Reaching the Sustainable Development Goals will require a collective action. This is no more so the case than for Goal 3: Health and Well-being, Target 3.8, 3b1 – which focuses on access to safe, effective high-quality and affordable essential medicines and vaccines. Achieving this target will require considerable input from both researchers working on health systems in general and those focusing medicines in health systems. But is the goal as formulated sufficient?
In the short interview below, Dr. Maryam Bigdeli asked fellow senior researchers Dr Anita Wagner (AW) from the Medicines in Health Systems Thematic Working Group and Dr Kabir Sheikh (KS) from the HSG Board of Directors to give us their viewpoint on this question.
From your perspective, do you think that by reaching Target 3.8, 3b, we will realize the benefits of medicines for the health of all?
AW– No, I don’t think so. As formulated, Target 3b perpetuates an emphasis on “access to medicines”, patents and prices. This focus, dating back to the HIV/AIDS epidemic, has not done proper service to the systems strengthening and medicines fields; increasing access without a focus on who uses medicines, for which indications, and how can be detrimental to the goals of Universal Health Coverage. Other objectives of medicines in health systems must also be considered.
KS – I agree with the two targets, but the SDGs could have seized the opportunity to go further than what was already expressed in the MDGs. In Target 3b, there is an implicit assumption that the primary obstacle lies in the issue of patenting regimes and medicines production. I don’t believe this is entirely correct, there are more proximal access obstacles, especially medicines supply and regulatory issues. The current articulation of SDG targets around medicines does not encompass the systemic factors.
As you seem to say that Target 3b is not adequately formulated, please describe what could be an important target for improving medicines situations in the coming 30 years?
AW – There are four key medicines objectives that health systems must aim for: availability of high quality generics and innovative products, equitable access to those products, appropriate use of those products, and affordable costs for both households and health systems. By definition, these four objectives compete: policies and programmes must try to address this competition and strike a balance. Toward this end, I think work on medicines should have two foci:
- A focus on advancing systems to generate information for decision making on how well the four key objectives are met, using data from different parts of the system and generated by different stakeholders;
- A focus on stakeholders’ engagement in both information generation and acting on the basis of that evidence.
KS – Medicines targets should also focus on regulatory and supply chain issues.
A first objective is to build stronger regulatory systems for better availability, quality and affordability of medicines. This objective applies for all low- and middle-income countries.
A second objective concerns the many countries that are not producers of medicines themselves. In that context, an important question is how to harness both public and private sectors to support domestic production. It is a common understanding that medicines production is a private business but the public sector must be engaged in innovative ways.
In which fields of research in health systems should we invest in the next 30 years to inform decision making on important questions around medicines?
AW – A key research question is how we define the value of medicines from different stakeholders’ perspectives, and how we can take socially responsible decisions based on these values.
The information used for decisions and the processes for system change are of utmost importance. We need to invest in research on how to efficiently generate and use information on medicines in health systems (with proper attention to ownership and confidentiality of the underlying data) and in research on processes for implementing system change, continuously and dynamically. To address these research questions, we certainly need much more collaborative approaches, with input from different fields.
KS – The medicines field is a politically charged domain as medicines are a huge commercial market and one of the most important health commodities. Yet there is not enough research on the political economy of medicines. In addition, implementation science can support improvement of regulatory, supply and procurement functions. Little is known on how regulatory agencies or supply and procurement agencies actually operate, what challenges they face, not only technical challenges but also pressures from lobbies.
Hear more from the Medicines in Health Systems Thematic Working Group at the 4th 2016 HSG symposium in Vancouver. The TWG will be hosting a session led by Dr. Calvin Ho, entitled “Universal health coverage as an ethical enterprise: Resilience and responsiveness of equitable health systems”.
1. Support the research and development of vaccines and medicines for communicable and non- communicable diseases that primarily target developing countries, provide access to affordable essential medicines and vaccines in accordance to the DOHA declaration on the TRIPS Agreement and Public Health, affirm the right of developing countries to use the full provision in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health and in particular provide access to medicines for all.