The 10/90 Gap in International Health Research and Drug Research and Development Whose Moral Responsibility is it? - PowerPoint PPT Presentation

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The 10/90 Gap in International Health Research and Drug Research and Development Whose Moral Responsibility is it?

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The 10/90 Gap in International Health Research and Drug Research and Development Whose Moral Responsibility is it? Udo Schuklenk www.udo-schuklenk.org – PowerPoint PPT presentation

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Title: The 10/90 Gap in International Health Research and Drug Research and Development Whose Moral Responsibility is it?


1
The 10/90 Gap in International Health Research
and Drug Research and Development Whose Moral
Responsibility is it?
  • Udo Schuklenk
  • www.udo-schuklenk.org

1/
2
The Issues
  • 10 percent of the worlds health research
    expenditure addresses diseases that account for
    about 90 percent of the global burden of diseases
    afflicting mostly the developing world. GFHR
  • From 1975-2004, for instance, 1,446 new drugs
    were made publicly available but only 20 of these
    were for tropical diseases and tuberculosis
    diseases that affect the developing more than the
    developed world. AWSJ
  • Communicable diseases kill app. 14 million people
    p/a WHO
  • Eliminating these diseases would level the
    mortality gap between developed and developing
    countries World Bank
  • Between 2/3rd and 9/10th of new medicines
    coming to the market are me-too drugs.

3
The Issues
  • Markets not health needs dictate commercial
    research agendas.
  • The patent regime arguably fails to stimulate
    innovation in the field of neglected diseases
    MSF/Ford
  • Those medicines that do exist more often than not
    are unavailable to the developing worlds poor
    due to patents designed to guarantee the IPR
    owner a substantial return on their investment
    (eg HAART drugs).
  • We could, spending the same resources, prevent
    almost immediately millions of preventable deaths
    by immunising newborns with existing (but
    unaffordable vaccines), instead of waiting for
    the outcomes of various (AIDS and other) vaccine
    initiatives.

4
(At Least)Three Problems
  • Drug RD ie inventing and producing the needed
    medication
  • Access ensuring affordable access for those in
    need
  • How should we decide which diseases to research
    (and who should decide)?

5
Ethical Responses
  • HR Human Right to Health
  • Utilitarianism Avoidable suffering
  • Kantianism Respect for persons
  • Contractarianism Support for attainment of
    normal species functioning as pre-condition of
    living a good life. GSK
  • Egalitarianism All human lives count equally,
    regardless of where they are located.
  • Virtue ethics Living a flourishing life requires
    to behave decently toward those in need.

6
Which begs the question
  • Who should be responsible for delivering the
    goods?
  • Various potential actors have been suggested
  • Industry
  • Philanthropy
  • States (on behalf of their citizens)
  • Individuals

7
Industry
  • Two takes
  • Industry is a moral player capable of preventing
    avoidable deaths
  • Might have agent-relative duties due to specific
    RD competencies/capacities that are unavailable
    elsewhere
  • Our pharmaceutical industry related finger
    pointing seems inconsistent. We do not require
    other commercial organisations to assist the
    developing world (say Daimler-Chrysler supplying
    vehicles to transport the sick to clinics, for
    instance).
  • Private enterprises have no societal mandate to
    provide health care to the sick.
  • Publicly listed companies exist to generate
    maximum returns to their owners. They deliver
    value by being innovative, employing people and
    pay taxes that the state may use as it sees fit.

8
Philanthropy
  • Philanthropic giving is usually meant to give
    something back to society that permitted someone
    to become very wealthy.
  • As Carnegie argued, business should pursue
    profit, but the wealth created should be utilised
    philanthropically by individual owners for the
    benefit of the community.
  • Eg Ford Foundation, Wellcome Trust, Gates
    Foundation
  • Nice as such usually very public giving might
    be, it seems doubtful that the called-for
    solution to our problems should have to rely on
    rich volunteers such as Mr Gates.
  • Its also disconcerting that unaccountable
    individuals should make decisions affecting
    millions of people re drug RD research
    priorities.

9
States
  • Developed countries have long since accepted some
    responsibilities toward the worlds poor.
    Rationales for this remain sketchy but often
    include the suggestion of a kind of reparation
    for past colonial exploitation of developing
    nations peoples, self-interest (instability
    over there might eventually affect me here), but
    rarely include any of the ethical rationales
    suggested initially.
  • Others have suggested that the State acts on
    behalf of its citizens. Citizens are moral agents
    and should act to assist those in dire need. The
    State could be seen as the instrument deployed to
    achieve this objective. (see also Individuals)

10
Individuals
  • Main rationale private citizens can, by pooling
    their resources (eg donation to MSF, GAVI)
    resource drug RD. They are moral agents and
    therefore responsible for their decision not to
    contribute personally toward preventing
    preventable suffering and premature death in the
    developing world. (See also States)

11
Proposed Solutions to the Access Problem
  • Drug Donations by Industry
  • Price Reductions by Industry
  • PPP
  • Compulsory Licensing
  • Only CL has so far managed to deliver the goods
    in appreciable quantities.

12
Proposed Solutions to the RD Problem
  • Pull Mechanisms
  • PPP
  • Problem Has not delivered the goods.
  • Push Mechanisms
  • AMCs/APCs
  • Problem Has not delivered the goods, seems an
    inefficient, high-risk means to push private
    players into funding drug RD.

13
So, Whose Responsibility
  • Much of the current rhetoric on a proposed human
    right to health doesnt address the question of
    whose responsibility.
  • Private sector will never have sufficient
    capacity and/or the will to deliver the required
    medicines in a timely and reliable fashion.
  • Even the Gates Foundation admits that it wont be
    able to develop medicines (to market) for most
    tropical diseases due to budget constraints.
  • Equally, it seems unreasonable to entrust the
    survival needs of millions of impoverished people
    into the hands of commercial operators and
    unaccountable do-gooders.

14
Whats Needed Opportunities for Research ?
  • It is necessary to find a persuasive answer to
    the question of who ought to finance drug RD for
    neglected diseases.
  • It is necessary to find a persuasive answer to
    the question of who ought to finance the
    production and delivery of drugs developed to
    fight neglected diseases.
  • Relatedly, we should probably consider which
    international institution should manage that
    process, and which international regulatory
    frameworks should be put in place to ensure
    subsequent availability of the developed
    medicines.
  • Should we aim for the international equivalent of
    the Manhattan Project?
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