WHO transparency resolution seeks to dispel opacity around drug prices and sheds light on international policy-making

First Published by International Health Policies Blog

Disease unites the world. So does the impact of unbridled capitalism. Rich and poor countries alike, came together this week to take first steps to understand why medicines cost as much as they do. The 72nd World Health Assembly that convened in Geneva, adopted a resolution to push for greater transparency around the prices of drugs, but fought shy to endorse costs associated with research and development and clinical trials.

Countries, of course, can implement national policies that can go further than the letter of the resolution with respect to the disclosure of costs of R&D and clinical trials. For example, Thailand has said that it reserves the right to go beyond the resolution in terms of disclosure of R&D costs.

In an unusual move, a few countries (UK, Germany, Hungary) disassociated themselves from the resolution. 

For those who did and for others, the resolution will shine light on the opaque processes on how medicine prices are published, negotiated and protected. The resolution hopes that “availability of comparable price information may facilitate efforts towards affordable and equitable access to health products”. 

Global health media was awash with the news of a “watered-down” version of the transparency resolution. Activists may quibble on the scope of the resolution itself. The final version of the resolution was softer on the language around costs of clinical trials and R&D costs. The agreed text was the result of more than 70 hours of negotiations during the World Health Assembly, and in addition to  formal consultations since February 2019, when Italy first proposed the resolution. But to be sure, the stream of information that the resolution seeks to make way for, might open the floodgates on transparency in the pharmaceutical sector.

And why not, everyone, not just patients, stand to gain from more transparency. Information, after all is power. And transparency is good for governance.

Shareholders for example, will benefit from more information on costs of clinical trials, James Love of Knowledge Ecology International said. For smaller companies, such costs are material to share price, he added.

Activists are optimistic. This is the first time the WHO has been asked to engage in transparency as cross cutting issue, and it can be seen as a solid start, Love said on Twitter.

The resolution makes a slew of “requests” to the WHO secretariat, including to analyse the availability of data on inputs throughout the value chain (including on clinical trial data and price information). It says WHO must analyse relevant information about the transparency of markets for health products, including investments, incentives, and subsidies. It further asks WHO to support research and monitor the impact of price transparency on affordability and availability of health products, including the effect on differential pricing, especially in Low and Middle Income Countries.

Member states have been asked, among other areas, to work collaboratively to improve the reporting of information by suppliers on registered health products, such as reports on sales revenues, prices, units sold, marketing costs, and subsidies and incentives.

How the negotiations played out

Negotiations around the resolution captured attention for much of the duration of the Assembly, even so far as threatening to precipitate into a vote on the matter. There were murmurs that the UK would force a vote on it. There was a collective sigh of relief and applause in Committee A, when countries let the resolution pass without objection. Few countries did put their statements on record raising procedural and substantive issues on the resolution.

How did this ambitious, high-stakes resolution that has now been referred as a milestone and a game-changer, pass muster?

A number of factors came together to bring this into fruition – a “huge” engagement by ministries of health, an active NGO army, social media chatter and blow by blow news coverage even before the resolution was passed, according to those present. It is understood that while there was no “advance” plan of action, activists noted how civil society organizations came together organically and engaged with respective governments to support the resolution – particularly in Germany and France. In addition, more than sixty NGOs from sub-Saharan Africa wrote to the UK government to support the resolution.

“It is easy for an NGO to talk about transparency. But it is very difficult for a government to do so. There was enormous pressure on Italy, by other member states including Germany, UK, Sweden, Denmark. As a member of the European Union, it is not that easy to push through something like this,” Love said.

Personalities make a difference during such negotiations. Sources said that the chair of the drafting group on the resolution, Luca Li Bassi, the General Director of the Italian Drug Agency (AIFA), also on board of the European Medicines Agency, was fully engaged and was present every single day. He also had the backing of his minister of health Dr Guilia Grillo. As many as 19 other countries eventually became co-sponsors of the resolution.

In their statements after the adoption of the resolution, several countries, including Germany, UK, Australia, France, Belgium, New Zealand, Sweden and Canada expressed concerns and disappointment on the processes of tabling the resolution. The UK said that more time should have been allowed to consider the complexities and potential wide-ranging ramifications on price transparency.

Some countries were of the view that the resolution should have been brought up at the Executive Board meeting earlier in January this year. They also expressed displeasure on the way the discussions around the resolution surfaced in public especially on social media. Ironically, this was even as there were calls to make the country positions public when the negotiations were underway.

