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Mr Barre,
Mr Lindberg,
Professor Gros,
Mr Desmarescaux,
Ladies and Gentlemen,
At the beginning of this new century, I see two
critically important forces shaping the world we live in: the
revolution that is taking place in information and biotechnology, and
the growing momentum of globalization.
Both of these forces carry with them immense
potential for good. But, as we are all aware, they carry risks.
Between them, they can help to transform the lives of millions. But
they will not do so just because we want it to happen.
A world in which the divide between the haves and
the have-nots continues to deepen; a world in which only a privileged
few have access to the fruits of the technological revolution; is a
world which will become ever more insecure. Despite what the critics
may say, it is not inevitable that globalization will lead to
inequity. If it does, it is a sign of failure. For our challenge is to
make positive things happen. To shape the world. To make certain that
the forces of globalization contribute to a more just and inclusive
global society.
Let us look at the agenda from the perspective of
global health.
In the modern world, bacteria and viruses travel
almost as fast as money. With globalization, a single microbial sea
washes all of humankind. There are no health sanctuaries.
The separation between domestic and international
health problems is no longer useful. Millions of people cross
international borders every single day. A tenth of humanity each year.
It is not only the infectious diseases that spread
with globalization. Changes in lifestyle and diet can prompt an
increase in heart disease, diabetes and cancer. More than anything,
tobacco is sweeping the globe as it is criss-crossed by market forces.
Only weeks after the old socialist economies in Europe and Asia opened
up to Western goods and capital, camels and cowboys began to appear on
buildings and billboards.
If the growth in tobacco use goes unchecked, the
numbers of deaths related to its use will nearly triple, from four
million each year today, to 10 million each year in thirty years time.
Practically the entire growth in tobacco-related mortality, more than
70% of these ten million deaths, will take place in developing
countries.
Differences in health status dramatically
illustrate the divide between the rich and the poor in today’s
world.
We know, for instance, that the poor – those
living on less than $2 dollars a day – suffer disproportionately
from the ravages of communicable diseases. In 1998, communicable
diseases were responsible for about 34% of the total burden of disease
world-wide, but nearly twice that - 64% - among the fifth of the
global population living in countries with the lowest per capita
income. Most of these diseases can be prevented or easily
cured with available vaccines and drugs, but poor countries and poor
people do not have access to them.
We know too that communicable diseases –
particularly HIV/AIDS, TB and malaria are themselves major causes
of poverty. The success or failure of our collective response to these
threats is critical. It holds the key to the economic and physical
security - not just of individuals and communities – but of nations
and continents.
Health is not just one of the most potent symbols
of a divided world, it is an integral part of the remedy for healing
that divide.
HIV prevalence rates of 10-15% – which are no
longer uncommon – can translate into a reduction in growth rate of
GDP per capita of up to 1% per year. TB, which is made worse by HIV,
takes an economic toll equivalent to $12 billion dollars from the
incomes of poor communities.
Africa's GDP would probably be about $100 billion
more now if malaria had been tackled 30 years ago, when effective
control measures first became available.
Globalization does not have to lead to human
insecurity because of the spread of illness. Inequities in health are
not inevitable. Better health will result in major economic
benefits – for families and for nations. All this is now quite
clear. But to reap those benefits there is a need for a completely
different approach to investment.
Poor countries cannot reduce the burden of diseases
associated with poverty if they can only spend 5-10 dollars per person
on health each year. We estimate that to reach agreed targets for
malaria in Africa will require an additional 1 billion dollars a year.
For TB, around half a billion dollars per year in high burden
countries. For HIV/AIDS the gap is even larger – probably in the
order of 3 billion dollars for expanded prevention and support in
Africa alone. Add in antiretrovirals and the costs rise even more
dramatically. When it comes to health systems, no matter how good the
structure is – as long as you can’t afford to pay your doctors and
nurses proper salaries and fill the shelves with essential medicines
and vaccines, the system will not perform adequately.
To achieve the targets that national leaders have
set means we must go to scale. Matching new ambitions with realistic
levels of resources. Business as usual is no longer an option.
Ladies and Gentlemen,
Let us reflect for a moment on some of the
challenges we face as we look at access to biotechnology.
Here too globalization is at work. It is quite
clear, for instance, that the development, marketing and sales of
genetically modified agricultural products might have taken a very
different course in the absence of a global debate about their value
and safety.
But let me keep the focus on health. No matter
where they are – in Rio, in Lusaka, in Mumbai or Moscow – people
living with HIV know that now there are drugs available which can
effectively prolong their lives. They can read news articles
describing what they are called and how they work. And they know that
only the most privileged among them can afford to buy them. This
widespread knowledge, a consequence in part of globalization,
radically changes the social and economic context within which these
drugs are developed and sold.
There is no doubt that these changes add to the
pressures placed on the global pharmaceutical and health technology
sector, which is among the most competitive and profitable in the
modern economy.
We cannot ignore the fact that essential drugs are
not an ordinary commodity. Access to health care is a human right and
governments and international agencies have an obligation to see that
this right is progressively realised. Access to essential drugs is
part of this obligation.
