Sandra and Sargam both present similar symptoms of high fever and headache, but only one of them survives. Sandra lives in Canada and receives the appropriate medication to beat the seasonal cold. However, living in rural India and having a progressively worsening dengue fever, Sargam is not so lucky.
As in the case of the hypothetical patient described above, the World Health Organization reports that dengue fever annually infects 100 million people, and yet there is no specific targeted treatment or vaccine available. One may ask, with almost half the world’s population currently at risk of developing dengue fever, why does a primary intervention not exist? The answer is both logical and heartbreaking. Dengue fever is one of the many neglected tropical diseases, which together affect more than 1 billion people. These diseases are primarily prevalent in underprivileged populations of tropical and sub-tropical climates. Under the current system, pharmaceutical firms target diseases of the affluent nations, while overlooking the poor populations that cannot pay the big bucks. With monsoon rains hitting these countries and cases of associated neglected diseases on a rise, the question of how appropriate medical care would be provided remains. In a pharmaceutical regime starved of therapeutic innovations and guilty of impeding global access to life-saving drugs, the Health Impact Fund (HIF) may just be the potential answer.
The HIF, proposed by Incentives for Global Health, aims to reward pharmaceutical companies in respect to the global health impact of their medication. Instead of replacing the current system, HIF invites pharmaceutical firms to voluntarily register their new drugs. Once registered, the drug firm agrees to sell their medication world-wide at a price close to the manufacturing cost. The firm is not rewarded on the medication sales, but according to the HIF’s assessment of the drug’s impact, which is measured by the number of healthy years the drug adds to a person’s life (Quality Adjusted Life Years). Performance of the registered drug is re-evaluated each year, and the firm is rewarded a share of the Fund accordingly for ten years. After the reward period is over, the firm allows royalty-free generic version of the drug to be produced. The reward pool of about 6 billion dollars is required to register 10 drugs, which would potentially be funded by governments and private foundations.
Today, majority of the pharmaceutical efforts are concentrated on addressing diseases of the rich nations that provide maximum profit. New drugs are formulated by making minor modifications to existing medications, while patent rights are used to raise drug prices as desired. In this scenario, disparities in income within and between populations is disregarded, and the necessity for creating drugs that address greatest global needs is overlooked. The HIF provides a more ethical alternative, where innovative pharmaceutical companies can reap rewards by creating and delivering medication pertaining to greatest global disease burden.
Although objectives of the HIF are admirable, transformation of the proposal into reality would require effort and time. A valid health impact assessment criteria and subsequent test trials would be needed to evaluate registered drugs. Measuring health impact may be particularly challenging in developing countries, where delivery issues, lack of appropriate diagnosis and poorly structured healthcare system could make it difficult to track the demand and effectiveness of drugs. However, by acknowledging and addressing these obstacles, the involved drug firms and the developing nations may both benefit. Strategies implemented by drug firms, such as better prescription instructions, may increase not only the impact of medication but may also introduce positive changes in the healthcare system of the developing nations. Another obvious hindrance in realization of the HIF is the need for financial support from governments. German Social Democrat party has already endorsed the HIF, and sets an example for other nations to follow.
Denying millions of underprivileged people the access to life-saving medicine is morally wrong, while expecting philanthropic contributions from pharmaceutical companies is economically unfeasible. The HIF provides an ethical and rational middle ground, where worth of medication is based on its impact, and socioeconomic levels don’t dictate the right to a healthy life. By addressing global health needs through pharmaceutical innovations, the HIF presents a sensible plan that is worth supporting.
By Sana Gill
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3. Dengue Cases and Deaths in Country (India) since 2007. National Vector Borne Disease Control Programme (NVBDCP). 2013 September.
4.Why are some tropical diseases called “neglected”? World Health Organization. 2012 January.
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6. The Health Impact Fund. Incentives for Global Health. 2013 September .