Global treaty would improve access to health

A binding international convention would facilitate a move towards more equitable access to R&D in health, according to Suerie Moon and colleagues.

The current system for the research and development (R&D) of new medicines do not adequately meet the needs of the majority of the world's population, over 80 per cent of which live in low-and middle-income countries, say Suerie Moon, Jorge Bermudez,and Ellen 't Hoen, in PLoS Medicine (15 May).

Examples of this are the lack of new medicines for neglected diseases, which primarily affects populations with little purchasing power, and also a need of access to antimicrobials and affordable medicines for diseases with global incidence, such as diabetes and cancer.

Yet, the authors acknowledge that some progress has been made. Changes in policies  of patent holders and low-cost generic drugs have widely increased the access to antiretrovirals for HIV; new international funds are supporting treatment programmes; and product development partnerships (PDPs) have increased R&D in new drugs for malaria, sleeping sickness, visceral leishmaniasis, and Chagas disease.

However, those efforts are still fragmented and insufficient to generate the funding needed for research; many of them rely heavily on donor financing and priorities, and cover a limited set of diseases.

According to Moon, Bermudez, and 't Hoen, effective tools for global governance are required to generate medical R&D as a global public good, based on the understanding that a politically and financially sustainable system will require both fair contributions from all, and fair benefit-sharing for all.

To face that challenge in a systematic way, last April the WHO Consultative Expert Working Group on R&D: Financing and Coordination (CEWG) recommended that governments begin negotiations over a global medical R&D convention.

Proposals for such a convention include binding obligations on governments to invest in R&D, equitable distribution of contributions across countries, priorities driven by health needs, measures to ensure affordability of the end product, and innovative approaches to incentivising R&D.

The authors encourage a R&D treaty that complements and builds on existing initiatives by addressing four areas where the system remains particularly weak: affordability, sustainable financing, efficiency in innovation, and equitable health-centered governance.

The recommendations of the CEWG can be seen as the product of nearly two decades of growing dissatisfaction with the shortcomings of the current R&D system. Leaders of governments, civil society, industry, and academia should seize this unprecedented opportunity to move forward, the authors say.

Suerie Moon (Forum on Global Governance for Health, Harvard Global Health Institute, Cambridge, Massachusetts, USA), Jorge Bermudez (Harvard School of Public Health, Boston, Massachusetts, USA, and Fundação Oswaldo Cruz, Rio de Janeiro, Brazil), Ellen 't Hoen (IS Academy HIV/AIDS, School for Social Science Research, University of Amsterdam, The Netherlands).

Link to the full article in PLoS Medicine