By Yannis Natsis @ynatsis Policy Coordinator, Universal Access & Affordable Medicines, EPHA
“Healthy Innovation for All”, the 2016 Universal Access and Affordable Medicines Forum of the European Public Health Alliance (Brussels, 29 November 2016) organized under the auspices of the Polish Perm Rep brought together top experts, policy-makers and key stakeholders to discuss the problems and the future of drug development in Europe. The format of the Forum itself fostered a genuine dialogue as there were no presentations and guest speakers engaged in a real debate among themselves and with the audience. This was the primary aspiration of the co-hosts, EPHA and the Polish Perm Rep to the EU.
Social cohesion and social justice in question
There was a common understanding that the question of equitable access to medicines constitutes a shared problem for member states across the continent. A problem that touches upon the core of European values & principles including the one of solidarity. It tests social cohesion and puts social justice into question. This growing challenge actually diminishes countries’ capacity to fulfil the basic human rights of their citizens including the right to health.
In many parts of Europe, away from the ivory towers of Brussels, a fully-fledged access to medicines crisis is already the reality on the ground. Europeans cannot access their treatments because they cannot afford them. Patient groups compete with one another and are forced to fight over access. Some of them even cross borders in the pursuit of their medicines. Physicians complain that they are not free to prescribe what they deem best for their patients. At the same time, policy makers are designing and imposing rigid access restriction policies in order to ration the number of patients entitled to the most expensive treatments. If they don’t the risk of bankruptcy is a clear and present danger. The survival and sustainability of the health care systems are in danger. Ethically and politically speaking, this is unacceptable.
The issue in question goes well beyond the needs and specificities of a business sector. It is safe to say that the question of equitable access to medicines represents one of the greatest tests for social cohesion and social justice.
Pharma & the Stockholm syndrome
That is why bold and brave action is necessary now. Paradoxically enough, we do not realize it but when it comes to pharma, we seem to be collectively suffering from the Stockholm syndrome whereby the hostage develops feelings of trust and affection for its captor. The same applies to pharma, we feel that we are stuck that there is nothing we can do about it; there are no alternatives. This is false.
Let’s start by fixing the issues identified by the EU Health Ministers in the groundbreakingJune 2016 Conclusions. The case of orphan drugs is a loud and clear example of how incentives and rewards put in place to achieve genuine innovation are now used for genuine profit maximization. The system has been abused. The good news is that the situation can be reversed. It is not set in stone. If we chose not to address it, we will go bankrupt and we will keep getting medicines of very questionable innovative value. Speaking of orphan drugs, the further orphanisation of pharmaceutical regulation is a number one danger. This is also reversible. National governments have the power to send a clear signal to the European regulator to stop and change course. It is high time, we had a critical look at the regulator itself. Isn’t it self-defeating that 83% of the revenue of the EMA comes from the regulated? Where has this brought us and where does this lead us? Who does the regulator really work for? Its clients; as the EMA describes the pharmaceutical industries or European citizens?
Bold action, no taboos
Another key priority should be to Increase public funding in medical R&D, if governments want to be realistic about having a say in the final price of drugs. In doing so, policy-makers should make sure that we are not paying twice or thrice for our medicines. Attach public interest conditionalities to the public funds, guarantee public return on public investment. Besides; we should not forget that the pharmaceutical expenditure essentially is vast amounts of taxpayers’ money going towards the private sector.
No proposal should be considered taboo or off limits. Besides, the patent-based pharmaceutical “business as usual model”, these government-issued monopolies contributed to the access and innovation crises we face today. It is up to us, in our respective capacity, at the European and national levels to set the new rules of the game to ensure that our health is the real winner.