Health economists call for strategies for universal access to medicines

In an editorial in the journal The Lancet Professor Niessen and Dr Khan argue that strategies to make medicines more available and affordable are critical in increasing their use in low- and middle- income countries. There is a double burden of infectious and chronic diseases, while the awareness of the benefits of prevention and treatment has grown.

Their comment comes following the publication of the McMaster University-lead Prospective Urban Rural Epidemiology (PURE) study on the availability and costs of cardiovascular medicine across 18 countries. This landmark health economics study on the empirical costs of medicines with comparisons across both high- and low-income settings, shows that secondary prevention is unavailable and unaffordable in the surveyed 94,919 communities across the world. Professor Niessen and Dr Khan argue that its findings are important in the formulation of policies on universal health coverage and the mobilisation and use of resources in relation to NTDs, and infectious and chronic diseases.

They state that it is unlikely that surplus household income is available for prevention. Household expenditures relate to all major health events -- including strokes, infarctions, neglected tropical diseases, major infections, injuries, and cancers. Many households become poor due to income loss from illness. Health safety nets such as insurance in advancing systems provide broader coverages. In fragile communities societal safety nets may cover all types of events as food shortages and disasters. Secondly, they explain that use of medicines is influenced by general awareness, health literacy, service quality, and the quality of workers. This is all important as increased availability may lead to misuse.

They acknowledge that universal access to medicine promotion has to address these multiple obstacles in the provision of appropriate care to communities. At national level, options for policy-makers are price control measures, price management of generic medicines and promotion of market entry through flexible TRIPS arrangements and licensing, and internal reference pricing of generic. An increase in international co-ordinated actions, such as mass production of low-cost antiretroviral drugs and the mass drug provision in the control of neglected tropical diseases is needed. Low cost treatments are possible for many conditions through mass production.

Professor Niessen and Dr Khan call for more efforts to develop national regulating mechanisms and on pricing closer to drug production costs. Universal access to medicines is accelerated through better health financing and the availability of affordable medicines targeting major diseases among the poor. This is what LSTM's health economics research is mapping out and contributing to.