Everyone everywhere should have access to essential medicines
By Dr Poonam Khetrapal Singh
Access to medicines is a critical factor to ensure healthy lives and promote well-being of all people of all ages. Medicines exist. But are often inaccessible for reasons beyond control. They may be too costly – purchasing them may burden household finances, risking poverty or debt. They may be in short supply due to delivery issues in distribution channels, making continuity of treatment difficult. They may be of substandard quality – when medicines are falsified or poorly produced, they are not only ineffective, but also dangerous.
The sentinel role of countries for access to medicines has become more challenging than ever before, given the nature of the pathogens and reduction in time and space on travel. The rising concern of noncommunicable diseases requiring life course management makes access to medicines key to good health and prosperity. Ensuring all people everywhere can access essential medicines is one of WHO South-East Asia’s priority areas of work, and a key tool for achieving the Sustainable Development Goals agenda 2030 of health and wellbeing for all.
In recent years, many countries have made notable progress. Affordability of priority medicines has increased. Supply of priority medicines has become steadier.
Flexibilities in global trade agreements have been leveraged to reduce prices in several countries; there are numerous regional examples of improved public sector purchasing. The countries in the Region have updated their Essential Medicines lists; supply chain management systems have improved to be more effective and reliable. And action by countries to improve quality of medicines has accelerated. Many countries have included health as top priority in national goals. We could do better.
Certain persisting inadequacies are yet to be addressed: Out-of-pocket spending – including on essential medicines – remains high. Further, supply chains in some areas remain weak; countries lacking manufacturing capacity often cannot leverage competitive prices from suppliers.
Despite challenges, the Region’s economic status is changing for the better, a positive sign that, however, will lead to reduced access to external financing for medicines and vaccines.
This calls for self-reliance and collaboration by the countries in the Region. The South-East Asia Region member countries, supported by WHO, launched South-East Asia Regulatory Network (SEARN) to enhance information sharing, collaboration and convergence of medical product regulatory practices across the Region to guarantee access to high-quality medical products to their people.
There are three key areas of action by the countries for increasing access to essential medicines and accelerate progress towards health and wellbeing for all. First, countries keep their Essential Medicines List (EML) and medicines policy current. By developing clear accountability systems for medicines selection and procurement, health authorities can harness opportunities for access to affordable medicines.
Despite the rising antimicrobial resistance, purchasing and supply of antibiotics is seldom rationalized. In a major revision of the antibiotics section in the EML’s 40-year history, WHO experts have grouped them into Access, Watch and Reserve —three categories, with recommendations on when each category should be used. This is a good yardstick and starting point for antibiotic use. Also, across the Region, countries are yet to capitalize on the massive drop in price of a range of game-changing medicines – most notably for hepatitis C. This must change.
Second, guarantee quality and affordability of medicines. The role of the National Regulator needs to be redefined to that of a facilitator for quality production. This entails providing adequate technical assistance and handholding for achieving quality standards at the level of manufacturing as well. Countries should continue with targeted quality control and testing of medicines that are sub-standard or falsified. From manufacture to sale, locally produced medicines should always meet international standards. For affordability, main stress points are promoting competition, implementing a series of price control measures, encouraging doctors to prescribe generics to regulating wholesale and retail mark-ups. Developing pricing strategies linked to health insurance programmes, especially where national schemes are in place is equally important. Further, countries can actively exploit flexibilities in global trade agreements when negotiating with medicines manufacturers. They can also bargain collectively to increase market buying power.
The SEARN can help make regulation more efficient by developing the Region’s diverse capacities and strengths, with significant gains.
Third, generating high-quality information on access to essential medicines within the countries so that the problems may be better addressed.
Knowing where and why people are facing shortage, where unsafe or ineffective medicines are being sold, is essential to developing lasting solutions. From smartphone apps to household surveys, the array of tools at health authorities’ disposal is considerable. By using them effectively authorities can garner the information needed to make smart, high-impact interventions that drive life-changing gains.
Essential medicines should be accessible for all, to achieve universal health coverage. Supported by a clear vision, the dream of health equity and the Sustainable Development Goals of health and wellbeing for all are within reach. A healthier, more equitable and sustainable South-East Asia Region can be ours.