Monday, May 4, 2009

Presentation of the Health Impact Fund

Thomas Pogge, from Yale University, came today to the PRBB to present, for the first time in Spain, the Health Impact Fund (HIF). This is an interesting initiative of the Incentives for Global Health (IGH)
Incentives for Global Health (IGH), a non-profit organization, and its aim is to stimulate research and development of life-saving pharmaceuticals accessible to the world's poor.

I believe that this is an issue of global importance, and so I was a bit disappointed to see the PRBB conference hall was not very full at all. But then I am often disappointed by this fact…

Access to medication in poor countries is a big problem. Not the only one leading to poverty and disease in these countries (there’s the lack of drinking water, corruption, etc.), but one that should be preventable.

There are two main related issues that affect accessibility to drugs nowadays:
- the innovation problem: that is, the fact that there is little R+D+I investment in diseases that affect mainly the developing countries. In fact, out of the 1558 new drugs developed between 1997 and 2004, only 21 were for tropical diseases and tuberculosis.
- the access problem: that is, that the price of patented drugs is too high for many people (specially in the developing world) to pay

Both problems are related since, if prices of drugs go down so that everyone has access to them, the return for the pharma companies is lower and they are therefore less interested in spending money in innovation.

The Health Impact Fund (HIF) presents itself as a long-term sustainable solution to continue innovation in the drug market without impending access to the medicaments. The idea, as I understand it, is the following.

- When a new drug is developed, the company can choose to register it with the HIF, rather than applying for a patent, as they currently all do.
- By doing so, they compromise themselves to sell the drug at cost-price (that is, to not make any money from the selling of the drug to the patients).
- In exchange, they will receive money from the HIF during the next 10 years. That money will be a share of the total HIF fund, which is expected to be about 5 bilion €.
- The amount of that share will be calculated annually, and will be proportional to the drug’s global health impact (understood as how much is that drug improving people’s lives).
- The total amount of the fund will be financed by governments. Other agencies, funds, etc. could also participate (e.g. Gates Foundation), but governments are the only ones that can commit for a long-term funding, which is needed to give the industry
- After the initial 10 years, the company must offer, at zero cost, global licenses on all the intellectual property required for the manufacture and sale of the drug, so that from then on anyone can manufacture the drug.

After Dr Pogges’ talk there was a round table that included members from pharma companies, NGOs, the Catalan government, researchers, and patent experts. Some of the questions and concerns raised there were:

- How would the price of the drugs be decided? Who should participate in this decision? Should the pharma companies be involved, or should it be independent assessors?

- How would it be decided what health impact each drug has and what percentage of the fund they are therefore entitled to?
o an important role of the HIF will be actually to collect lots of data regarding this – actually 10% of the fund would be used for following specific drugs, see who takes it and what are the consequences, etc. These data would be useful not only for the HIF but for lots of NOGs, international agencies, etc. interested in the health situation in poor countries.
o The idea is to check the real impact of the drug, and to give money back to the industries based not on ‘how many drugs they sold’ but on how much those drugs improved the condition of patients. This means (and this is an interesting point) that it would be in the interest of the pharma industries not only selling the drug, but also making sure that they are well prescribed, taken properly (a big problem in these countries is that people don’t take the drugs for the amount of time necessary, etc.), etc. Some ways in which the industry could help with this is writing instructions in the local languages, offering courses to local doctors and nurses, collaborating with NGOs and international agencies who work locally, etc.

One question I have is: would the pharma companies be really interested in this? I don’t see them making more money with this initiative than they currently make, so why would they decide to go for HIF? One suggestion that came from someone at the audience was to create a ‘HIF’ stamp that would give companies quality/moral value that would make them more attractive to costumers (similar to having a ‘fair trade’ stamp, or ‘organic’, etc.). I am not sure that would work for medicines, but it’s a good idea…

There were many other things discussed, and many more that were remained unspoken, but if you are interested you can check more about this initiative in the Health Impact Fund (HIF) website. At the moment Thomas Pogge is travelling the world talking to all the potential stake holders (governments, scientists, pharma companies, NGOs, lawyers, economists, philosophers, everyone!), presenting the initiative and collecting all the possible feedback to improve the proposal.
I hope that soon we will see a final HIF proposition that responds to everyone’s concerns and that can help, finally, making good drugs accessible to those who need them.

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