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World Cancer Day 2018: It’s time to bring down the price of medicines. Authors: Tabitha Ha, Advocacy and Campaign Officer, Oxfam International and Mohga Kamal-Yanni, Senior Health policy Advisor, Oxfam GB

Sunday 4th February is #WorldCancerDay and the theme is #WeCanICan – a message uniting the world in the fight against cancer. Indeed, the world must unite to stop high prices being charged for medicines, which prevent patients from getting the treatment that can save their lives. People across the globe need to unite to push for tough actions by governments and UN bodies to change the system that leads to high medicine prices.

The high price of medicines can be a death sentence to those who cannot afford it. Tobeka, a mother from South Africa, spoke in 2016 about her experience with breast cancer. She said that she wanted to live so that ‘I can bring up my two boys’. However, neither herself nor her insurance company were able to cover the high price of the medicine that could have saved her life. Tobeka passed away in 2017, spurring on action amongst people who stood in solidarity with her. They came together to demand that Roche (the pharmaceutical company that markets the breast cancer medicine) drop the medicine’s price so that other breast cancer patients could dramatically increase their chance of survival.

Cancer incidence is increasing all over the world including in low and middle-income countries. Women bear the brunt of lack of access to health services and to medicines. They are often the last in the family to seek healthcare if cost is an issue and they carry the lion’s share of the burden of care for sick family members, especially those who cannot access treatment. Breast and cervical cancer are the main cancer killers amongst women in developing countries. More than 95% of cervical cancer deaths occur in low and middle income countries. Breast cancer cases are increasing at a greater speed in these same countries.

This is the case even though prevention for cervical cancer and treatments for breast cancer already exist. The problem lies in the fact that prices of cancer medicines are soaring and are a major access barrier for patients. In South Africa, a 12-month course of Herceptin, a breast cancer medicine produced by Roche, costs approximately $38,000 or around five times the country’s average household income. Yet at least one possible supplier of the medicine suggests it could be produced and sold for as little as $245. The HPV vaccine that helps prevent cervical cancer, marketed by Merck and GSK, is one of the most expensive vaccines in developing countries. Merck’s vaccine is sold by Gavi, The Vaccine Alliance, at $ 4.5/dose (total of $13.5 for the recommended three doses).

High prices of medicines are not only a developing country issue. In the past 15 years, the average cost of new anti-cancer treatments in Europe has more than quadrupled and some women in the UK have had no choice but to seek charitable donations  to pay for their medicines.

Pharmaceutical companies can charge high prices because new medicines are patented. This gives companies a monopoly on a newly created medicine. Without competition, companies can sell medicines at whatever price they want. The pharmaceutical industry often justifies high prices by claiming that they are necessary to recoup high research and development (R&D) expenditures. However, little is known about the true costs of R&D due to the secrecy of the industry. The ever-escalating figure quoted by the industry and its supporters is based on studies by one university, which has been funded by the pharmaceutical industry. The figure is contested by experts, some of whom estimate that in fact as much as two-thirds of upfront R&D costs are paid by the public sector and not pharmaceutical companies. The lack of evidence to justify high prices of patented medicines, and the devastating consequences of these prices, demonstrates the urgent need for transparency around the costs of R&D.

The fight for access to cancer medicines is inextricably linked to a wider access to medicines fight: the fight to ensure public health has supremacy over profit. Oxfam advocates for governments to adopt the recommendations of the UN High Level Panel on Access to Medicines (HLP) , which tackle the issues caused by the current R&D model that prioritises profit over public health.

Last week at the WHO Executive Board (EB), Oxfam spoke[1] of Tobeka’s story and the reality of the impact of high prices of medicines on patients. The WHO EB debate on medicines represented a fierce battle between protecting the public health of patients all over the world and protecting the commercial interest of pharmaceutical companies. There was wide support from developing countries to urge the WHO to take action on the recommendations of the independent review of the ‘Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property’ without delay. Many of the strategy’s recommendations echo those from the HLP. A number of European countries also raised the issue of high prices in their own domestic markets and called for fair pricing.  But the US and Japan objected to implementation of the recommendations of the review of the Global Strategy – and to specific language on transparency on the cost of R&D. Eventually a draft decision was agreed and will be put forward at the upcoming World Health Assembly in May. If passed, the final decision text would allow member states to implement the majority of recommendations except for a few that require further discussion, including on the transparency of R&D costs,.

High prices affect everyone but they affect the poorest most and especially women. The fight for affordable and accessible medicines is a fight for women’s health. Governments have a set of promising solutions in the form of the HLP recommendations. These recommendations must be implemented without further delay. World Cancer Day is a strong reminder why action must be taken to implement them.

 

 

[1] Under agenda item 3.7

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni