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State
Secretary,
Ladies and
Gentlemen,
Let me add my own warm welcome to you all, and
extend my thanks to the Government of Norway for hosting this
important meeting.
Exactly one year ago – in the first week of April
2000 – I addressed the Parliamentary Commission on the Investigation
of Medicines in Brasilia on the subject of access to essential drugs
and vaccines. My focus then – as it remains today – is how we can
ensure that vital medicines are accessible to all the people that need
them – regardless of their income, regardless of the health
conditions they are suffering from, regardless of the country they
live in. Reliable access to medicines on the basis of need rather than
on the ability to pay. That is the goal. That – I believe – is
what brings us all together here.
Just twelve months on: and a great deal has
happened. With the rapid unfolding of events, almost on a day by
day basis, one could be forgiven for believing that the situation has
been transformed. Perhaps in some ways it has.
Greatly increased access to treatment for
people living with AIDS, TB and malaria in low income countries is
now on the agenda in a way that many would not have thought
possible a year ago.
Real reductions in the price of drugs for
treating people living with AIDS are now beginning to happen.
And perhaps most important of all: access to
pharmaceuticals is no longer an issue for health professionals and
government officials alone. It is headline news. A much wider
constituency is now engaged – with all the complexity that
this brings in terms of new possibilities and public expectations.
These are significant changes. We should give
credit to those who have helped to bring them about.
In the last twelve months, we have witnessed an
unprecedented effort, driven by committed people in governments,
non-governmental organizations, activist groups, UN agencies,
bilaterals, different branches of the pharmaceutical industry, and the
media. Together we have begun to tackle the obstacles that are
preventing essential drugs from reaching the millions who need them.
Popular outrage, political will, market forces and the best of
science: a powerful coalition. There are things we can rightfully
celebrate.
But let us pause. The excitement of the campaign
and the growing attention of the international media must not divert
us from basic realities. For too many of the world’s poor people
– those with an income of one or two dollars a day – nothing very
much has changed at all. The onset of serious illness in the
family too often leads inexorably to death, disability and
impoverishment.
In over 30 countries public spending on
medicines is less than two dollars per capita per year.
I recently heard the Minister of Health from Malawi,
describing how changes in the value of the local currency
devaluation had reduced planned government spending on drugs this
year from $1.25 to just 75 cents per head.
Inevitably, in such circumstances, the cost of
care falls to the individual and the family. Few poor people have
access to health insurance. They have to pay for drugs when they
get sick. Out-of-pocket payments – a large proportion of
which go on medicines – constitute up to 90% of total health
spending in some poor countries. No matter what the time of year,
no matter what the state of family finances, the situation for
many is stark: no cash, no cure.
Access to care is not just about access to
drugs. It is about access to effective health systems. Safe
and reliable care requires trained staff who receive their
salaries on time and who stay in post. It requires supplies,
buildings, information systems, supervisors. All this and more is
needed for the safe diagnosis and treatment of childhood pneumonia
– let alone more complex problems like the management of
multi-drug resistant TB or HIV. We will hear in this meeting about
huge differences in access to health services that exist between
and within countries.
A substantial increase in development
assistance can make a difference. The OECD estimates that
total Official Development Assistance for health – for all
purposes, for all countries, from all sources, loans and
grants – is currently about $3.5 billion a year. We now suspect
that this estimate might be a little low. But just to treat one
million people with AIDS in Africa, with the prices now on offer,
would require that the $3.5 billion be increased, almost
immediately, by one third.
This then is the background against which we must
frame our discussions and measure our progress. Drug prices are
critically important. New financing even more so. But we must never
forget that some of the most basic problems of development are not
going to be amenable to quick-fix solutions.
Ladies and Gentlemen,
Let me turn now to meeting itself. We have a
unique opportunity over the next three days. WHO’s collaboration
with WTO has helped to bring together an extraordinarily exciting and
knowledgeable group of people, representing some of the most important
actors concerned with access to essential drugs in the world today. We
all come to the meeting with different perspectives. The ethical and
financial stakes are very high. So are the issues we are dealing with
emotive and complex. There are different and deeply held opinions as
to the way forward.
Let us be clear about the purpose of the meeting.
Achieving greater clarity about strategies that will make the prices
paid for key pharmaceuticals more closely in line with the economic
circumstances of the purchasing countries. This is our task.
We are not here to make decisions. Nor are we here
to prepare a grand plan – as I have seen in the press.
For WHO, however, the results of this meeting will
be an important input to be considered by our Member States when they
debate the follow-up of the Revised Drug Strategy at the forthcoming
World Health Assembly.