In this regard, I believe the past year has shown
that there is an unstoppable political and commercial momentum that
points toward a change in the way drugs are priced for those countries
with the least financial resources and the greatest need.
Drug prices, of course, are only part of the story.
Access to essential medicines needs to be seen as a table with four
legs: rational selection, affordable prices, sustainable financing,
and reliable supply systems. These four components of the strategy are
inter-dependent. Lower prices attract more donor and government
financing; radically increasing drug availability boosts health
systems development; more effective supply systems mean greater
coverage; and more coverage increases sales revenues.
Drug prices may not be the only issue, but they
have the potential to trigger important changes – and a virtuous
cycle of development – in their wake.
It is on the issue of affordable prices, that the
world is looking to the health care industry and WHO. And as I see it
the challenge is this: how can we make sure that low income countries
can purchase essential medicines at prices they can afford? And, in
the case of on-patent medications, how best to contribute to equitable
access through enlightened pricing strategies?
We know some of the things that it will take to
make more equitable pricing work in practice. We have to protect
intellectual property rights. We need them to ensure that R&D will
yield badly needed new tools and technologies. We need mechanisms to
prevent illicit re-export of lower priced drugs into richer economies.
We must also recognize the concern of companies that lower prices in
the developing world not be used as a lever to influence negotiations
in countries that can easily afford to pay more.
Creative solutions can be found for a more
equitable and prosperous world.
Ladies and Gentlemen,
I have focused so far on the present: how to make
the technologies that we have today accessible to a greater proportion
of the world’s population. But let me now turn to the future, the
real focus of BioVision Forum 2001.
To sustain our efforts to reduce human suffering
and promote equitable development, we will need better tools – the
best that science can offer. New vaccines, new drugs and new
diagnostics – designed, developed and priced to respond to the
health needs of the poorest countries.
We need to ask ourselves: which essential global
public goods are unlikely to be developed or distributed at a
reasonable price through normal market forces alone? We need to think
about how we structure incentives to promote the necessary changes. We
need to decide who should pay the cost of R&D for diseases that
drive poverty. These, I believe, are policy questions for which we
need urgent answers.
We also need to look ahead and think about the
implications of knowledge resulting from new advances in genomics and
other areas of biotechnology.
The basic knowledge on the human genome is, of
course already in the public domain. In fact, the journal
"Science" will begin publishing a series of articles next
week that will give the full sequence of the human genome.
Today, most biotechnology research is carried out
in the developed world, and is primarily market-driven. It is
inevitable therefore, if this pattern continues unchanged, that the
knowledge and technology gap between developed and developing
countries will widen, and that the health needs of poor nations will
fail to get the attention they deserve.
Let us, first of all, get away from the notion that
it is only cutting-edge research efforts in the industrialised
countries that are responsible for the advances in medicine, and that
developing countries are largely spectators and passive recipients of
this ‘intellectual largesse and generosity’ from the western
world. This assumption is unhelpful and outmoded. Research performed
in the developing countries is equally important to the future
advancement of medicine and to the health of all people on our planet.
I see this as being as true in genomics as it is in
the more established branches of science. Developing country
researchers need to participate, and to be involved in the innovative
aspects of biotechnology. There is much they can contribute, not only
scientifically, but also social and economic, from their own diverse
cultural perspectives. Only by their participation can they eventually
reap the full benefits biotechnology has to offer.
Ladies and Gentlemen,
Scaling up our response to the diseases that create
and perpetuate poverty. Creating the conditions which will allow more
equitable access to the information, services and technologies that
have the potential to transform peoples lives. Pursuing a more
inclusive agenda for research and development. These are the
challenges as I see them today.
The road ahead will not be easy or straightforward.
But I believe we have some clear signposts, and we have some important
milestones behind us on which we can build.
We have succeeded in putting health on the global
agenda. Political support is unprecedented – from leaders in both
the developing and developed world. And this support is beginning to
find practical expression, as in the commitments of the G8 and in the
new policy on accelerated action against communicable diseases adopted
by the European Union under the French Presidency. We now need to move
from commitments to action – backed by real resources.
We have shown that new forms of collaboration and
partnership are possible and productive. They take many forms – from
those like the Global Alliance for Vaccines and Immunization –
increasing vaccine coverage in the poorest countries, to the
ground-breaking work taking place in relation to the International
Framework Convention on Tobacco Control. We have broken the mould when
it comes to traditional models of development which rely on the state
alone. And we have learnt more about what it takes to make these
partnerships work: patience, transparency, imagination, trust – and,
above all, shared responsibility for jointly agreed goals.
Ladies and Gentlemen,
The need for improved global health: duty or
opportunity? That was my question. The answer of course is both.
Better health provides people with an opportunity – both as a good
in its own right, and as a means which can enable many of the
world’s poorest to emerge from poverty. Better health is a duty in
the sense that we cannot ignore or condone growing inequity. But the
key point I want to leave you with is this: We have an unprecedented
opportunity to make a difference.
We must seize it. Turning commitments into actions,
and actions into results that change people’s lives. Let us use the
extraordinary political energy and humanitarian concern that has been
so well exemplified by hosts here in France. The prize is
extraordinary. We cannot afford to fail.
Thank you. |
