A WHO Committee is Negotiating with Drug Manufacturers in order to Improve Access to Medicines

"Igwg on Phiip" sounds like a rural Welsh village on the River Phiip, named to eulogize a local notable named Igwg. In fact, with a different capitalization, it's the cumbersome acronym for a working group that is attempting to improve the poor's access to pharmaceuticals while maintaining incentives for innovation.Since the CGD is a member of the "Global Health Technology Coalition", I've just received the minutes of their event on November 18 at which Dr Gaudenz Silberschmidt delivered the attached PPT presentation . It is full of acronyms, but most can be deciphered from the previous slides and the context. For example, "IGWG on PH, I, IP" means "Inter-Governmental Working Group on Public Health, Innovation & Intellectual Property".The IGWG on PH, I, IP was created by the WHO "World Health Assembly" in 2006. The minutes of their meetings can be found on the WHO website. This working group has generated a "Global Strategy" and a "Plan of Action" submitted to, and adopted by, the World Health Assembly in May 2008. The formal name of the submitted document is "Resolution WHA 61.24: Global strategy and plan of action on public health, innovation and intellectual property." Presumably this resolution should eventually appear on the WHO website that displays such items, but at the time of this writing it has not yet appeared.According to Dr Silberschmidt's presentation, resolution 61.24 empowers the "IGWG on PH, I, IP" to "negotiate" with industry on measures that firms might take to increase access. It's not clear how the working group can make much headway. What do they have to offer firms in exchange for concessions?Among the "upcoming challenges" which Dr Silberschmidt lists on his penultimate slide are the following which link to various aspects of CGD's work:

• How to deal with differential prizing (sic) in emerging economies with legitimate markets and legitimate demands for access for the poor?
• Links to challenges in pharmaceutical policies of industrialized countries (e.g. lack of research in antibiotic resistance)

The typo on Dr Silberschmidt's slide which replaces "pricing" with "prizing" is ironic, because I see no mention of prizes or "advanced market commitments" (like those promoted by the CGD based on the work of another working group) anywhere in the PPT. Perhaps AMCs are in the negotiations, but there is no sign of them in these slides.One might ask, "what ELSE is worth doing if the group isn't able to make progress on differential pricing?" Perhaps the answer lies in the "Access to Medicine" or ATM index, displayed on the last of Dr Silberschmidt's slides. The index has eight components, only one of which is pricing. The index is thus suggesting that excellence on many other dimensions could offset failure to aggressively pursue differential pricing. I find this rather a stretch. Differential pricing has the advantage of engaging the full power of both the private and the public drug distribution networks in expand sales to everyone who can pay more than the marginal cost of production. Where the distribution networks are well developed, it would take a lot of "drug donations" and "philanthropy" to make up for any reduction in use of differential pricing. (This observation leads to the suggestion that these three components of the ATM index could be usefully collapsed into a single component, defined as the dollar value of concessions in these three areas.)The second bullet is too abstract to understand until one gets to the example. Ahhhh. They think industrialized countries are to blame for the fact that private pharma does little research on antibiotic resistance. That seems a very big stretch to me. The fact that drug resistance is an international public bad should maybe come first in the list of causes of insufficient research. Not only does no firm have sufficient incentives. No country does either. In fact the only body that has at least a partial mandate to regulate an international bad in the public health domain is the WHO "which has failed to take a strong stand on the issue so far."Meanwhile the CGD is currently hosting a working group on drug resistance, which will publish recommendations on policies that WHO and the donors might follow to reduce the danger of drug resistance and lengthen the usefulness of our existing pharmaceuticals. Once the recommendations have been announced, perhaps this IGWG on PHIIP will endorse and help implement them.