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Medical students throughout North
America are stepping up campaigns to get better access to essential drugs in
the developing world, Toby Reynolds writes
Global health is moving up the
agenda at universities in North America, partly because of the efforts of a
student led campaign to broaden access to essential medicines.
Activists hope this momentum will help the development of new
drugs and increase the availability of existing ones, which are too expensive
for many people. The medical aid organisation Médecins Sans
Frontières (MSF) says that a third of the world's population lacks
access to the drugs they need most, rising to a half in the poorest parts of
Africa and Asia.
CGH/University of Virginia
Peregrinations
The campus movement began in 2001 with frustration over the
way that intellectual property rights, particularly those owned by
universities, were getting in the way of treatment. Although drug companies
are still the main players in getting medicines to market, much of the work of
drug development is done in universities, and they have become increasingly
active in patent applications.
Yale University owned intellectual property rights to the
nucleoside analogue AIDS drug stavudine, which it had licensed to the drug
firm Bristol-Myers Squibb. The drug was far too expensive to be
affordable in South Africa, which at that time had the world's highest
HIV caseload.
Students, scientists, and MSF mounted a campaign to change
this, and shortly afterwards the university and drug maker agreed to allow
generic versions to be sold in South Africa, bringing a huge reduction in
price.
The student movement involved in the campaign has now
coalesced into a group called Universities Allied for Essential Medicines
(UAEM), with groups at more than 30 campuses.
The organisation is trying to get academic institutions to
attach a higher priority to the health needs of the developing world in their
drug licensing negotiations, especially in cases where allowing the drugs to
be used cheaply in poor countries may make no difference at all to the income
generated from selling them in rich ones.
"We believe that universities are committed to the
creation and dissemination of knowledge in the public interest. And as global
public health is a vital component of the public interest, universities best
realise their objectives when they promote both innovation and access to
health related technologies," said Caroline Gallant, a member of the
group's national coordinating committee.
The stavudine campaign's success was a landmark, but
other more recent cases show the need for a proactive strategy, the
organisation warns. It says that it has been disappointed with provisions for
access in developing countries in some other more recent licensing deals
involving universities.
Ms Gallant says it is important to get universities to start
thinking about ensuring access for poor countries before the licence is
agreed. "It is more difficult to negotiate access provisions once an
innovation has been licensed out," she said.
"As an organisation, we are focused on facilitating
collective change-having universities collectively adopt policies that
will prospectively ensure access to all health related innovations developed
in universities."
The campus movement is gathering steam. In a separate effort,
the University of California in Berkeley has launched a "socially
responsible licensing initiative" which has yielded, among other deals,
a royalty-free agreement that could lead to cheap, artemisinin based
treatments for malaria.
Legislation may also follow. The US senator Patrick Leahy has
introduced a bill that would allow generic production in poor countries of
drugs and medical devices invented at federally funded research institutions.
Global health is not all about drug patents, though. Many of
the most important diseases affecting poor countries simply don't have
good drug treatments. UAEM has introduced the Philadelphia Consensus
Statement, which not only calls on universities to promote equal access to the
fruits of their research but also to do more work on diseases that
disproportionately affect poor people and to measure research success by the
impact on human welfare rather than by profit.
So far the statement has attracted the support of four Nobel
laureates as well as treatment campaigners and many distinguished scientific,
medical, and legal academics.
Peter Hotez, professor of the department of microbiology and
tropical medicine at George Washington University and head of the newly formed
Global Network for Neglected Tropical Disease Control, is one signatory.
"I think one of the most effective elements of UAEM ultimately will turn
out to be in raising the whole level of awareness about global health
problems," he said.
"I envision for the UAEM a much larger role than
intellectual property, which is only one very small hurdle in access to
essential medicines for people in developing countries."
He said universities needed to put more into research towards
producing the sort of drugs that would never be financially attractive enough
to win over drug companies' shareholders.
"These are diseases that by definition have no US or
European market, and because they have no US or European market there is no
incentive for pharmaceutical companies to go out and do research and
development on these drugs. Almost by definition, neglected diseases only
occur among the 2.7 billion people who live on less than $2 a day," he
said.
"We need a new model to develop products. That model so
far has been through product development partnerships, and academic
institutions have a potentially enormously important role in creating
these."
The momentum created on campuses by groups like UAEM might
help get universities to hire more neglected disease researchers and direct
more effort into developing treatments for these conditions, he added.
"I just think this is an issue where the students are
ahead of the curve," he said. "There has been a generally
heightened awareness of global health issues, and a lot of it is coming from
the students. The students are clamouring for more attention to global health
and health disparities in the developing world."
In January, UAEM brought together leaders at three prestigious
centres of research, Weill Medical College of Cornell University, Rockefeller
University, and the Sloan-Kettering Institute, to discuss ways to
collaborate on controlling neglected tropical diseases.
"This is going to be another very important role for
UAEM: not to confine their role to intellectual property, but working with the
global network to take on the development of these products," Professor
Hotez said.
Toby Renolds, London
studentBMJ 2007;15:89-132 March ISSN 0966-6494
