

The working party included four UK government Ministers along with representatives of the EC Directorates on Trade and International Development, the World Trade Organisation, WHO, Wellcome Trust, Rockefeller Foundation, the Association of British Pharmaceutical Industries, GSK, AstraZeneca and the Uganda High Commissioner, HE Prof George Kirya.

Comment

The most obvious limitation of these proposals is that they don't address the needs of middle-income countries, such as Brazil and Thailand, which have large HIV epidemics and cannot afford to provide treatments at US/European prices. However, such countries are able to use other strategies, such as generic production by state-owned companies, to control the cost of treatment. The least developed countries, and most of the African countries addressed in these proposals, do not have that option. Even if they were to import generic drugs, they would still need international funding to pay for them. There is not necessarily any conflict between these proposals and the ideas put forward for more extensive use of generic drugs. Both are ways to ensure that governments and international donors get value for money, in making best use of limited resources in the interests of people affected by poverty.