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Drugs/Vaccines |
PROLOGUE
Drugs And Vaccines Around The World
Affording access to essential medicines in a global economy represents a twofold challenge. Pharmaceutical therapies have played a rapidly increasing role in health care generally in the past generation. Even in prosperous countries, public and private financing systems have struggled to keep pace with the growth in spending driven by biomedical innovation. At the same time, the pharmaceutical industry has become ever more visible as the epitome of global enterprise—at times wildly successful but also jolted by price transparency, scrambling to adapt to evolving trade and aid arrangements, and goaded by a flow of information on the Internet and in the media that makes it impossible to ignore the consequences of inadequate access to medicine in poor countries.
The four papers in this section reflect the humbling complexity and 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 issue raised 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 world affects more than access to available drugs. It means that incentives are lacking for researchers and manufacturers to focus on new vaccines and treatments for the infectious diseases that account for the greatest losses of life and health in poorer countries. Ridley and colleagues propose a mechanism that could greatly reduce the direct subsidies that are needed to shore up demand—with possible fringe benefits for U.S. consumers.
Meanwhile, subsidizing purchase of antimalarial drugs stands as one of the highest priorities on the global health agenda, in proportion to the enormous burden of mortality that malaria imposes on many low-income countries. Donor countries and international organizations like the World Bank and the Global Fund have signaled their willingness to help. But Ramanan Laxminarayan and colleagues offer compelling arguments here that show how carefully future investments 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, demonstrates that the challenge of achieving optimal access to a rapidly expanding universe of pharmacotherapies is testing policymakers in relatively affluent as well as poor countries. Efficient resource allocation is the goal of international subsidy programs, national health systems, and private markets. But ensuring rational decision making requires high-precision tools, which have yet to be perfected by even the most sophisticated health systems. David Bishai and colleagues round out this group of papers with a further study of resource allocation challenges in the poorest countries.
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