Fighting for Survival

By Pecoul, Bernard | Harvard International Review, Fall 2001 | Go to article overview

Fighting for Survival


Pecoul, Bernard, Harvard International Review


Access to Essential Medicines in Poor Countries

Essential medicines, a limited subset of existing medicines that satisfy the health-care needs of the majority of a population, are the foundation for nearly every public-health program aimed at reducing morbidity and mortality in the developing world. They are, however, increasingly out of the reach of these same populations. A variety of factors contribute to this appalling situation: old medicines are increasingly rendered ineffective due to widespread resistance; others are withdrawn from the market; no new medicines are brought into the market when the primary populations affected are poor people living in poor countries; and newer medicines developed primarily for wealthy markets are priced out of the reach of people living in the developing world.

In a world that is embracing the free market at a global level--under the pressure of the richest countries, especially the United States--and that considers essential medicines to be like a commodity; we must admit that market forces alone do not address the health needs of populations living in poor countries. Not only does such a commodification eventually result in a sort of market failure, but it is also a political failure. It is the failure to recognize that access to adequate health care and treatment is a human-rights issue and that global health is the public sector's responsibility. Governments have an obligation to ensure that their people can enjoy the benefits of scientific progress and its applications, including improved health.

The example of AIDS illustrates dramatically how global health policies, ignoring basic medical ethics, have failed to deliver effective treatments to more than 90 percent of people living with HIV/AIDS (PWAs) on the planet today. It shows how some international trade agreements and foreign policies that are oblivious to their consequences on health are locking people in desperate situations with no access to adequate treatment, and how they have stalled the few isolated national initiatives that have tried to address the issue, ultimately causing needless deaths.

Since 1996, the advent of protease inhibitors, a new class of anti-retroviral medicines, and the use of triple-combination therapy have resulted in significant improvements in quality of life and life expectancy of PWAs in wealthy nations; as a result, AIDS-related deaths in such countries have decreased by almost 80 percent. Unfortunately, these spectacular advancements in HIV/AIDS case management have mainly benefited the less than 10 percent of PWAs who live in industrialized countries. Today, more than 32 million out of a total of over 36 million PWAs live in the developing world and do not have access to these effective therapies. As the health minister from Zimbabwe put it bluntly during the World Health Assembly in 2000, "With AIDS, treatment is in the North, and patients are in the South."

Beyond the ethical issues raised by this standard denial of care to millions of people, the sheer progression of the epidemic in developing countries over the last decade illustrates the magnitude of the failure of this strategy. The Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) now estimate that the number of people living with HIV or AIDS at the end of the year 2000- 36.1 million-is more than 50 percent higher than what the WHO's Global Program on AIDS projected in 1991.

The Constraints

Many factors influence access to effective treatments, including the quality of diagnosis; accurate prescribing, selection, distribution, and dispensing of medicines; drug quality; and the capacities and budgets of health systems. But one of the most fundamental barriers to access is price. High prices of AIDS medicines and failing health-delivery systems in the developing world are among the constraints most widely cited to justify inaction in the field of treatment. …

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