Medicines and health systems – a new global health security dimension to consider?

The emergence of public health threats, interconnected markets and increasingly complex trade and property rights rules raise questions on the role of pharmaceuticals in global health security

Medicines and health systems – a new global health security dimension to consider?

By Giuliano Russo of the Instituto de Higiene e Medicina Tropical and Oxford Policy Management and member of the Medicines in Health Systems Thematic Working Group, and Stefan Elbe – Director of the Centre for Global Health Policy, University of Sussex

The importance of safe, effective and affordable medicines in meeting global health objectives and in building comprehensive health systems has long been recognised. However, in a rapidly globalising world, the emergence of public health threats, interconnected markets and increasingly complex trade and property rights rules, raise a number of questions around the role of pharmaceuticals in global health security. Global health security can be thought of as the capacities required for countries to respond to emerging (or re-emerging) public health threats and the ability of these countries to reduce the risk of these threats crossing borders. The risk is believed to be particularly high for low-and middle-income countries (LMICs) with underfunded and less-developed systems.

On 9 June 2016 a workshop took place on Medicines and Markets: the Role of Pharmaceuticals in Global Health Policy, co-hosted by the Institute of Hygiene and Tropical Medicine of Lisbon and the Centre for Global Health Policy of the University of Sussex. Across four panels and 12 presentations, UK-based and international experts from diverse academic disciplines presented and discussed ongoing research on pharmaceuticals and health security. The topics ranged from the global supply of medicines, the political economy of manufacturing pharmaceuticals in LMICs, and Anti-Microbial Resistance (AMR) in resource-poor settings.

A number of key issues were raised in relation to the role of pharmaceuticals in the health security domain. First of all, the emergent, pluralistic international order – with the rise of India and China in particular – has important ramifications for the future management of health security threats. Global security efforts must be reconciled with the needs of many other countries around the world; needs that may be at odds with the particular interests of the Western and U.S. pharmaceutical industry. In particular, the relevance of medical countermeasure development for the world must be balanced with improving access to existing medicines.

Analyses of the evolution of the political economy of patents for medicines, the role of patent implementation for the availability of pharmaceutical products and the effect of national patent systems’ discontinuity were presented at the workshop. The evidence indicated that governments’ early choices in setting up national patent systems influence the availability of drugs, length of patents and introduction of generics. As the world enters a post-transition period for TRIPS implementation, this creates the need to better understand the changes happening right now in the implementation of patents, the launch of generics, and the development of trade patterns in emerging economies like India, that play a key role in the global supply of medicines.

The influence of countries that are home to large pharmaceutical sectors was also highlighted, balancing the international need to discover new molecules with the host country’s needs to innovate and develop local capacity. The role of African countries in particular was flagged as increasingly critical for defining a global health and medicines agenda, as ‘global’ health security can only be achieved through ‘local’ health security and local economic development. For this to happen, the right economic incentives must be harnessed in local pharmaceutical markets, so that the most needed medicines are produced. Interestingly, a need was also identified to find a common way of dealing with pharmaceuticals and medical devices when discussing global health security, as the latter often represent a neglected case of dependency and insecurity for less industrialized countries.

Finally, it was highlighted that the impact of the widespread attention on AMR for low-income countries raises significant concerns around ensuring the access and the right to antibiotics for the poor. In order not to jeopardize the substantial health gains made in the past through the availability of antibiotics in low-income countries, an international agreement must be reached as to how newly developed antibiotics will be used. It was suggested that the debate should therefore shift from restricting the use of antibiotics in low-income settings to how to achieve a just and sustainable use by focusing on its governance. Some of the key problems that must be addressed in managing this balance between continued access and the efficacy of newly developed medicines include: understanding community perceptions of antibiotics and their use, the role of informal providers in dispensing antibiotics, and understanding more clearly the role that antibiotic use in animals plays in generating resistant bacteria in humans.

Watch the workshop follow-up video (by The Centre for Global Health Policy at the University of Sussex) below:

At the Fourth Global Symposium on Health Systems Research, there will be an organised session covering similar issues titled “Resilient and Responsive Health Systems for a Changing World: the Role of Health Markets in Managing Antibiotic Use in Low and Middle Income Countries”, which will be taking place from 11:00 – 12:30 on November 17th, 2016 in Room 18.

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