A dose of reality on pharma intellectual property

Health officials from all over Asia will gather at a World Health Organization (WHO) meeting in Manila next week (5th Sept) to discuss an issue that is rarely out of the papers in the Philippines: how do patents affect drug prices, and what can be done to ensure that the poor can get access to high quality medicines?

At the WHO meeting, delegates will claim that patents drive up drug prices and therefore deny the poor the care they need. However, framing the issue in such black and white terms distracts attention from the real causes of ill health in countries such as the Philippines, which revolve more around poverty and inadequate health infrastructure.

It is not surprising that the price of medicines should become the focus of debate. After all, who wants to hand over large sums of hard-earned cash to pay for expensive drugs when copies can be made for a few cents? Surely by weakening patents the government would reduce drug prices, thereby increasing access to medicines for all?

Taken at face value, the answer would seem to be yes. But look a little deeper and you will find that intellectual property and the price of medicines is largely irrelevant in the face of the other major factors that affect a nation's health.

Take the example of India. From 1972, it weakened intellectual property laws in the belief that it would drive down the price of medicines. It certainly did that for some drugs, but did it make the Indian people any healthier?

Access to even basic medicines in India remains unacceptably low. Children go without routine vaccinations. About 60% of Indians do not have access to basic, off-patent (“generic”) medicines. Children go without routine vaccinations. Despite pumping out cheap generic AIDS drugs for years, only 5.5% of India’s AIDS sufferers were receiving any drugs by the end of 2006.

For the Indian poor, the price of drugs is not the issue. The real issue is the state of their healthcare infrastructure.

The government-run system is a shambles, riddled with inefficiency and corruption and beset by a lack of resources. The transport network is so bad that rural people struggle to get to a clinic, even if one exists within 1,500km of their home. Meanwhile, dirty water and cooking fuels exact a terrible toll of disease on the poor.

So, when the Indian government decided in 2005 to strengthen its intellectual property laws in order to accelerate India's economic development, it was able to do so because the people did not see a connection between arcane patent laws and the reality of their lives.

What they want are hospitals, clinics, doctors and nurses. Without these things, you can give drugs away for free and they still won't get to the most needy.

The Indian voters understood this -- and the prices of medicines have not shot up, despite activists' forecasts.

There are similarities with many other countries. In the Philippines, 40 percent of people will never see a doctor in their entire lives. Clinics and hospitals are rare. PhilHealth, the government-run social insurance scheme, provides very basic cover for only around half of the population.

The exodus of healthcare workers to better opportunities overseas has reached such high levels that the Filipino Alliance of Healthcare Workers recently warned that the healthcare system faces "imminent collapse."

This is compounded by counterproductive policies. In 2005, the Philippines increased VAT on medicines from 10 to 12 percent and -- incredibly -- made previously exempt things like doctors' fees subject to VAT. This amounts to little more than a tax on the sick and dying.

The Philippines is not unique. Most countries in Africa, and many in Asia and Latin America have dysfunctional health systems, a lack of health insurance and regressive taxes on medical goods and services.

As a result of these failures of governance, less than 50 percent of people have regular access to essential medicines in some parts of Africa and Asia.

In the end, it is the patients who are suffering from the current fixation with patents and prices. It is taking energy and discussion away from the things that really matter, such as infrastructure, doctors and nurses. Unless these things are made more widely available, people will go on dying from easily preventable diseases.

As for prices, out of 18 comparable AIDS drugs named by Doctors Without Borders in an attack on patents, 14 patented drugs sell below or around the cost of generics.

In 2005, the head of the WHO's AIDS division said: "It is very obvious ... that the elephant in the room is not the current price of drugs. The real obstacle is the fragility of the health systems. You have health infrastructure that is dilapidated, a health workforce that is demoralized, labs that don't work, supply chains that don't exist and diagnostics that are missing."

Improving provision is not easy. But it would help if debate focused on these life-saving factors. In the face of widespread health crises, diverting energy and attention toward patents is a disservice to patients.