The Case for Essential Medicines

It’s well-known that the diseases of the ‘first world’ do not align with those of the ‘third world.’ Malaria, measles, polio—these became rare in the US even before our grandparents were born.

In the 2010 census, the average tuberculosis prevalence in the US was 5.8 per hundred thousand. That same year, Nepal’s prevalence was about 250 per hundred thousand. Pakistan saw rates as high as 325. We see similar prevalences among most of the world’s population; by the numbers, the first world citizens are in the great minority. It might not come as a surprise, then, that no new tuberculosis drugs have been developed since the mid-1970s. Malaria is in a similar state: though new antimalarials have been developed, the inexpensive types come with terrible side effects. Meanwhile, drugs to combat the issues of the first world—cancer, diabetes, heart disease—have boomed, both in terms of availability and profit margin.

Back in 2001, a team of health specialists led by Dr. Patrice Trouiller put together a great paper on the economics of drug development, making a case for why there has been so little innovation in drugs to treat tropical diseases. The basic answer? The demand is almost completely in the developing world, and the developing world can’t return the initial investment. This imbalance is crystallized in the figure below (Trouiller 2001).


Depressing? Maybe. But Trouiller et al. offer a solution: research policy reform. They call for certain drugs to be classified as ‘essential’—that is, the “neglected diseases” (948) such as tuberculosis, malaria, and measles, should be subsidized by international organizations like the WHO to be developed more cheaply. In addition, they argue that patent policy should be modified to make sure these crucial drugs can be developed in the countries that need them most. As we can see, the free market alone can’t fix this problem.

Link to the full article here.


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