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YonseiUniversityGSISNMPF2011:MDG8EPolicyMemo

ByYonseiGSISMastersCandidates:NicoleFitch,MAin
blablabla
BrianGleason,MAin
GlobalStudies
RoxannaWilson,MAin
KoreanStudies
MillenniumDevelopmentGoal(MDG)8EAim:
PharmaceuticalCommunication
TheaimofMDGgoal8Eisincooperationwithpharmaceutical
companies,provideaccesstoaffordableessentialmedicinesin
developingcountries.
YonseiUniversityGraduateSchoolofInternationalStudies
(GSIS)
NewMillenniumPolicyForum(NMPF)Aim:PolicyMemo
TheNewMillenniumPolicyForum(NMPF)whichisinplace
tofacilitatediscussiononthecurrentissuessurroundingunmet
MDGs.TheMDG8EPolicyMemo,inassociationtothe
NMPF,addressesexistinggoalimpedimentsandrecommendsa
policythatincludeshowaninternationalcommunitycan
reconciletheinterestsbetweenlargepharmaceuticalcompanies
andhumanrightstohealthanddevelopmentinrelationto
providingaccesstoaffordableandessentialdrugs.(aka.
Overview)
InthedevelopmentoftheMemo,literaturereviewsrelatedto
MDGgoal8Ewereundertaken.However,theevidence
gatheringandconstructionofthePolicyMemowasmuchmore
variedthanonlyliteraturereview;ourteamalsoinvestigated
realworldapplicationthroughcasestudiesanddiscussedour

policyproposalwithimportantstakeholders.(aka.Methodology
<thiswontbeadded>)
TheMemomakestwomainrecommendationsaimedatpolicy
makersanddecisiontakersatinternational,nationalandlocal
level.
Structure(ornameTableofContents?)
ThePolicyMemoisdividedinto3mainparts:
Part1Background,existingproblemsandneedfor
action
Theexistingproblemsaredividedintofourdimensions:
(referencetoppt)
1a.Pharmaceuticalindustrysrole
1b.Sustainabledevelopmentandintellectual
propertyrights
1c.Cultureandideologicalimpediments
1d.Flawedhealthsystems
Part2Evidenceandevaluation
Part3PrinciplesandPolicy
Principlesexplainhowtheresearchinggroup
arrivedattheconclusionandtherationaleusedtodevelop
thepolicy.
ThePrinciplesaredividedintothreedimensions:
3a.Healthassustainabledevelopment
3b.Allactorstoworkinconcert
Policy

ThePolicyisdividedintotwodimensions:(Whateverwe
putontheslide)
3c.InformationNetwork
3d.DevelopmentthroughBusiness

Part1
Background:
In evaluating the efficacy and progress towards goal 8E, the lack
of benchmarks or measurable deliverables was apparent. The
focus seemed too broad for the time frame, which now seems to
be far too optimistic and unrealistic. How can one know if the
goal has been met or when it could be expected? Thus, our
group has focused on the issues pertaining to the persistence of
untreated diseases in the developing world and the system
responsible for provision of the corresponding medication.

ExistingProblems:
1a.Pharmaceuticalindustrysrole
One major issue is the lack of R&D targeting diseases prevalent
in the developing world, which highlights the role of market
forces in determining the priorities of the pharmaceutical
industry. With little or no incentive to conduct expensive

research on medication desperately needed in the developing


world, the pharmaceutical industry tends to neglect researching
medication for diseases like diarrhea, pneumonia and TB, which
cause 18 percent of all illnesses (Bailey). The pharmaceutical
industrys need to protect patented prescription drugs, contrasted
by the urgent need to provide essential medication to those
unable to afford it at market price, has created a fragile
relationship between large pharmaceutical companies and the
developing world.
1b.Sustainabledevelopmentandintellectualproperty
rights
Our research also emphasizes that intellectual property rights are
tied to more than just the profits of large corporations. The
World Intellectual Property Organization (WIPO), a specialized
agency within the United Nations, has been working on creating
an international framework for the definition and protection of
intellectual property rights that would be enforced by all
member states, including the developing world (Kogan). This
multilateral agreement, along with other bilateral and unilateral
declarations serves to protect the intellectual property of the

poor. These rights extend beyond the individual and apply even
to traditional knowledge and processes, and the rights can be
held by a group of people or whole community who could then
benefit from the licensing.
The Institute for Trade Standards and Sustainable Development
(ITSSD) presents data that demonstrate the importance of
intellectual property right protection in the fight for sustainable
development. Without the assurance that rights will be
protected, would-be innovators have no incentive to innovate
(Hunt and Kosla 2). This presents a problem to the international
community that lacks an easy solution. In the rush for
development and in an attempt to meet the MDGs by 2015,
states can take advantage of the TRIPS clause permitting the use
of licenses in certain emergency situations (Joseph 428). This
trend of pushing the pace of development beyond the capacity of
the international community to draft IP agreements is risking the
destruction of any progress made so far toward an international
agreement (Kogan).

