Addressing the Innovation Gap in Health
On September 14, a United Nations high-level panel on access to medicines published a report that discusses the gap between the research and development (R&D) of health innovations and health outcomes. Broadly, the report recommends the following: making intellectual property laws more sensitive to public priorities; creating new incentives for health R&D; and establishing good governance, better accountability mechanisms, and greater transparency. Some world leaders have applauded the report for making concrete steps in solving this health gap, such as former Swiss president, Ruth Dreifuss. But other organizations, such as Doctors Without Borders, worry that the report does not do enough to guarantee any meaningful changes.
When discussing this gap between R&D and health outcomes, it is important to separate the issues that comprise this gap. The first issue, which is sometimes called the price gap, pertains to the lack of affordable medicines for important diseases. The price gap is a relatively familiar topic in the public consciousness. Most can identify Turing Pharmaceutical’s Martin Shkreli or EpiPen’s Heather Bresch for their companies’ role in increasing the price of pharmaceutical medication beyond the reach of many patients. Some are also aware of the price difference between patented and generic drugs, as well the aggressive attempts by pharmaceutical companies to ensure that developing countries do not have access to these cheaper generic alternatives.
However, relatively fewer people are aware of the innovation gap between neglected tropical diseases and R&D. These neglected diseases are a medically-diverse group of illnesses that affect low-income developing countries in Africa, Asia, and South America, collectively affecting more than 1.4 billion people. Some of these diseases, such as rabies and leprosy, are well-known but underserviced. Others, such as onchocerciasis or ‘river blindness,’ are completely foreign in developed countries but affect millions of lives in developing countries.
The innovation gap refers to the stark differences in R&D priorities for pharmaceutical companies; although many lives are affected by neglected tropical diseases, pharmaceutical companies do not invest in R&D for cures. Since the demand is mostly coming from developing countries, where consumers have fewer resources to spend on medication and where distribution to rural areas is often prohibitively expensive, the market is relatively weak. Companies would much rather spend money researching more lucrative but less impactful products, such as pain medication in developed countries.
Understanding both the price gap and the innovation gap is crucial is tackling the broader issue of access to medicine. It was great to see the renewed political activism surrounding the price of pharmaceuticals over the summer and the innovations created by organizations that were intended to reduce the price gap. However, having relatively cheaper products can only go so far. Indeed, it is incredibly dangerous to assume that pricing alone is the issue because it ignores entirely the needs of millions of lives in developing countries. And yet, relatively fewer activists and organizations are urging for R&D into neglected tropical diseases.
Perhaps a significant, underlying issue when it comes to health activism is its roots in the developed world. It is difficult to change a society’s framework and perspective. Often, issues that arise in developing countries are implicitly refitted and changed to suit the familiar frames that the developed countries are used to. As such, activists and organizations focus on the pricing of pharmaceuticals because it is a common issue. Similarly, these actors are interested in considering universal health care, or at least alternatives to two-tier health insurance systems. When looking at the state of health in developing countries, these actors tend to focus on the monetary aspects of the health care system without considering whether there are particular treatments to give in the first place. The gap in innovation is, at least in some respects, due to a lack of sympathy on our parts to see the particular, contextualized needs of those different from us.
The health social movement to uphold the human right to health requires a concerted effort from many multidisciplinary actors. It is difficult enough for them to focus their efforts into a particular health issue, such as the price gap. However, we must still bring attention to the particular needs of the underserviced and underrepresented. While the United Nation’s recommendations for expanded R&D to include neglected tropical diseases may be less familiar to actors in developed countries, it is still necessary to pressure companies to make those investments.
This article was published as part of the Osgoode chapter of Canadian Lawyers for International Human Rights (CLAIHR) media series, which aims to promote an awareness of international human rights issues.
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