SKOPJE, Macedonia, June 6 (UPI) -- Last April, the World Health Organization, the World Trade Organization, the Norwegian Foreign Ministry, and the U.S.-based Global Health Council held a three-day workshop about "Pricing and Financing of Essential Drugs" in poor countries.
Not surprisingly, the conclusion was: "... There was broad recognition that differential pricing could play an important role in ensuring access to existing drugs at affordable prices, particularly in the poorest countries, while the patent system would be allowed to continue to play its role in providing incentives for research and development into new drugs."
The 80 experts, who attended the workshop, proposed to reconcile these two, apparently contradictory, aspirations by introducing different prices for drugs in low-income and rich countries. This could be achieved bilaterally, between companies and purchasers, patent holders and manufacturers, global suppliers and countries - or through a market mechanism.
According to IMS Health, poor countries are projected to account for less than one-fourth of pharmaceutical sales this year.
Of every $100 spent on medicines worldwide -- $42 is spent in the USA, $25 in Europe, $11 in Japan, $7.50 in Latin America and the Caribbean, $5 in China and South East Asia, less than $2 in East Europe and India each, about $1 in Africa and the Commonwealth of Independent States each.
Vaccines, contraceptives, and condoms are already subject to cross-border differential pricing. Lately, drug companies, were forced to introduce multi-tiered pricing following court decisions, or agreements with the authorities. Brazilians and South Africans, for instance, pay a fraction of the price paid in the West for their anti-retroviral AIDS medication.
Even so, the price of a typical treatment is not affordable. Foreign donors, private foundations -- such as the Bill and Melissa Gates Foundation -- and international organizations had to step in to cover the shortfall.
The experts acknowledged the risk that branded drugs sold cheaply in a poor country might end up being smuggled into and consumed in a much richer ones. Less likely, industrialized countries may also impose price controls, using poor country prices as benchmarks. Other participants, including dominant non-governmental organizations such as Oxfam and Medecins Sans Frontieres, rooted for a reform of the TRIPS agreement -- or the manufacturing of generic alternatives to branded drugs.
The "health safeguards" built into the Trade-related Aspects of Intellectual Property Rights convention allow for compulsory licensing (manufacturing a drug without the patent holder's permission) and for parallel imports (importing a drug from another country where it is sold at a lower price) in case of an health emergency.
Aware of the existence of this Damocles sword, the European Union and the transnational pharmaceutical lobby have come out last May in favor of "global tiered pricing".
In its 2001 Human Development Report, the United Nations Development Program called to introduce differential rich versus poor country pricing for "essential high-tech products" as well. The Health GAP Coalition commented on the report: "On the issue of differential pricing, the report notes that, while an effective global market would encourage different prices in different countries for products such as pharmaceuticals, the current system does not. With high-tech products, where the main cost to the seller is usually research rather than production, such tiered pricing could lead to an identical product being sold in poor countries for just one-tenth or one-hundredth the price in Europe or the United States.
But drug companies and other technology producers fear that knowledge about such discounting could lead to a demand for lower prices in rich countries as well. They have tended to set global prices that are unaffordable for the citizens of poor countries (as with many AIDS drugs).
"Part of the battle to establish differential pricing must be won through consumer education," said Sukaki Fukuda-Parr, the lead author of the report.
"The citizens of rich countries must understand that it is only fair for people in developing countries to pay less for medicines and other critical technology products."
Public declarations issued in Havana, Cuba, in San Jose, Costa Rica, in the late 1990s touted the benefits of free online scholarship for developing countries. The WHO and the Open Society Institute initiated the Health InterNetwork Access to Research Initiative, or HINARI. Peter Suber, the publisher of the Free Online Scholarship newsletter, summarizes the initiative thus:
"Under the program, the world's six largest publishers of biomedical journals have agreed to three-tiered pricing. For countries in the lowest tier (Gross National Product per capita below $1,000), online subscriptions are free of charge. For countries in the middle tier (GNP per capita between $1,000 and $3,000), online subscriptions will be discounted by an amount to be decided this June. Countries in the top tier pay full price. The six participating publishers are Blackwell Synergy, Elsevier Science Direct, Harcourt IDEAL, Springer Link, Wiley Interscience, and Wolters Kluwer. The subscriptions are given to universities and research institutions, not to individuals. But they are identical in scope to the subscriptions received by institutions paying the full price."
Of 500 bottom-tier eligible institutions, more than 200 have already signed up. Additional publishers have joined this three- to five-year program, and most biomedical journals are already on offer. Midtier pricing will be declared by January next year. HINARI will probably be expanded to cover other scientific disciplines.
Authors from developing countries also benefit from the spread of free online scholarship coupled with differential pricing. "Best of Science," for example, a free, peer-reviewed, online science journal, subsists on fees paid by the authors. It charges authors from developing countries less.
But differential pricing is unlikely to be confined to scholarly journals. Already, voices in developing countries demand tiered pricing for Western textbooks sold in emerging economies. Quoted in the Free Online Scholarship newsletter, Lai Ting-ming of the Taipei Times criticized, on March 26, "Western publishers for selling textbooks to third world students at first world prices. There is a "textbook pricing crisis" in developing countries, which is most commonly solved by illicit photocopying."
Touchingly, the issue of the dispossessed within rich country societies was raised by two African special rapporteurs in a report submitted last year to the U.N. Subcommission on Human Rights and titled "Globalization and its Impact on the Full Enjoyment of Human Rights."
It said: " ... The emphasis on R&D investment conveniently omits mention of the fact that some of the financing for this research comes from public sources; how then can it be justifiably argued that the benefits that derive from such investment should accrue primarily to private interests?
"Lastly, the focus on differential pricing between (rich and poor) countries omits consideration of the fact that there are many people within developed countries who are also unable to afford the same drugs. This may be on account of an inaccessible or inhospitable health care system (in terms of cost or an absence of adequate social welfare mechanisms), or because of racial, gender, sexual orientation or other forms of discrimination."
Send your comments to: [email protected].
