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5 Increasing access to
medicines
Prof Khalil Ahmed, 1 Franklin Cudjoe, 2 Eustace Davie, 3
Dr John Kilama, 4 Prof Martín Krause, 5 Andrés Mejia, 6
Barun Mitra, 7 Nonoy Oplas, 8 Martín Simonetta, 9
Philip Stevens, 10 Jose Luis Tapia, 11 Margaret Tse, 12
Jasson Urbach 13
Ashasbeendemonstratedinthepreviouschapter,accesstomedicines
in many less developed countries is extremely low. According to the
WHO, an estimated 30 per cent of the world population lacks regular
access to existing drugs, with this figure rising to over 50 per cent in
the poorest parts of Africa and Asia (WHO, 2003). As chapter 4 has also
shown, there is some concern that certain diseases unique to less
developedcountriesdonotrepresentaviablecommercialprospectfor
would-be innovators of new medicines, resulting in a shortage of
appropriate treatments. Citing this alleged ‘market-failure’ as justification,
some have proposed alternative mechanisms to the commercial
R&D paradigm in order to stimulate research into these areas.
This chapter examines some of the factors that prevent existing
medicines from being distributed in the most effective manner, as
well as those elements of governance which actively undermine the
supply of new medicines.
We begin with a description of the major barriers to access,
which include weak healthcare systems, taxes on imported medicines,
and poorly functioning insurance markets. We then examine
several related issues, including the impact of poor government
policy on the supply of medicine and the impact of pre-market
regulations and price controls.