Many poor people in developing countries do not have access to the drugs they urgently need. Often they cannot afford them. But cheapness is not everything when it comes to making drugs more accessible.
Drugs become cheaper as soon as the patent on them expires. Then, other pharmaceutical companies are allowed to produce the same drug under a different name and sell these generics at lower prices. "A number of countries are trying to switch to generics," says Joe Kutzin of the World Health Organization WHO.
But selling all medicines to everyone at the price of their production would not work in the long run, says Anita Katharina Wagner, associate professor in the department of population medicine at Harvard Medical School in Boston: "Pharmaceutical companies need to make profits to keep developing new medicines. So the payment has to come from somewhere," she noted.
To make drugs affordable in developing countries, pharmaceutical companies charge their customers in Europe and the US much more than the drugs are worth. In exchange, they sell the same substance at lower prices in poorer countries, explained Francois Bompart, of the "Access to Medicines" Program of the pharmaceutical company Sanofi.
"The same vaccine, for example, will be sold at 50 euros ($68) in the US or in Europe and for three to four euros in Africa," said Bompart. "The whole system works because in the middle you have countries like Brazil, South Africa and Thailand that pay 10 to 20 euros."
Donations as an exception
This tiered pricing policy "makes sense," according to WHO's Kutzin. It is even essential for pharmaceuticals that are very high priced like the new generation of HIV and cancer drugs.
Tiered pricing fails, though, when it comes to many tropical diseases which affect only poor people in low income country, sleeping sickness for example. Here, partnerships between non-governmental organisations, governments and pharmaceutical companies are the only way to develop and produce lifesaving drugs.
In the case of malaria, the pharmaceutical company GlaxoSmithKline works together with eleven African research centers to develop a vaccine against malaria for children. The Bill and Melinda Gates Foundation supports the studies financially.
Even a cheap drug can be too expensive if the money is just not there. Therefore, the key to making medicines more accessible is the health financing system, Kutzin says. "What we would like to see is that people do not have to pay at the time of use - or at least not so much that it is really an obstacle. People shouldn't be forced to choose between their financial well-being and their physical well-being."
Tim Evans, director for health, nutrition and population at the World Bank, adds that there are several ways to achieve that. One way is health insurance. Another is "putting taxes on cigarettes and alcohol and having those taxes go into health-promoting funds."
According to Kutzin, a health insurance system must be compulsory to be effective. "No country has really got into a universal population coverage relying on voluntary insurance."
Success in India
In India, the German Society for International Cooperation (GIZ) assisted the government in setting up a system that allows poor families to receive free treatment in hospitals. For each patient, the government will pay up to 30,000 Indian rupees (about 340 euros) per year.
The government handed out electronic smartcards to the poorest families in the country so that the hospitals know these patients are part of the program, which started in 2008.
If the treatment is more expensive than 30,000 rupees, the families have to pay themselves. Nishant Jain of the Social Security Program of GIZ in India explains that they chose a low limit so that the program can cover more people.
"This looks like a small amount, but it is a fair amount of money," said Jain. "We have more than five million cases and in less than two percent, they have touched the ceiling - so we were able to treat most of the people with this limit."
To Jain, improving the health system of a country works best with a good business model. Before the program started, the health care was very bad in rural areas with a lot of poor people - there simply weren't any hospitals. "Now, private companies are setting up hospitals in these rural areas because they see that so many people have the card. They see a business."
Education more important than drugs?
"Medicines are an essential part of health care but they are not the most critical one in many situations," Bompart of Sanofi said. "You need to have good nurses, good doctors, good specialists. Drugs without education don't make any sense."
One illness which is often left untreated is epilepsy. This chronic neurological disease affects 50 million people worldwide, and 90 percent of them live in developing countries. The patients suffer from recurrent epileptic seizures due to abnormal brain activity. Pharmaceuticals can suppress the seizures but the WHO estimates that in developing countries, three fourths of people with epilepsy do not receive the treatment they need.
"If people with epilepsy are not treated today, it is not because drugs are expensive, it is because the patients are not properly diagnosed," Bompart said.
Speciosa Wandira-Kazibwe, senior presidential advisor on population and health to the president of Uganda, adds that African countries like Uganda "don't have the technology to diagnose diseases."
In some cultures people believe that epilepsy patients are doomed, even possessed by the devil. Many families are ashamed of bringing their epileptic children to a healthcare professional and, instead, hide them inside. In this case, combating stigmatization by educating communities about the medical causes of epilepsy is the very first step in improving access to drugs.