Whether or not some member states approve of it, international diplomacy will continue to be impacted by public participation, especially online. (A press conference by Italy’s Minister of Health Dr Giulia Grillo on the transparency proposal was broadcast live on the Ministry’s YouTube channel in February this year.)

These are the new rules of engagement, which are likely here to stay. It may not always be possible to control the message any more. (The hashtag of the week, at least for global health geeks was #TransparencyResolution)

Is the resolution really watered down?

As has been reported, stronger commitments around transparency of costs of clinical trials  weakened as the negotiations evolved. In addition, the text does not make distinction between health “technologies” and “products”. Experts believe that this could have implications that could result in higher patent protection.

However, it is expected that the resolution could help open future discussions on costs of R&D and even costs of clinical trials. If costs of clinical trials are made public even in one country, say the US, it would be useful across other jurisdictions.  

“The beauty of something like this is, even if there are 50 countries disclosing prices, that is sufficient to help us get a better picture. Currently there is hardly any information or transparency around prices. You just need a critical mass of countries to come on board,” Love of KEI said. “I think we are winning the hearts and minds around this conversation on drug prices. The industry will fight back, but I do not think they will be able to stop us,” he added.

What next?

Transparency is the djinn that will not go back into the bottle. The industry will no doubt fight back and want to stanch this.

While transparency itself is not the magic potion to reduce drug prices, the resolution, if implemented well, will gather evidence to address information asymmetry that favors sellers of drugs while negotiating drugs prices in secret, experts have said. “Better information on prices agreed in other countries strengthens the negotiating leverage of buyers (e.g. through reference pricing policies)”, a global health expert said last week.

The negotiations around the resolution, also demonstrate the role of WHO in convening these discussions and getting member states together to take responsibility to fix intractable problems in global health today. Brazil said that this resolution showed that WHO is able live up to its mandate  to improve access to medicines and contribute to the goal of Universal Health Coverage.

Multilateralism has won this round.

WHO Report Flags Distortion of Investment and Innovation in Cancer Research

Originally published in The Wire.

Geneva: High prices of cancer drugs hurting desperate patients have caught the attention of policymakers everywhere. But do high prices of medicines that provide huge financial returns to pharmaceutical companies also distort innovation?

A new cancer report by World Health Organisation (WHO) has both countries and the pharma industry debating on just how much profit cancer drugs generate for pharmaceutical companies. At stake is not only how much money the drug industry makes from high priced cancer drugs, but also, as the report suggests – is this investment really efficient? Is too much money chasing too few cancer drug candidates with only marginal benefits, diverting funds away from other therapeutic areas?

The technical report that minced no words, said that “pharmaceutical companies set prices according to their commercial goals, with a focus on extracting the maximum amount that a buyer is willing to pay for a medicine”. The industry denounced the report as flawed.

The report showed that in some cases, the return on investment on research and development fetched companies as much as $14 for every dollar invested. The report infers:

[T]he high financial returns from cancer medicines, together with other government’s incentives, might have over-incentivized the pharmaceutical industry to dedicate considerably higher, possibly disproportionate, levels of investment towards the R&D of cancer medicine.

The innocuous-looking comprehensive technical report on pricing of cancer medicines, issued by the WHO, drew widespread support and endorsement from most countries. Member states came together to endorse and support the crucial report on cancer medicines at the 144th Executive Board meeting in Geneva in January 2019.

All countries suffer from exorbitant prices of drugs which balloon procurement costs to meet rising burden from cancer related deaths. The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. A majority of these deaths occur in low and middle-income countries.

Countries called the report a milestone in the debate around high prices of medicines. It is now aiding international cooperation and dialogue on addressing rising prices of cancer drugs in the wider context of access to medicines.

This story tries to understand and explain some of the issues raised by the industry, including on returns on investment, pricing transparency and efficiency of investments – and compares it to what the WHO’S report has said. It also places the report in the context of the discussions at the executive board meet last week. The Wire exclusively spoke to the author of the report.

Background: The need for the report

The report, titled ‘Pricing of cancer medicines and its impacts’, was first released in December 2018. It was taken up and noted by the WHO’s 34-member Board. Some member states, notably the US, wanted the WHO to organise an information session on the report ahead of the World Health Assembly in May 2019.

