| Ladies
and Gentlemen,
Good morning - and welcome to this third WHO/public interest NGO
Pharmaceuticals Roundtable. It is a great pleasure for me to be with you
today. I welcome this opportunity to continue our dialogue.
When we first met in October 1998 we concluded that we shared a
common vision. I was very happy to see that vision included in the
principles for collaboration through the roundtable process that were
adopted last year. We said:
"Our concern is health. We are lobbyists for equity in access to
health - specially concerned about extending access to essential drugs
and promoting the rational use of medicines everywhere. Our work centres
on reaching decision-makers with a convincing case, and drawing their
attention to human need - trying to help break the vicious cycles which
link ill-health, poverty, and other manifestations of human and social
development. Fundamental to our concern is the need for sustainable
health systems, giving more access to basic health. More needs to be
done. We want to help do it."
[Speech of Dr Gro Harlem Brundtland,
September 1998, Washington, quoted by NGOs at 1st roundtable and
included in the Principles for Collaboration.]
Today, I hope we can share ideas and perspectives, update each other
on activities and approaches to improve access to essential drugs, and -
through such collaboration - enhance the impact of our work. I believe
that WHO’s greatest contribution to world health is working together
with others: supporting them all as they do important things; trying to
contribute where we have the most to offer but also learning from their
experience and knowledge.
The roundtable process provides us with an opportunity to exchange
views on the big challenges. Let me restate the fundamentals from our
side. WHO has a strong value base for its work. This reflects our
responsibility to fight poverty and inequity and to strive for the goals
of health for all. We will keep these values alive and present as we
progress in our technical work.
Another core value is that of ethics, not only for biomedical
research but also in terms of services and commitment to society. We
must have the independence and courage to speak out for the
disadvantaged, to argue against unethical practice; and to advocate the
cost-effective use of resources.
WHO sets normative standards for medical products; provides guidance
in regulating standards; defines and classifies diseases; provides
therapeutic advice, such as treatment guidelines; produces the model
list of essential drugs, and actively advises countries in such areas as
the development of national drug policy. We recognise that the economic
impact of such decisions is huge and that it is therefore essential for
WHO to act independently, according to the best scientific evidence. We
are currently working on strengthening the evidence base of such work.
We are also, through our Guidelines on interaction with the private
sector to which the public interest NGOs have contributed, seeking
to ensure that there can be no possible conflict of interest.
I know that you will be discussing these issues this afternoon and
I welcome your interest and contribution.
Let me now turn to the critical problem of access to essential drugs
and health care. The people of our world do not need to bear the present
burden of illness. Most of the severe illness that affects the health
and well-being of the poorer people of our world could be prevented. To
do so, those at risk need to be able to access health care - including
essential medicines, vaccines and technologies. Millions cannot - they
cannot get the help they need, when they need it. As a result they
suffer unnecessarily, become poorer and may die young.
At the beginning of the 21st century, one-third of the
world’s population still lacks access to the essential drugs it needs
for good health. In the poorest parts of Africa and Asia, over 50% of
the population do not have access to the most vital drugs.
According to the latest figures that WHO will be presenting in the
forthcoming World Health Report, 10.3 million children under five years
of age died in developing countries last year. About 8.6 million of
these deaths are due to communicable, perinatal and nutritional
conditions. A large proportion of these deaths could be prevented if
those at risk could access essential care.
A country's health service cannot respond to people's needs unless it
enables people to access essential drugs of assured quality. Indeed,
this access represents a very important measure of the quality of the
health service. It is one of the key indicators of equity and social
justice.
Many factors determine the complex question of access; such as
distribution systems, financing procurement and prices. Medicinal drugs
are not ordinary commodities: their procurement, storage, regulation and
distribution need special skills.
How can we arrive at a situation where the poor get sustainable
access to drugs at affordable prices? The pharmaceutical companies are
important partners. They have a social responsibility, and they can
contribute to the solution. We also need to see protective tariff
barriers and distribution margins come down, and we must strengthen
national procurement and distribution systems.
We need to get political acceptance for the concept of equity
pricing, especially for newer essential drugs of vital public health
importance. Equity pricing means that the poor would not have to pay the
same price for life-saving drugs as those who are better off.
To accept this principle is a political decision. Governments of
industrialised countries must lead in its establishment. Meanwhile,
governments in developing countries must do their share to facilitate
access by improving financing, importation, purchasing and distribution
systems for medicines in their own countries.
There is no quick fix. A single focus on prices will miss two other
crucial factors which prevent medicines from reaching those who need
them; namely adequate financing and well functioning health systems with
reliable supply systems. Sustainable access will require progress on all
three dimensions. Making a specific drug massively available for a time
limited period - without a system on the ground able to manage and
distribute the drugs and follow up the patients may even be
counterproductive.
In line with the Revised Drug Strategy resolution adopted by last
year’s World Health Assembly, WHO, in close cooperation with the World
Trade Organization and the World Intellectual Property Organization, is
ready to provide advice to ministries of health on how to assess the
public health consequences of international trade agreements. That
includes informing them on provisions relating to the public health
safeguards included as part of the TRIPS agreement.
We now need to study how the global rules and regulations work in
practice. One assumption in strengthening intellectual property rights
was that more research, development and production would take place in
developing countries and that prices would come down. We have to ask: is
this happening? WHO, in collaboration with other partners, including the
public interest NGOs, will be monitoring the impact of TRIPS on issues
relating to public health.
On intellectual property rights WHO’s position is clear: they must
be protected. We depend on them to stimulate innovation. However,
patents for pharmaceuticals should be managed in an impartial way,
safeguarding basic public health principles as well as protecting the
interest of the patent holder.
We need to build new bridges between supply and demand. Today’s
gaps amount to a giant market failure. There are no simple solutions.
Ensuring access to treatment for HIV/AIDS illustrates dramatically the
complex issues and decisions facing health systems today. To resolve
such issues, we will need broad partnerships between governments in
developing and industrialised countries, financial institutions, civil
society and the pharmaceutical industry. We will need to build an
emerging consensus on the needs of the poor and the basic requirements
for improving their access to life saving drugs.
Public interest NGOs throughout the world make a major input to
providing and strengthening health care. Many of the NGOs represented in
this roundtable are contributing to vigorous debate and advocacy around
issues of access, as well as action in the field. We are partners in
health, and we need each other.
WHO will support measures which will enhance access to all essential
pharmaceutical products in a sustainable way. We have to find a way to
bridge the issues of commercial viability and right to access. WHO will
take this public health debate forward, with our Member States, with our
other United Nations partners, with civil society and with industry.
Thank you. |