I find it helpful to think about moving from positions
to principles. If we are to move forward on the issue of
differential pricing in a way that ensures more equitable access,
there are many questions that need to be addressed. We need principles
that can act as a lode stone or a compass as we, and many others, deal
with the details and the practical problems that lie ahead.
Let me give you an example. If I were to put myself
in the position of a Minister of Health or Minister of Finance, I
would attach considerable importance to predictability and
sustainability. Is the price I am paying for drugs now going to
change dramatically next year? How long – as they say – does the
current offer last? Predictability and sustainability of demand is
just as important to the producers of medicines. We can use these
principles as a yardstick against which to assess the effectiveness of
different approaches to improving access.
Another principle is to recognise that if we are to
achieve the goal of more equitable access to good quality health care,
all the different groups represented here today have a role to play.
It is easy for diversity to appear as an obstacle to progress. The
challenge, indeed our main challenge at this meeting, is to turn
diversity into creativity.
We must remember the capacities that each of the
different actors brings to the table: the major investments and
risks born by the research-based pharmaceutical industry in developing
new products; the convening power and country experience of the UN,
underpinned by the mandate provided by its Member States and Governing
Bodies; the resources available from development banks and other donor
agencies; the role of the generics industry in promoting commercial
competition for drugs no longer protected by patents; and the critical
role of governments in low income countries. We need WTO as an
effective and fair forum for negotiating trade rules and resolving
disputes. We need groups and individuals that provoke us into thinking
differently – groups that force us to confront problems and
solutions from radically new perspectives. And of course we need those
NGOs and other bodies that demonstrate effective ways of improving
access through their work on the ground in low income countries.
Productive working relationships do not necessarily
mean we will agree on everything. Nor do we become, or adopt the
agenda of, those with whom we collaborate. In WHO, just to give an
example, we meet regularly with NGOs, with staff of the WTO, with the
CEOs of several research-based companies, and with generic
manufacturers. We often get the impression that each of these groups
thinks that we favour one or more of the others. This suggests to me
that we probably have our position about right.
As we move from positions to principles, let us
also try and get away from some of the unhelpful dichotomies
and repetitive arguments that have characterised the debate about
access to drugs. Reducing prices versus investment in health systems,
for instance. Both are important. They are complementary, not
competitive agendas to be used in defending rigid positions. If we are
going to fix the pipes, we have to put water in them to see if they
work.
But in our search for principles, there are also
some fundamentals. Drugs are not a commodity like any other.
Access to health care is a human right and many of the actors I have
mentioned have an obligation to see that this right is progressively
realised. Access to essential drugs is part of this obligation. Not
just for one set of health conditions, but for all.
We need new technologies. We do not yet have a cure
for AIDS and our present tools for HIV/AIDS, TB, malaria and for many
other conditions leave much to be desired. Continuing innovation
– which requires both incentives to invest in the diseases that
drive poverty and protection provided by international agreements on
intellectual property – is essential.
We have some fundamental positions on the way
health systems function. Particularly about the way they respond
to peoples needs, about fairness, responsiveness and solidarity in the
way they are financed – and about the key role of government in
overall stewardship. Health care provision is not just the business of
the public sector, in all our deliberations we must factor in the
important role of the private sector, NGOs and civil society groups.
The task of governments is to set the frameworks, to make the hard
choices, and to ensure delivery of required services.
Our job in WHO and in the other UN agencies is to
do what we can to help governments make wise choices, based on
the best information and evidence available. This includes monitoring
the impact of international agreements on trade of services and
intellectual property on health.
As I talk to Ministers and Heads of State about the
health crises they are confronting, I realise that recent developments
have in some ways made their task harder. Reducing the prices of
previously unaffordable medicines has fuelled public expectations. A
significant and sustained increase in external financial assistance
has to be part of the answer. But external aid cannot and should
not remove the responsibility of governments to set priorities.
Ladies and Gentlemen,
This is a long awaited meeting. I am sure that its
outcome will be scrutinised carefully in the weeks and months to come.
Achieving greater clarity about approaches to
ensuring more equitable access to drugs is an important part of a
larger picture. That picture is one in which people, particularly poor
people, are not excluded from care by virtue of their poverty. It is
one in which poor people can expect to be treated with respect and
receive quality treatment whenever and wherever they fall ill. And it
is a picture that for a large part of the world’s population remains
distant and hazy. We can make an important contribution to bringing it
into sharper focus.
I look forward to joining you in the debate.
Thank you. |