The WHO issued the 171 page report following a resolution on cancer prevention and controlin the context of an integrated approach at the 2017 World Health Assembly. Following the parameters described in the resolution [para 2(9)], the report presents evidence on the impacts of pricing approaches (or lack thereof), availability and affordability of cancer medicines. It examines the possible relationship between pricing approaches and R&D of cancer medicines, including incentives for investment in R&D on cancer and in innovation of these measures. It also examines possible funding gaps in undertaking R&D and issues of transparency in price and governance.

The report, supported with more than 400 references, was crafted through several stages of consultations and meetings. There were consultations with member states on the report. The secretariat reported that there were several meetings with the Essential Medicine List Cancer Medicines Working Group and an informal advisory group on availability and affordability of cancer medicines, whose experts provided advice on the technical approach to assessing benefits of cancer medicines, the scope of the report, analytical feasibility and case studies, and suggested options that might improve the affordability and accessibility of cancer medicines.

The report on costs, transparency and efficiency of cancer R&D

The report untangles the complicated and connected issues of price of drugs, costs to make drugs, the incentives to invest in R&D; and whether these mechanisms should be transparent for the sake of public interest and good governance.

The report recognises that the industry considers a number of factors could determine prices including costs of R&D, costs of production and commercialisation, the “value” of medicine, sufficient returns on R&D. The industry disagrees on the extent of the returns on R&D in cancer research.

In what may sound counter-intuitive, the report found that “the costs of R&D and production may bear little or no relationship to how pharmaceutical companies set prices of cancer medicines”.

As mentioned before, the report says that companies put an overwhelming emphasis on commercial goals while setting prices.

There has been continued debate on estimates of R&D costs for drugs – but the most commonly accepted estimates are between US$ 200 million and US$ 2.9 billion, the report says.

Analyses in its cancer report involved examining the sales incomes from cancer medicines. According to the report, for the 99 medicines included in the analyses (those approved by the US Food and Drug Administration from 1989 to 2017 for the originator companies), the average income return by end-2017 was found to be US$ 14.50 (range: US$ 3.30 to US $55.10) for every US$ 1 of R&D spending, after adjustments for the probability of trial failure and opportunity costs.

Further, 33 of those medicines had already qualified as “blockbuster drugs” by having an average annual sales income exceeding US$ 1 billion, the report explains. (The Return on Investment (ROI) is basically a ratio between the net profit and cost of investment.)

The industry did not agree with this assessment. In its statement at the Executive Board on the WHO’s cancer report, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said:

[The report] relies on flawed methodology resulting in overstating the return on investment, suggesting that industry achieves a windfall 1,400% return on investment, contrary to a recent report that estimates R&D returns for biopharmaceutical companies have declined to 1.9%.

It added that revenue from oncology treatments support and fund research into other diseases. IFPMA represents research-based biopharmaceutical companies, and regional and national associations across the world.

The Deloitte report (‘Measuring the return from pharmaceutical innovation 2018’) cited by the industry, showed that Deloitte’s estimates of the projected return on investment of late stage pipelines 12 large cap biopharma companies drop to 1.9%. (A drug pipeline refers to potential drug candidates that a company has under discovery and development)

The Deloitte report calculated “the internal rate of return (IRR) and used it as a proxy to measure biopharma’s ability to balance R&D investment (initial and ongoing capital outlay) with the cash inflows (drug sales) the industry is projected to receive as a result of this investment.” Deloitte says, the IRR is based on the total spend incurred bringing assets to launch and an estimate of the future revenue generated from the launch of these assets.

The WHO says the two reports cannot be compared. In an exclusive interview, the author of the WHO report, Dr Kiu Siang Tay, technical officer, working on Innovation, Access and Use in the department of Essential Medicines and Health Products at the WHO, told The Wire that the information in the WHO report is based on direct observation of reported sales incomes, by considering return on investment as a measure.

Tay added, “We found a median of US$ 14.50 return in income for every US$ 1 of R&D cost, after adjustments for the probability of trial failure and opportunity costs. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs. The Deloitte report, on the other hand, looks at the internal rate of return for late-stage development drugs in 12 companies, based on future projections. These projections put profit return on research and development at 1.9% for these late-stage pipeline drugs. The set of products are not specific to cancer. The two studies are not comparable.”

On the issue of transparent pricing of drugs, the WHO report says that high prices of cancer medicines may have inadvertently caused inefficient R&D practices as well as unethical or illegal business practices. “The increasing use of agreements with confidential rebates and discounts has had a negative impact on price transparency, potentially leading to outcomes that are inefficient or not conducive to good governance,” the report said.

