Within the last few days, Raphael Correa, the president of Ecuador, made a statement encouraging domestic pharmaceutical companies to ignore drug patents and produce drugs that are still protected by international agreements. He said that this move was “in the name of human health.” Certainly, his thought is that by allowing local companies to manufacture drugs that are currently on patent in country, prices will decrease dramatically for sick Ecuadorians. As of now, there has been little comment from the major pharmaceutical companies, most likely because the country of thirteen and a half million people represents a small drop in the bucket of drug expenditures. Nevertheless, I would expect some generalized outrage from the companies if only because of the signal it sends to other nations considering similar moves.
At first glance, I thought that this move was generally a reasonable one. After all, our own personal experience revealed that the Ecuadorian people desperately need access to reasonably priced medicines. We saw how many sick individuals would pay for medication by the pill at the local pharmacy and quit when the symptoms subsided. Many more would not even buy the pills at all, letting the disease linger. Surely if the local pharmacies could sell locally manufactured medications at a discounted (generic) price, more people would be able to afford complete courses of treatment. Ultimately, this would lead to a healthier and more productive Ecuador.
After further consideration, I began to question such a policy. First of all, the only drugs that this would affect would be those that are on patent. Of the most commonly prescribed drugs, very few of them do not already have generics available or have generic alternatives available. In Ecuador, many of their problems are with GI or parasitic infections. Most, if not all, of the drugs to treat these conditions are already off patent. The drugs that are still on patent, are often minor adjustments to preexisting drugs marketed for the sole purpose of extending the drug companies monopoly on the medication.
Therefore, I question how much of an effect on prices and affordability this move will have. Sure, local pharmaceutical companies can begin to offer new, ‘state of the art’ drugs like losartan at reduced prices in the country, but does this significantly improve a country whose major cause of life years lost is lower respiratory infections ? Does this affect the average Ecuadorian who could use a prescription for an NSAID for his chronic back pain from working in the fields all day? More research into how much the ignoring of patents will affect the survival and morbidity of the average Ecuadorian is warranted.
If anyone is greatly affected by this, it will probably not be the average low class Ecuadorian who needs affordable access to antibiotics and antiinflammatory drugs. Rather, it is the upper class individuals in the private clinics whose problems closely mirror the medical problems in the more developed parts of the world: diabetes, hypertension, and heart disease. The medications for these ailments are the ones that still on patent because they are the ones that make the most money for the pharmaceutical industry. Therefore, I am afraid that this move by Correa, which on the surface seems to be for the health of all Ecuadorians, is really just a mechanism by which medical, social, and health inequalities in the country will be perpetuated.
By Sean Boley, MSII
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Data provided by the WHO on causes of mortality and years of life lost in Ecuador is nearly a decade old. While lower respiratory tract infections are listed as the largest cause of years of life lost, heart disease, hypertension, and diabetes are all among the top ten causes of mortality, even in 2002. It seems quite possible that the incidence of these chronic diseases has increased in the past eight years, reflecting a common trend among developing nations. Contrary to popular belief, these are not merely diseases of the rich, a fact that is particularly well evidenced in the US. Rather, they are chronic illnesses that are largely the result of genetics and lifestyle choices, and any nation would benefit greatly from affordable new drug options that improve compliance with prescribed treatments.
Furthermore, it should be recognized that a system of compulsory licensing, such as that utilized by Correa, requires the involvement of the implicated pharmaceutical companies before any approval can be granted, and it provides the affected industries with due compensation. However, it is likely that Correa's vocal presentation of his policy decision as a public health triumph greatly influenced the decision of the pharmaceutical industry to bend to his will. Yet, they managed to restrain any underlying resentment in a press release concerning their involvement, plainly stating, "We accept the democratic decision...to legally implement this extraordinary measure...No legal right is superior to the requirements of public health, especially in such serious circumstances."
Perhaps cheaper drugs will improve the prescription register at public health hospitals throughout Ecuador, which currently seem only equipped to dole out paracetamol and amoxicillin, and are clearly not capable of addressing the concerns of a rising tide of cancer and chronic disease.
It is worth noting that Correa has hinted at similar measures aimed at addressing agrochemical patents. This progressive process of internalizing international production measures, which began with petroleum processing, seems to have become a staple of his administration, but it remains to be seen what the long term effects of these changes will be.
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