Increasing access to affordable drugs in developing countries requires better government intervention, not less of it.
It is tempting to dismiss this week's World Health Organization report on the relationship between intellectual property rights and innovation as little more than a relatively unexciting survey of a complex and controversial field (see Patent study urges R&D boost for neglected diseases).
Certainly there are few radical conclusions or recommendations in the report, drawn up over two years by a ten-member panel of independent experts. And the main message — that governments should do more to increase poor people's access to medicines — is unlikely to make much impact in a world that has heard many similar calls over recent years from individuals ranging from presidents to rock stars.
Reading between the lines of the report, however, it is clear that the absence of concrete proposals for change reflects not so much the panelists' lack of commitment as their inability to reach a consensus on how to reach the above goal.
This is implied, for example, by the fact that half of the members — an unusually high number — felt it necessary to publish short statements, attached in an annexe, dissociating themselves from some of the report's conclusions.
Indeed, while the panel's chair has described the report as a "road map" of steps needed to ensure effective innovation in drug development and delivery, in many ways it also resembles the sketch of a battleground. For it clearly identifies the main features of the broad terrain across which two groups are currently skirmishing over how to meet the health needs of the world's poor.
On one side are those who believe the solution lies in the hands of pharmaceutical companies, open markets, and governments that believe these should be allowed to operate with minimal interference. On the other are those whose main concern is that the current lack of available and accessible medicines for the poor is clear evidence of market failure and who believe governments have a responsibility to intervene.
Contours of a contested terrain
Patent policy is one part of this contested terrain. While not challenging the basic premise on which the patent system is built — namely that the ability to benefit from patent protection is essential for successful innovation — the report points out various ways of modifying its implementation that could, it suggests, produce significant benefits.
For example, it says those responsible for implementing patent policies should take a firmer stance on 'evergreening'. This is the process by which companies may seek to extend the life of patent protection on a key product by introducing (and then seeking protection on) relatively minor modifications.
The case for change in this area is strong. Nevertheless, one of the panel members, the former head of Britain's pharmaceuticals trade association, dissociates himself from this conclusion, on the grounds that "incremental innovation is the lifeblood of medical progress and requires strong intellectual property rights to stimulate further innovation".
Not all of the dissent with the roadmap comes from the same side of the battleground. The report contains much that the pharmaceutical industry would agree with, such as the fact that delivering effective and affordable medicines depends on many factors, including the general state of a country's healthcare system.
Such a statement, however, came in for criticism from two panel members who argue that, in their eyes, focusing on delivery systems — including market effectiveness — deflects attention from the key issues concerning access to and control over scientific knowledge.
Conflicts are entirely understandable. After all, the pharmaceutical industry exists primarily to meet the financial interests of its shareholders — not the medical needs of developing countries. The relative absence of effective drugs and vaccines for neglected diseases such as malaria and sleeping sickness is not due to a lack of interest (or even goodwill). Rather, the poor of developing countries simply do not constitute lucrative markets.
Much has been done in recent years to bridge the gap between the motivations of the private and public sectors. As the World Health Organization (WHO) panel points out, major public-private partnerships have been created to address key diseases. Elsewhere, governments such as Britain's are pursuing the potential for advance purchase agreements, creating 'virtual markets' for products before they are developed in the hope of encouraging the industry to invest in the necessary research and development.
Addressing market failure
Such initiatives are to be applauded. Drug companies are not charities, and can be neither expected nor forced to operate as such. The challenge for governments is to find ways of harnessing the potential that these companies offer — particularly through their research and development expertise — to efforts to meet the health needs of the world's poor.
The companies also have a point when they say that governments can be part of the problem. There is no way that placing heavy taxes on the sale of drugs, for example, can improve their accessibility. Similarly, investment in both the physical and intellectual infrastructure that effective health delivery systems need is a public responsibility that should not be left to the private sector.
But the solution to this lies in better government, not less of it. Unfortunately, the pharmaceutical industry uses much of its political power to push a different agenda, namely that governments are part of the problem, and cannot be expected to be part of the solution.
If there is a bottom line to the WHO panel's report, which will be discussed at the World Health Assembly next month, it is the message that governments must indeed be part of the solution. The report provides a detailed shopping list of ways that well-targeted actions could improve the situation. It is in this sense that the chair of the WHO panel described the report as a "road map" for the future.
Almost all proposed actions, from increased investment in biomedical research to agreement on a global action plan, require action by governments in both developed and developing worlds.
Where the pharmaceutical industry agrees to support progress along the way, health care in developing countries will undoubtedly benefit. But if, by operating in the interests of its shareholders in the developed world, the industry undermines such progress, whether by transparent or covert means, overall achievement will inevitably be limited.
David Dickson, SciDev.Net Director