The industry believes that transparency on pricing could hurt preferential pricing strategies. IFPMA said in its statement, “The Report also failed to analyze the unintended negative consequences of its policy recommendations, such as the impact of full price transparency on the capacity of companies to provide preferential prices to developing countries. It does not appropriately take into account the specificity of different national healthcare systems, particularly between developed and developing countries, and promotes policies that could be detrimental to many countries.”

In addition to prices of drugs, incentives given for cancer research have generated much discussion in global health. To what extent to companies benefit from say sources of public funding and how does it impact prices. The report addresses this.

The report raised a fundamental argument on whether cancer research has been “over-incentivized” and more broadly on the efficiency of such large investments.

One justification for high prices of drugs has been ploughing back profits on sales into R&D in order to “reward innovation”. But given the extraordinary returns in some cases, the report said, “the returns on the factors of production of cancer medicines are in excess of what would be necessary to maintain operation of the pharmaceutical industry.”

The report goes further and suggests that “excessive returns, combined with market dominance, could encourage companies to engage in wasteful rent-seeking activities such as lobbying and filing patent clusters to delay entry of generic/biosimilar products, distort investment and stifle innovation.”

It cites evidence of disproportionate levels of research for cancer medicines, despite lower success rates of clinical trials and the highest number of discontinued projects. The potential for lost investment would normally mean that the pharma industry should have diverted investment away from cancer research, the report explains. But higher level of investment for cancer research, “might be explained by the considerable financial incentives in place to safeguard the higher risks of failure”, the report suggests.

The report warns that long-term innovation of cancer medicines might be at risk due to the inefficiencies and distortion of investment that could to excessive returns from cancer medicines combined with market dominance.

“It is simply ‘poor economics’ to chase drugs for the sake of profitability alone. Investment into drugs for cancer research has got the industry into a vicious circle,” one expert told The Wire on the condition of anonymity.

What the report suggests

In a departure from the tone of such technical reports, the report boldly suggests that, “..lowering current prices might in fact be conducive to long-term innovation.” After all, financial return is a function of price and volume; potential impact on revenue due to lower prices could be offset by higher volume, particularly when the marginal cost of production is low, the report justifies.

It cautions:

Global correction of unaffordable prices of cancer medicines will require considerable short-term system adjustments, but such adjustments are fundamental to the sustainability of access to cancer medicines, and medicines in general in the long term.

In bare terms, the report that has caused much consternation to the industry says, “Some stakeholders have influenced medicine prices higher than the true clinical value of cancer medicines, essentially lending higher negotiation power to the pharmaceutical industry. This power imbalance compromises the ability of the system and individuals to pay for these medicines, and deliver quantities less than what would be required for maximizing societal welfare.”

Citing evidence, the report says that lowering medicine prices would not impair the incentives for R&D of cancer medicines. Touching upon the much heated discussion on public financing of drug research, the report says, “Excluding infrastructure investment and labour development, public sector investments in health R&D accounted for 30% of the total US$ 240 billion funding globally in 2009. The remaining 60% of R&D investment came from the business sector and 10% from non-profit-making organizations.”

Stakeholders such as Knowledge Ecology International, believe that incentives to invest in R&D are linked to prices. On the cancer report, KEI said:

We believe international action is required to improve transparency in reporting the costs of R&D and production, including public sources of funding. We agree with the report that prices for cancer drugs are not based upon R&D costs, but also note that incentives to invest in R&D are linked to prices. This creates a conflict, or policy incoherence, between access and affordability on the one hand, and innovation on the other.

KEI has urged the WHO to host a meeting to look at the feasibility of progressively de-linking R&D incentives from prices, so that efforts to make cancer treatments more affordable do not conflict with innovation objectives.

What countries said

One developing country delegate told The Wire, that they see the report as a milestone. “This report will be used as a reference point and as a precedent to be cited in all future discussions on prices of cancer drugs and more generally on access to medicines.”

Australia told the meeting that costs of cancer drugs are the biggest driver of costs of medicines.

India asked the WHO to work on voluntary licensing of patented medicines to make cancer drugs more affordable. Italy called the report as a “tour de force” and said that international action is needed to take it forward.

Some countries hoped that the US would support and consider the report. “Drug prices for cancer are expensive everywhere – the American prices become like a reference price, so therefore important for the US, to engage on this,” one delegate said.

