Mainstreaming delinkage

At the 67th World Health Assembly

Last month saw the occurrence of a development which, even if small and under-reported, I would consider to be of significant importance – when the 67th World Health Assembly (WHA) announced a decision to give the World Health Organization (WHO) Secretariat a mandate to create a pool fund that will allow the price of a drug to be delinked from the R&D costs involved in creating that drug. Though the fund is to be administered by the “Special Programme for Research and Training in Tropical Diseases”, the WHA included a statement recognizing that the fund was not to be limited only to “Type III” (i.e., tropical diseases), meaning it was to be made available other types of diseases as well, including non-communicable diseases like cancerous diseases. The decision is available here.

In order to understand why a movement towards delinkage is important, as several scholars have already pointed out, one only needs to look at the effects of ‘drug price – R&D cost’ linkage. Essentially, it means that drug innovation can be rewarded based on the usefulness of the drug, rather than the pockets of the patient.

As drugs are expensive and risky to develop,  there is little incentive for pharmaceutical companies to invest much in drug research but rather to invest in ensuring sales are made. And thus we have the problem of ‘evergreening’, wherein pharmaceutical companies are incentivized into trying to get successive patents on minor variations of a drug, so as to extend their monopoly period. Similarly, there is little incentive to developing treatments for diseases that predominantly affect the poor.

That’s also why, for example, despite the stark warnings that scientists have been giving regarding the onset of a ‘post-antibiotic era‘ (where our current antibiotics are rendered redundant due to resistant, turning simple cuts, bruises and infections into potentially deadly conditions) the drug pipeline seems to be empty of new lines of antibiotics. Speaking of which…

Longitude Prize

longitude prizeOn 25th June, the Longitude Prize 2014 (named after the prize instituted by the British government in 1714) announced that their vote count had come in, and the public had voted for their £10 million prize to go towards solving this antibiotics crisis. The prize, which asks the public to vote on which problem’s solution they think is the most in need of a prize stimulation, puts forward global challenges under 6 broad headings – energy, environment, global development, technology and robotics, democratizing access to communications, and health and wellbeing. The prize is open to anyone – from amateur scientists to professional labs – for a period of 5 years. You can see more about how the prize works here.

Just like the R&D fund mentioned above, a prize system also delinks R&D costs from the ability of patients to pay for a treatment. With more prizes like this coming to the fore, as well as mechanisms like the R&D fund gaining more ground, it looks like there is some badly needed recognition of the requirement to delink when it comes to public goods like public health!

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