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Since 1977, the World Health Organization has been managing and updating a list of medicines that it describes as "essential". They urge governments, particularly in developing countries, to make these drugs widely available. The addition of a drug to the list is controversial because it can expand access to it, but also imposes new demands on health budgets.
The WHO added this week 12 drugs for five cancer treatments to its list, including several new and very expensive ones.
In the past, WHO's list of essential drugs has been almost entirely devoted to cheap non-patented drugs. In recent years, first with anti-HIV drugs, and more recently against hepatitis, cancer and autoimmune diseases, pressure has been exerted to include new drugs, some of which are extremely expensive. This poses challenges for governments' health budgets, as their use can potentially divert resources from more profitable treatments.
However, as we have seen with HIV and hepatitis treatments, governments can lower the price of drugs by voluntarily licensing patent rights to commercial drug manufacturers, or in a more coercive way by using compulsory licenses or price controls.
My partner and my co-author's partner are alive thanks to access to effective anti-cancer drugs. One of these drugs was added this week only to the WHO list. Two other drugs that my partner has used have been rejected, even though they are considered effective treatments.
We urge WHO to develop a second list of drugs – those that would be labeled "essential" if they were available at affordable prices.
Some of the newly added essential cancer drugs are available at relatively low prices in some countries or can be manufactured cheaply. The cost of producing afatinib, used to treat lung cancer, has been estimated at $ 8.85 per month, and lenalidomide, for the treatment of multiple myeloma, at $ 2.55 per month.
Patents will block competition and prevent the entry of cheap drugs in many countries. But governments can and must remove these barriers. Previously, when the authorities showed their willingness to use compulsory licenses, pharmaceutical companies responded by offering voluntary licenses through the UN-supported drug patent pool.
But this is rarely produced outside the field of infectious diseases such as HIV, tuberculosis and hepatitis. In 2016, Andrew Witty, then Managing Director of GSK, said that the company would consider submitting patents on new drugs to the MPP, but that his successor had not followed up on the anticancer drugs.
Our advocacy to make these new essential cancer drugs affordable in developing countries can only raise concern that low prices will deter spending on research and development of new drugs. But most of today's drug sales are in high-income countries, and developing-country earnings for many cancer drugs are unimportant.
These concerns about incentives for innovation do not require us to tolerate high prices and unequal access. They could be addressed through other measures separating drug prices from research and development expenditures, such as research grant programs or "market entry bonuses", which finance drug development. responding to specific needs.
We also call on WHO to change its approach to treating metastatic cancer. The Essential Drugs Committee rejected the inclusion of two important drugs used in the treatment of metastatic bad cancer, claiming that this was not considered a priority.
This is in contradiction with the evidence that cancer is often diagnosed late in low-income countries when cancer has progressed further. In addition, as first-line treatments improve and prolong life, this creates a need for treatment for metastatic cancer.
The author directs Knowledge Ecology International. Ellen 't Hoen, Senior Director of the Drug Patent Pool and Director of Medicines Law & Policy, contributed
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