The US said that the country cannot support policies that include the use of flexibilities in the World Trade Organisation Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) or increasing R&D cost transparency.

During the proceedings of the board meeting, the US drew attention to the lack of pharmaceutical industry involvement in the preparation of the report.

Given the contents, scope and tone of the report, the industry was reportedly “flabbergasted”that the WHO did not consult with companies on the report.

In its statement, IFPMA said, “…We are concerned that the Technical Report has been developed without adequate consultations with key stakeholders, including industry, as well as patient groups and national regulatory authorities, who could speak to industry practices, approval practices and the benefits of oncology therapies. As a result, this assessment does not reflect the full economic value to society from these innovations.”

Dr Mariângela Batista Galvão Simão, assistant director-general for drug access, vaccines and pharmaceuticals, informed the executive board during the discussions, “We believe that it would have been a case of perceived conflict of interest by consulting industry on this report. We would have been open to receiving information about net prices of individual cancer medicines their specific R&D costs, for example. But we believe this information would have been difficult to obtain from industry stakeholders.” She added that information from pharmaceutical companies can be included in an addendum to the report. The information furnished in the report is based on publicly available data.

What concrete actions will follow this report, remains unclear for now. But countries see an opportunity to work on high prices of medicines, in the wider context of the WHO roadmap on access to medicines and vaccines, that was also taken up at the Board meeting.

Specifically, the roadmap on access mentions that the WHO will coordinate actions on health research and development including, “Promotion of transparency in research and development costs; development of incentive mechanisms that separate/delink the cost of investment in research and development from the price and volume of sales; and establishment of additional incentives for research and development of new products where there are market failures. Support for implementation of schemes which partially or wholly delink product prices from research and development costs…”

Certainly for patients and for shareholders of pharmaceutical companies, the industry would do well to critically examine their pipelines and review how to invest more efficiently in R&D for cancer medicines, one expert said

What the recent discussions on access to medicines at WHO’s Executive Board tell us

Originally published in International Health Policies

When the Tedros administration assumed office in 2017, there was some apprehension in certain sections of the global health community, about the extent to which WHO would protect and pursue the contentious issue of access to medicines.

Less than two years on, one can be fairly convinced that this administration is serious in leading from the front and some might even say, successfully walking the tightrope – for now.

“Innovation without access does not mean anything,” Director General Dr Tedros Adhanom Ghebreyesus, told member states during a discussion on access to medicines last month at WHO’s 144th Executive Board meeting.

The event saw member states consider two agenda items on access to medicines.

THE WHO ROADMAP ON ACCESS TO MEDICINES

First, the WHO roadmap on access to medicines and vaccines was taken up at the Board meeting.

The roadmap is a product of consultations and discussions with member states during 2018 on ways to work on access to medicines, vaccines and other health products, between 2019–2023. In May 2018, the 71st World Health Assembly had considered a report on addressing the global shortage of, and access to, medicines and vaccines. The report had prescribed a list of priority options for actions.

The roadmap reflects existing WHO mandates in key Health Assembly resolutions of the last 10 years related to access to safe, effective and quality medicines, vaccines and health products, and also the Thirteenth Global Programme of Work, 2019–2023, the secretariat has said.

In their statements on the roadmap, countries stated their wide-ranging suggestions and concerns on the roadmap. While some countries pushed for regulatory harmonization such as Germany, others including Brazil cautioned against it. India asked for greater clarity on the resources to implement the roadmap.

Some stakeholders are not comfortable with the concepts of “fair pricing” and “equitable access” – as discussed in the roadmap. In the roadmap, WHO has referred to a fair price as one that is affordable for health systems and patients and at the same time provides sufficient market incentive for industry to invest in innovation and the production of medicines.

It is not clear when and how fair pricing as a term became an acceptable phrase in a WHO document, one observer remarked. During the discussion, the delegate representing Iran said, that there is no shared understanding on what “fair pricing” means and that WHO must stick to “affordable” medicines instead. In its statement, Romania on behalf of the EU, suggested that talking about market failure alone will not help.

Some believe that the fair pricing debate can be useful to arrive at more meaningful discussions on access issues. One developing country delegate believes that “fair pricing” can be a lever to open the wider discussion on access to medicines. “At least, the fair pricing discussion will serve the purpose of getting some of the European countries at the table to talk about high prices of medicines,” he said in an off-the-record conversation. (The previous fair pricing forum was in The Netherlands in 2017.)

