Essential Medicines: The Crisis in Developing Countries
On June 29, 1999, four Guatemalans learned that they had won the lottery. Their prize: anti-retroviral therapy for AIDS. The other eighty-six patients were not so lucky that day—they did not receive any treatment from the Luis Angel Garcia Clinic in San Juan simply because no medication was available.
Unfortunately, over a decade later, this lack of essential medicines persists, both in Guatemala and elsewhere in the developing world. From ibuprofen to penicillin, essential medicines address the most pressing needs of a population, and inadequate supplies result in a lower quality of life and often death for many patients in impoverished nations. Developing nations face the greatest difficulty in obtaining these medicines: low availability and high prices prevent the world’s poorest and most in need from obtaining adequate health care. Although both public and private groups have invested significant resources toward the alleviation of these inequalities, much work remains to be done.
Essential medicines vary in nature. They can include vaccines, treatments for chronic and acute diseases, and items for emergency preparedness. Population health needs are not homogenous, however, and thus each nation’s government ultimately must be responsible for the construction of its own list of essential medicines. The World Health Organization (WHO) assists nations in the production of their lists by compiling a “Model List” of medications. The power behind the WHO’s list lies in three major areas: the comprehensiveness, the inclusion of only cost-effective treatments, and the up-to-date content. This list provides important guidance, oversight, and standardization for many countries in terms of which medicines should be prioritized.
Even with a list of essential medicines, developing nations are consistently unable to provide for the needs of its patients. High prices and low availability in both the public and private sectors combine to make these drugs largely inaccessible to the lowest income populations. The WHO calculated shocking reference prices that showed the cost that individual nations must pay relative to this standardized value. Public health facilities in poor nations face prices at around 270% of the international reference price and on average have access to only 42% of essential medicines. While the private health sector has increased access to essential medicines by 64%, private providers’ 630% markup of the international reference price prevents this increased availability from being of any benefit to the poor. Rather, high costs force developing nations to devote most of their resources simply to the attainment of medicine, money which in developed nations is employed toward better technology and more advanced treatment options. This further aggravates the vicious cycle of high prices and low availability in the developing world.
These inadequacies in the distribution of essential medicines are even more pronounced in the availability of treatments for chronic diseases than for acute diseases. In Africa, countries have, on average, nine times the amount of resources for acute diseases than for chronic diseases, yet chronic disease accounts for 25% of the mortality in the continent. Failure to treat these conditions introduces significant long-term economic strains on individual households and on the economy at large. By impairing the ability of individuals to sustain jobs for extended periods of time, chronic disease shatters the economic stability of individual households, which cumulatively serves to weaken the entire economy of developing nations. Furthermore, the rise of multi-drug resistant strains of acute diseases, such as MDR-Tuberculosis, has significantly decreased the impact of the more available acute treatments, thereby rendering the difference in treatment availability for acute and chronic drugs even more strenuous to developing nations.
The global economic crisis resulted in funding cuts to basic healthcare. Yet from 2008 to 2009, pharmaceutical prices rose 5% in high-income countries and 11% in low-income countries. In the face of such bleak circumstances, however, both public and private organizations are striving to reverse the growing disparities in access to essential medicines between rich and poor nations. Several economic strategies are being employed to this end. Groups such as the Global Fund to Fight AIDS, TB, and Malaria are working to create alternative financing strategies to significantly decrease the price of essential medicines in developing nations. Alternatively, local production of these drugs is seen as a potential path toward achieving adequate availability.
This latter system has already encountered several difficulties in regions where it has been implemented. In Africa, local drug producers face challenges in receiving official recognition from organizations such as the WHO and the United States Food and Drug Administration (FDA). Without this recognition, these companies are cut off from major sources of financing received through the WHO and FDA associated groups like the Global Fund. Furthermore, the processes to confirm the adequacy of local drug products and active ingredient supplies are often too expensive for these local groups. These roadblocks prevent local drug production from being a financially superior alternative to production elsewhere.
Increased research and development and a “pooled resources” approach to drug acquisition have also been proposed as possible solutions to this essential medicines crisis. Encouraging research and development on diseases primarily afflicting these low-income nations could potentially result in more cost-effective disease treatment. The “pooled resources” approach proposes that nations collaborate to purchase drugs in cases where they otherwise might not qualify for discounts of purchasing these drugs en masse. In fact, members of the Organization of Eastern Caribbean States, including nine island nations, have already adopted this procedure with much success, seeing prices reduced by as much as 44%. This offers much hope for its adoption by other groups of nations throughout the world.
With both individual health and general economic viability at stake, immediate attention must be devoted to providing adequate essential medicines to developing nations. We can no longer allow situations such as the Guatemalan “lottery” for AIDS medication to persist.