The Sixth Regional Meeting on the Right to Health and Health Systems took place in Santiago de Chile from 6th to 8th of September. This event gathered country representatives (ministers and vice-ministers of health), academics and other stakeholders from different countries that are part of the World Bank Initiative Salud Derecho. This is an effort to promote the exchange of experiences and knowledge on how to overcome the common challenges that health systems in the region face to achieve universal health coverage, provide access to quality essential health care services and guarantee the right to health. 8 Latin American countries are involved in this initiative: Chile, Argentina, Brazil, Costa Rica, Colombia, Mexico, Peru and Uruguay. This year’s event also included the participation of South Korea, a country that is providing technical and economic support in the region with the Korea-World Bank Partnership Facility, along with other entities such as NORAD (Norwegian Agency for Development Cooperation) and PAHO (Pan American Health Organization).
The theme this year was ‘Ethics and transparency in access to medicines’, a hot topic across the globe now, including in Latin America. The agenda featured 2 main panels on the first day: the first panel focused on transparency in the negotiation process and access to medicine information and medical supplies, the second one zoomed in on ethics and conflicts of interest in the management of medicines and medical supplies.
This was an opportunity to discuss the many barriers that hamper equitable access to medicines in these Latin American countries. One of the main barriers is related to the rising cost of high-cost medicines (such as antiretrovirals, orphan drugs and biologics, … ), a global trend as you know, which in turn jeopardizes the sustainability of health care systems. A well-documented case is that of cancer drugs. For instance, it has been reported that the median annual price of cancer drugs has increased from US$ 12,000 before 2000 to more than US$ 120,000 by 2015, much higher than the per capita gross domestic product (GDP/capita) of any Latin American country. Even more disturbing is the fact that many new cancer medications do not always offer meaningful clinical benefits or therapeutic value to patients despite their elevated cost. Additionally, in some cases (cancer) treatment drugs are costlier in LMICs than in high-income countries. Drug prices are usually set at whatever “the market” will put up with.
We think it is important for governments to do their own (internal) analysis on the transparency of the pharmaceutical sector. Regulating entities play a vital role, trying to strike a balance between the practical guidelines, supplies and technologies and the ethical practices. Therefore, disciplinary strategies should be implemented to prevent corruption in the negotiation process of purchasing medicines. An example of this is the Ricarte Soto Law in Chile, which states that technical commissions in charge of making recommendations on which treatments should be financed, cannot comprise professionals who have had financial links with the pharmaceutical industry in the previous 24 months; these professionals are also forbidden to have any link till up to 24 months after playing a role in such commission.
The strengthening of national regulatory agencies, with a view on increasing their regulatory competencies and control over health technologies is urgent and necessary. These efforts should reach beyond local action by governments and also involve regional action, allowing the implementation of strategies to improve access to medicines, supplies and technologies. An important regional initiative is DIME (Informed Decisions over Medicines), a platform that has been built through Communities of Practice, coordinated by consultants and health authorities from the 8 participating countries. The platform will soon be open to the public.
Another example of how to mitigate the burden of public spending on high-cost medicines was the joint bargaining effort & purchase of high-cost medicine by countries from the intergovernmental regional organizations UNASUR and MERCOSUR, in 2015. This smart move resulted in collective cost savings of approximately US $ 20 million for the involved countries in the joint purchase of darunavir—an antiretroviral treatment for HIV and AIDS. Hopefully we can see more of this in the years to come, despite the political changes (and challenges) in the region.
Scarce knowledge and expertise, weak institutional structures vulnerable to pressure from suppliers, lobbyists and other unwanted influences are among the other obstacles to be overcome by most of the fragmented health care systems of the Latin American region. The development of entities that can detect, analyze and penalize anticompetitive and corrupt activities should be another aim. For instance, the former Minister of Health in Guatemala, Lucrecia Hernández Mack, had signed an anti-corruption and transparency agreement. She recently resigned, however, in protest of the presidential decision to expel the International Commissioner Against Impunity in Guatemala – a major setback to the efforts made to curb corruption in the country, obviously. Even when there are legal mechanisms to improve the access to generic medicines, these have not always been used due to the lobbying of private stakeholders of the pharmaceutical industry and the lack of knowledge of the technical, political and judiciary authorities on the topic. Making use of the existing legal mechanisms requires capacity and technical expertise of national authorities along with a strong political commitment to take on market forces. PAHO and other expert agencies (including non-governmental ones) should support the member states in this respect—as is the case with the Salud Derecho Initiative.
Anyhow, the issue of access to medicines is here to stay. It will definitely also be a hot topic at the upcoming G20, hosted by Argentina in 2018.