Firstly, to improve access and affordability, we must emphasize the need for the removal of both mark-ups on generic medicines, and regulatory barriers on imported essential medicines, such as duties and sales taxes, at country levels. In the past, as part of its qualification process, the Global Fund required a recipient country to remove taxes and duties, and to import tariffs on medicines. Governments have also made exceptions for other health care goods, such as wheelchairs. This is not currently the unilateral case for essential medicines, importantly those for non-communicable diseases. For example, countries across all income levels currently apply tariff rates to essential cancer medicines such as methotrexate, tamoxifen, and paclitaxel, ranging from 10% – 25%. This results in the differential taxing of the sick and, particularly, in the case of chronic disease care, puts a lifetime burden of catastrophic costs on patients, pushing some further into poverty.
Secondly, the global market for many pediatric medicines, such as those for cancer, are characterized by small and inconsistent demand, erratic production, and volatile prices. This market failure gives rise to poor access to essential, often low-cost medicines, and hence, preventable loss of lives of thousands of children each year. In order to address this problem, Member States should seriously consider the development of regional pooled financing and procurement mechanisms, such as the PAHO Revolving Fund. Such pooled mechanisms will aggregate demand, resources, and procurement; stabilize drug production, prices, and quality; and save lives by enhancing access to care for vulnerable children.
Finally, in their efforts to improve access to medicines, Member States should thoroughly consider the forthcoming recommendations of the the UN High-Level Panel on Access to Medicines, which has gone through a robust process to address the policy incoherence between public health, human rights and trade.