Health equity in economic and trade policies

A disproportionate burden of infant and under-five childhood mortality occurs during the neonatal period, usually within a few days of birth and against a backdrop of socio-economic deprivation in developing countries. To guide programmes aimed at averting these 4 million annual deaths, recent reviews evaluated the efficacy and cost-effectiveness of individual interventions. However, no systematic review of the empirical data on packages of interventions, including consideration of community based intervention packages, has yet been performed. To address this gap, we reviewed peer-reviewed journals and grey literature to evaluate the content, impact, efficacy (implementation under ideal circumstances), effectiveness (implementation within health systems), type of provider, and cost of packages of interventions reporting neonatal health outcomes.

Least developed countries (LDCs) have used the 2016 transition period for TRIPS and have demonstrated the value of the flexibility provided by the extension. There remains opportunity to further enhance the benefits of this transition period through the end of the period in 2016. LDCs and other stakeholders, like civil society, can all play a role in maximising opportunities to improve access to HIV-related medicines in least developed countries during this period. By January 2016, the patenting situation of HIV-related medicines, particularly second and third-line treatments, as well as diagnostics, will be even more complex than it was in 2001 when the Doha Declaration was adopted. Therefore LDCs will continue to need maximum flexibility beyond January 2016 with respect to their TRIPS obligations in order to address their public health needs. There are clear parameters and rationale for granting LDCs further extension before full pharmaceutical patenting is required. The case for extension should be made clearly and in timely manner by LDCs with the support of other WTO Members and international organisations, such as UNAIDS. It is key that a coherent legal, political and practical case is presented, complying with TRIPS procedures, in order to ensure success.

This new book was launched on 10 July and has been called the ‘most progressive agenda we’ve ever had at the World Intellectual Property Organisation.’ Implementation of the ‘Development Agenda’ will be complicated, however. First, there is a divergence at the national level between different stakeholders whose work touches on intellectual property (IP). There are ‘very few delegations that can say there’s a consensus domestically,’ notes the author. And countries must also close the gap between what is said at the international level and what is done at home. A development agenda will ‘never have legs on the ground unless member states go home and implement it.’ But IP laws must also be sensitive to cultural norms and context, lest they alienate key stakeholders. Laws that have lost touch with reality are ‘less likely… [to] be enforced,’ he said. More moderate IP laws, with flexibilities, could increase enforcement. The author also affirms the need to develop good partnerships and good governance.

This work is a review of public sources including white papers, news and peer-reviewed literature with a focus on mainstream approaches used by the pharmaceutical industry (such as unaffordable price premiums for innovative medicines) and governments (such as denial of intellectual property rights) to support their interests. The authors also explore the implications of possible approaches on pharmaceutical policy in the context of global health diplomacy. The latter is a requirement for universal health coverage given the increasing power of state and non-state actors in emerging markets. The authors conclude that evidence and due processes, through inclusive and transparent priority-setting mechanisms, offer a reconciliatory way forward for both parties. Value-based pricing, underpinned by Health Technology Assessment (HTA), could leverage global health diplomacy to set priorities and resolve the perhaps unsustainable status quo. HTA is itself a diplomatic, consensus building and evidence-based approach that can help diffuse the current tension, enhance mutual understanding and perhaps help strengthen (or even mend) the current model of product development. Value-based pricing and HTA offer a potential priority setting mechanism that can serve as a transparent, non-adversarial platform for governments and the pharmaceutical industry to engage with each other and work towards enhancing access to medicines. Further quantitative research, exploring the impact of different policy-setting approaches by governments on medicine access using HTA, would strengthen this discourse.