To be sure, European countries have already been drawing attention to rising drug prices.

MEDICINES, VACCINES AND HEALTH PRODUCTS – CANCER MEDICINES

During the EB proceedings, The Netherlands among others drew attention to its efforts to get more transparency on drug prices, in the context of the discussion on WHO’s cancer report.  Italy in fact called for a resolution at the next World Health Assembly on transparent pricing of medicines. In a statement, Italy suggested that WHO must enhance and broaden the discussion on prices and transparency of medicines to improve competition, affordability and availability of drugs.

High prices of drugs continued to dominate discussions at the Board. Member states came together to note  the crucial report on cancer medicines.

The WHO issued this comprehensive 171 page report in December 2018 following a resolution on cancer prevention and control in the context of an integrated approach at the 2017 World Health Assembly. The report untangles the complicated and connected issues of price of drugs, costs to make drugs, the incentives to invest in R&D; and whether these mechanisms should be transparent for the sake of public interest and good governance. The industry, represented by IFPMA has said that the report is flawed.

Some WHO insiders say that the report is very “un-UN” like in its tone, because it speaks directly. Apart from saying that companies set prices according to their commercial goals and focus on extracting the maximum amount that a buyer is willing to pay, it essentially said that an over-incentivized industry may be distorting investment and stifling innovation.

The report, supported with more than 400 references, was crafted through several stages of consultations and meetings. There were consultations with member states on the report. Sources say, no objections were raised by any country on the scope of the report. The secretariat reported that there were several meetings with the Essential Medicine List Cancer Medicines Working Group and an informal advisory group on availability and affordability of cancer medicines, whose experts provided advice on the technical approach to assessing benefits of cancer medicines, the scope of the report, analytical feasibility and case studies, and suggested options that might improve the affordability and accessibility of cancer medicines.

As I reported recently, countries have called the report a milestone, a tour de force among others. It is now seen to be an important reference for the future and is shaping international cooperation and dialogue on addressing rising prices of cancer drugs in the wider context of access to medicines.

Not all stakeholders were happy with the report. Notably, the US and IFPMA asked WHO why the private sector was not consulted for the cancer report.

Dr Mariângela Batista Galvão Simão, assistant director-general for drug access, vaccines and pharmaceuticals, gave a clear debrief on how the cancer report was shaped, and admitted to the constraints in involving the private sector for the cancer report.

She informed the executive board during the discussions, “We believe that it would have been a case of perceived conflict of interest by consulting industry on this report. We would have been open to receiving information about net prices of individual cancer medicines their specific R&D costs, for example. But we believe this information would have been difficult to obtain from industry stakeholders.” She added that information from pharmaceutical companies can be included in an addendum to the report. The information furnished in the report is based on publicly available data.

This was not the only occasion when WHO top brass spoke in clear terms.

In a related discussion on the roadmap on access to medicines, the US continued to reiterate, as before, that IP related issues (“trade deliverables”) fall outside the expertise and mandate of WHO. In its statement, Canada also urged for more collaboration with WIPO and WTO on these matters.

Soon, Director General Tedros defended WHO’s turf on the IP territory, while acknowledging the continued need to work along with WTO and WIPO on these matters. He said that it has indeed been very much a part of the mandate of WHO to address matters of intellectual property in relation to public health.

Ultimately how far WHO will go on these issues, will be a function of how it handles the sustained pressure from many quarters – some overt and others subtle. This space will get more interesting – the rope will get tighter.

We will likely hear more. “Transparency is good for governance and it is good for health,” Dr Simão declared during one of her interventions at the meeting.

Battle for Access to Medicines Takes Centre Stage at WHO

Originally published in The Wire.

As the business of global health expands, inevitably the gatekeepers of international trade and investment have become important at World Health Organization (WHO) – the axis on which public health policy rests. Of the many policies that get formulated at WHO, discussions on the access to medicines including cost of drugs, transparency in research and development, transfer of technology have been contentious for years. In parallel, how the UN’s only norms-setting body engages with non-state actors while dealing with policies that have implications for giant businesses, has also drawn attention.

At this decisive stage in his tenure at WHO, Director General Dr Tedros Adhanom Ghebreyesus sits down to decide who gets a seat on the table and how he would preside over seemingly irreconcilable positions among member states on matters such as access to affordable drugs.