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 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.
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