1c.Culturalandideologicalimpediments

Colonizationandexploitationbywesterncountriesmay
influencefeelingstowardWesternideologyandmedicinein
developingcountries.Othermisunderstandingsalsooccurwhen
patientsarenotabletounderstandtheimportanceofdosage
managementorsideeffectseitherbylinguisticorcultural
differences(Wilhelm,616).Distrustofforeigncompanypower
andextremecautiontoprotectthelocaleconomyFearby
westernworldthinkingethicsinquestion.(expoundRoxy)

1d.Flawedhealthsystem
Health systems in emerging markets suffer from a variety of
ails, such as corruption and poor infrastructure, which prevent
even the pharmaceutical products that are injected into the
market from reaching those who most need them (Cohen,
Mrazek, et al 445 - 449). <Something about dosage here Nicole?
Lets explain the above in more detail> Developing countries are
also dealing with the issue of counterfeit and substandard drugs.
The WHO puts the annual amount of counterfeit drug sales close
to 35-40 billion dollars a year and that one in three drugs in the
worldwide market is counterfeit. Pfizer alone estimates its

annual losses at two billion dollars (Tomas et. Al, 1-2).


Counterfeit drugs can be virtually indistinguishable until
chemically tested. These drugs pose serious health issues and
can possibly lead to drug resistance which would be a huge
drawback for developing countries if resistance became too
prevalent as well as a threat to Pharmaceuticals because of the
extremely low price of counterfeit drugs (Shakoor et. Al, 844).
Access to medicine is also inhibited by poor infrastructure
and lack of resources (FIP 2007). <something on LDC country
and system corruption here?> These problems with delivery and
access cannot be resolved by simply producing unlimited free or
generic drugs. The national systems themselves must be
addressed.
NeedforAction:
According to the 2010 MDG Gap Task Report, the availability
of essential medicines in developing countries continues to be
low, especially medicines to treat chronic diseases. Therefore, it
is generally assumed that the focal point of goal 8E is for the
international community to provide adequate health,
pharmaceutical supply and distribution systems, as well as

technological and other health care essentials to developing


countries. Stats(countriesdiseasesvaccinepricesgenericand
counterfeitdrugs?)
Part2
Evidence:
<talkaboutinterviewsgeneralinformationwefoundinallthe
readings:needinfosystymneedfinancialaidandstability,etc
>
Evaluation:
In order to reach the goal of improving access to essential
medications and to involve pharmaceuticals in the process, bold
steps need to be taken by Inter-Governmental Organizations
(IGOs) such as the World Bank and International Monetary
Fund (IMF), but more importantly by individual low and middle
income states. Development Goal 8E asserts that the
international community needs further partnerships between
pharmaceuticals and developing countries. In order to facilitate
such coordination and cooperation, the UN should offer a way to
organize, disseminate and regulate systematic health care
information; such a network only exists piecemeal via different

government and NGOs, regulatory agencies and local health


organizations.
This information network should adhere to the Diagnostic
Approach supported by key scholars like Jeffrey Sachs, which
emphasizes that as each country has different needs and in turn
each country requires a unique plan of action (Sachs 76-90).
This network would also be useful in the standardization of
drugs sold worldwide, giving legitimacy to new and effective
chemical compounds while recommending caution or avoidance
of others.
Partnerships between developing countries and pharmaceuticals
are often inhibited by the conflict of interest. Developing
countries desperately need the drugs produced by
pharmaceuticals, but cannot afford them. Pharmaceuticals are
businesses whose profit margins are affected by such actions as
allowed by the TRIPS agreement, permitting the use of licenses
at low or no cost by poor countries in emergencies. Countries
who have made use of this clause are no better off economically
than they were before they used the licenses (ITSSD).

As mentioned above in the existing problems section a lack of


intellectual property rights hurts not only the profit margins of
large pharmaceuticals, but affects the sustainable development
of countries working to rise out of poverty. Without the right to
keep the profit from their innovation, individuals, communities
and businesses have no incentive to innovate. A loss of profit
also means less incentive to participate in the markets of these
countries, in addition to a reduction in R&D spending on the
development of essential medications to treat the diseases
prevalent in the developing world. (maybe we dont need this
here because it sounds the same as the problem section maybe
we can just suggest funding towards pharmaceuticals in the
shape of a grant would be good and then connect to the below
paragraph.)
One type of grant could stipulate that the pharmaceuticals
and research organizations are required to submit any patent
resulting from the R&D into a patent pool; this allows individual
distributors to access the patent and compete with each other in
the free market, thus eliminating a monopoly on the patent and
driving down the price of the drugs on the market (Runyowa).

