Drugs And Vaccines Around The World

Affording access to essential medicines in a global economyrepresents a twofold challenge. Pharmaceutical therapies haveplayed a rapidly increasing role in health care generally inthe past generation. Even in prosperous countries, public andprivate financing systems have struggled to keep pace with thegrowth in spending driven by biomedical innovation. At the sametime, the pharmaceutical industry has become ever more visibleas the epitome of global enterprise—at times wildly successfulbut also jolted by price transparency, scrambling to adapt toevolving trade and aid arrangements, and goaded by a flow ofinformation on the Internet and in the media that makes it impossibleto ignore the consequences of inadequate access to medicinein poor countries.

The four papers in this section reflect the humbling complexityand scope of the global pharmaceutical issues facing the U.S.and international policy communities. In the first of them,David Ridley and colleagues at Duke University revisit an issueraised in 2005 in Health Affairs by Ernst Berndt and John Hurvitz("Vaccine Advance-Purchase Agreements for Low-Income Countries,"May/June 2005). The lack of buying power in the developing worldaffects more than access to available drugs. It means that incentivesare lacking for researchers and manufacturers to focus on newvaccines and treatments for the infectious diseases that accountfor the greatest losses of life and health in poorer countries.Ridley and colleagues propose a mechanism that could greatlyreduce the direct subsidies that are needed to shore up demand—withpossible fringe benefits for U.S. consumers.

Meanwhile, subsidizing purchase of antimalarial drugs standsas one of the highest priorities on the global health agenda,in proportion to the enormous burden of mortality that malariaimposes on many low-income countries. Donor countries and internationalorganizations like the World Bank and the Global Fund have signaledtheir willingness to help. But Ramanan Laxminarayan and colleaguesoffer compelling arguments here that show how carefully futureinvestments must be made to avoid counterproductive outcomes.

The next paper, on drug review in Canada, Australia, New Zealand,and the United Kingdom, by Steven Morgan and colleagues, demonstratesthat the challenge of achieving optimal access to a rapidlyexpanding universe of pharmacotherapies is testing policymakersin relatively affluent as well as poor countries. Efficientresource allocation is the goal of international subsidy programs,national health systems, and private markets. But ensuring rationaldecision making requires high-precision tools, which have yetto be perfected by even the most sophisticated health systems.David Bishai and colleagues round out this group of papers witha further study of resource allocation challenges in the poorestcountries.

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Drugs And Vaccines Around The World