The field of global health is constantly evolving. From its murky origins in colonial medicine, to its shift from vertical to horizontal care, to today’s technological age, global health has been shaped by a variety of societal forces. Today, we observe the phenomenon of pharmaceuticalization (Biehl et. al). With scientific and technological innovations, diseases like tuberculosis, malaria and AIDS, that were once thought to be fatal are now treatable. It is unjust to discriminate who deserves biomedical cures for life-threatening diseases based on race or socio-economic status. Doing so would deepen inequities and promote forms of structural violence (Farmer 265). In response to this problem, in 1975, WHO Director-General Halfan Mahler highlighted the need for a list of basic, essential medicines that every individual deserves access to. The WHO published this list of “essential medicines” two years after his speech. This list was assimilated after consulting ministry officials, doctors and health care providers across over twenty-five countries (Greene 17).
While the document was no doubt well intentioned, the subjectivity of the word “essential” itself makes me question its effectiveness. The criteria used to dictate which medicines made the list and which did not, were not necessarily comprehensive. The idea of “local biologies,” itself shows that there is a great deal of regional disparity among the symptoms of various afflictions; certain diseases have more potent effects than others due to cultural and social differences among nations (Lock 1). How can we create a blanket list of only 186 worldwide “essential medicines,” when each region and its government have specific health issues and unique barriers to access drugs?
Furthermore, our list of “essential medicines,” may in fact perpetuate inequities rather than eliminate them. For example, it favors prevalent conditions over rare diseases (Greene 18). In the summer of 2013, I interned with the Rare Genomics Institute, an organization focusing on developing treatments and bringing awareness to those suffering from rare genetic diseases. After interviewing over thirty individuals with rare diseases, a common theme emerged. There was a lack of research and development for cures due to the low profitability of rare disease ventures. Rare disease drugs, also known as “orphan drugs,” were not seen as profitable by large biotech companies (Jessop). Or, if the drugs were available, they were placed at exorbitant prices. Is it just, to tell a woman I interviewed with Gaucher disease, that she deserves to pay $310 250 for one therapy treatment? Neglected by the health care system, many individuals suffering with rare diseases succumb to despair and hopelessness. Is it fair to favor the majority in our definition of “essential”? The blanket statement of the word “essential,” gives biotechnology companies and governments an excuse to not care for those in the minority. In addition, its inflexible structure obstructs new medicines from being added, preventing individuals from benefiting from the dynamic innovation occurring in the global market.
What truly is concerning, is that pharmacologists developed the first list of essential medicines (Greene 24). In today’s market, pharmaceutical companies have the power in deciding what these “essential drugs” are and how much they should cost. A recent controversy regarding drug pricing has emerged from an agreement known as the Trans-Pacific Partnership (TPP). A Wikileaks document shows one of the final drafts of its chapter on intellectual property, which entails policies that will limit the competition of generic drugs. Through allowing patent term extensions and market exclusivity for drugs, this agreement will result in higher drug prices (Gleeson 1). Especially in developing countries, with weakened economies, this agreement will prevent access to affordable medicines. Medicins Sans Frontiers and other international organizations have protested the institution of this plan due to its destructive effects on the poor (Medicins Sans Frontiers). In Julie Livingston’s Improvising Medicine, we can see the devastating effects resulting from a scarcity of affordable medicines. In PMH, “some people shared stories of a profound physical agony and deaths born of the near total lack of medicines, sutures and bandages” (Livingston 177). It is not ethical to have a system where corporations and market- driven governments profit from causing misery and death. Yet, Greene notes that pharmaceutical companies brand themselves as “global health,” companies, falsely portraying themselves as supporters of the WHO’s initiatives.
And so as we shift towards emphasizing PHC, we must recognize that in some ways, the WHO’s list of essential medicines is enabling the oppression of the poor and supporting pharmaceutical companies in their profit- driven initiatives. While the WHO’s list of essential medicines was an important start to promoting health equity, I believe that we must look towards new approaches in the 21st century.
- The definition of “essential,” has caused great debate in the global community. Currently, the WHO has defined its list of essential medicines based on popularity, previous establishment, efficacy and cost. How do you think the word “essential” should be defined? Do you think it is necessary to have a list of essential medicines? Should the WHO redefine or modify its list?
- In the case of pharmaceuticals, do you think it is possible to balance profit- driven incentives with a desire to improve the common good? In other words, can we still create incentives to innovate while ensuring the affordability of essential drugs?
In Class sources
Biehl, Joa. When People Come First Critical Studies in Global Health. Princeton: Princeton UP, 2013. Print.
Farmer, A. Kleinman, J. Kim and M. Basilico, eds. 2013. Reimagining Global Health: An Introduction. Berkeley: University of California Press.
Greene, Jeremy A. “Making Medicines Essential: The Emergent Centrality of Pharmaceuticals in Global Health.” BioSocieties 6.1 (2011): 10-33. Web.
Livingston, Julie. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham: Duke UP, 2012. Print.
Lock, Margaret. “Menopause, local biologies, and cultures of aging.” American Journal of Human Biology 13, no. 4. 2001.
Out of Class Sources
Gleeson, Debrorah. “Comments on the Completed Trans Pacific Partnership (TPP) Intellectual Property Chapter.” N.p., 10 Oct. 2015. Web. 01 Nov. 2015.
Jessop, Nathan. “The Dilemna with Orphan Drugs.” PharmaTech. N.p., 1 Aug. 2013. Web. 2 Nov. 2015.
“Statement by MSF on the Conclusion of TPP Negotiations in Atlanta.” MSF USA. N.p., 05 Oct. 2015. Web. 01 Nov. 2015.