Another important aspect that cannot be overemphasized is the


need for prevention of these debilitating diseases in the
developing world through vaccinations and immunizations
(Lob-Leyvt 209) ( I erased about Gavi, it didnt seem to fit, but
maybe the pg number changed or maybe it is still not from this
reading? Brian).
Part3
Principles:
3a.Healthassustainabledevelopment
Healthisessentialforproductivity,productivityessentialfor
sustainabledevelopment;ultimatelythedevelopmentofastate
isinstrumentaltopeopleshealth.Highratesofpovertyand
inequalitywithinstateshasveaprofoundlynegativeimpacyton
underlyingdetermintsofhealth().Itseemsdevelopment
policiesthatreduceprovertyhaveincreasedthenumberof
peoplelivinginabsolutepoverty,orweakendpublichealth
systems(Meyer&Fox,263).
3b.Allactorstoworkinconcert(Needsexpounding,
maybeNicole?)

Strategicactionneeded
Actors:
Multinationalbodies
Civilsocietyorganizations
Government
NonGovernmentOrganizations(NGOs)
PharmaceuticalIndustryandRepresentatives
Media
WorkplacesandInstitutions
Practitionersinglobalhealth
World Intellectual Property Organization (WIPO)
People
Policy:(needstobeexpounded)
3c.HealthInformationNetwork(HIN?)
In order to rectify the lack of benchmarks or measurable
deliverables in Goal 8E, we advocate the creation of a Goal 8E
Health Information Network for every developing country. Each
country is a complex system that requires a unique
understanding of context, monitoring and evaluation. Thus, the
HIN in each country will gather and centralize all of the relevant
health data pertinent to Goal 8E and provide specific, constantly
updated data regarding the diseases that are affecting the
population, the amount of medication required to combat these
diseases, and the estimated costs of treatment. Although some of

this data already exists in WHO databases and UN MDG


reports, the information is not centralized and is often outdated.
Another important function of the HIN is to increase
communication and cooperation between the different officials
and agencies that are involved in gathering data, administering
aid, analyzing information and formulating plans. This means
that local health officials, UN health officials, pharmaceutical
industry representatives and philanthropic organizations must
correspond with each other and publish that correspondence as
part of the HIN. Far too often, each of the aforementioned
entities will make unilateral statements about their position and
assessment of Goal 8E in a certain country without addressing
what the other entities have stated. These official statements and
analyses are often scattered, fragmented and isolated, which
makes it extremely difficult to form a consensus. The HIN will
bring the different actors together by facilitating dialogue and
consensus building via published responses to each entitys
position on Goal 8E. By facilitating this dialogue and debate
among the different entities, each with unique viewpoints and
assessments of Goal 8E, we can move forward toward a more

specific and comprehensive plan with clear benchmarks and


measurable deliverables.
The Health Information Network will also function as a
tool to promote ethics, hygiene, and information on the
proprietor of intellectual property rights, drug dosage guidelines,
processes and norms for both Eastern and Western medicine.
This will help to promote cooperation, reduce fears of the
unknown and promote higher levels of care among those who
have access to it.
Theentirenetworkwillbeinternetbasedforeasyaccessand
searchfunctionalityandwillbetranslatedsothatthelocal
populationscanaccessalloftheinformationintheirnative
language.<Whoispayingforitorhowwillitbesponserd?
Nicolemaybeyoucananswerthis>Itisunderstoodthatin
manydevelopingcountriestheinternetisdifficulttoaccessor
maybebecompletelyabsentinsomeareas.Inordertoimprove
accesstotheselocations,eachdevelopingcountrywillhaveat
leastoneinformationofficeorheadquarterswhereatechnician
wouldbeavailabletoreceivecalls,lettersandotherformsof

correspondencefromthosewhodonothaveinternetaccessand
conducttheHealthInformationNetworksearchforthem
directly.Thispersonwillthenrelaytheneededinformationback
tothepersonwhomadetheinquiry.
3d.DevelopmentthroughBusiness
In order to promote further collaboration, we suggest turning
current World Bank and IMF funding that is distributed to each
countrys health budget into grants or programs proposed and
implemented by pharmaceuticals. Such programs could involve
R&D, professional development of local medical practitioners,
or the creation of regulated drug production facilities within the
state receiving the funds. This puts the impetus for improving
access to drugs for the worlds poor into the hands of those who
stand to profit from the development of the country: the
pharmaceuticals and other organizations receiving the grants.
This new collaboration between grant recipients and developing
states will give each incentive to see to the improved health of
the population and to protect intellectual property rights,
including the increased regulation of generic drug producers
within the developing countries.

This Policy proposes that implementations of a combination of


these two dimensions, the Health Information System and
Development through Businesses, will dramatically improve
individual access to drugs and community health in general,
while also encouraging investment and development in the
poorest countries.

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