Access to Medicines: When the gloves come off, who comes out on top?

When I set out to plan the Access to Medicines: Innovation, Industry and Advocacy panel discussion that took place on January 27, I think my intentions were somewhat naïve. After taking Global Health Governance and completing an analysis of five financing proposals to reform the current global system of funding for research and development for neglected diseases, I felt that I had a grasp on the complexities and players that govern the global effort to achieve access to medicines. I knew that any solution that could feasibly and sustainably improve the state of global access to essential medicines would have to work within the current intellectual property and market systems. I wanted to hear how experts in the field felt about the issue of access to medicines in a global context. So I offered to work with the McMaster Health Forum Student Subcommittee to ask three of these experts to share their thoughts with students and the larger McMaster community. When we invited the three panellists – Philip Blake, CEO of Bayer Canada and chair of the board of the Rx&D Council of Canada, Richard Elliott, executive director of the Canadian HIV/AIDS legal network, and Aidan Hollis, Vice-President of Incentives for Global Health – I expected more of a “let’s all hold hands and work on this together” message, since this was the conclusion we as a class came to in terms of advocating for an effective approach to improve access to medicines.
As undergraduate students, we are too often blind to the real life complexities that govern challenges such as access to medicines. On paper we determined that any strategy to encourage research and development for drugs that primarily affect the poor had to maintain the backbone of international patent law, encourage new incentives for major pharmaceutical firms, ensure that grassroots advocacy is heard, and that the product reaches the individuals in need. After a semester of thought, that’s a pretty hefty solution and I thought that these three experts would agree with our class of undergraduates.
I was wrong. They did not agree. They did not buy into my pitch of discussing holistic strategies to work towards achieving universal access to medicines. Some part of me thought that our panelists would get up and sing Kumbaya, metaphorically speaking, and realize that any solution does require collaborative efforts from the groups that each of them came to represent. Instead, Mr. Blake, and big pharma in general, were essentially vilified as being the root cause of the problem within the constraints imposed by WTO trade and patent agreements on drugs.
When the gloves came off, there were three men standing in the ring. A quiet Mr. Hollis generally stayed out of the debate, having presented his case for a fund that provides incentives to create drugs for diseases that primarily affect the poor based on the health impact of the medicine, in a calm and academic fashion. Mr. Blake kept his initial presentation very personal, and when he stepped in the ring during the question-and-answer period, handled the jabs like a seasoned pro… he had clearly fielded all of these questions and criticisms before. Finally, Mr. Elliott appeared to be the emotional one, vying to present the most eloquent argument and shaming the global trade system – and all those that work within it – that has lead to current global inequities in access to medicines. The debate offered unique insight into the obstacles that stand in the way of achieving universal access to medicines that you don’t necessarily read in published literature. The serendipitous nature of drug development is not discussed in any of the papers we read on access to medicines, nor was the prohibitively complex nature of the Canadian Access to Medicines Regime. Although the fiery debate that took place during the event painted a very real picture of the present state of research and development and the Canadian Access to Medicines Regime, I remain optimistic that those that need to make the large-scale decisions to fund efforts such as the Health Impact Fund and other promising proposals to offer incentives to encourage access to medicines in a global context will maintain a holistic “big picture” outlook that involves stakeholders from the pharmaceutical industry, groups that encourage innovation, and advocacy NGOs. This event was a unique opportunity and I am hopeful that students that learn about challenging issues, such as access to medicines, in both an academic and experiential context, will be able to contribute to the global effort in a professional sense, in a holistic and collaborative way.