Universal Health Coverage Day 2019: Who’s being left behind and why?

Ending AIDS by 2030, healthy lives and well-being for all, and the ambitious treatment target of 90-90-90, just three of the key commitments made to ensure that everyone has access to HIV treatment and other essential medicines.

Yet despite global and national commitments, along with scientific advancements, millions of people are being left behind. A lack of access is devastating, both on an individual and societal and moral basis. When the drug to save someone’s life exists, no-one should be dying.

The majority of people living with HIV reside in middle-income countries but this is also often where the treatment gap is the largest.

So why? Why are drugs not reaching everyone who needs them?
What stops universal health coverage being achieved?

Our partners, from middle-income countries around the world, share their perspectives and frustrations about what the barriers are; the consequences; and what needs to change:

“We appreciate the commitment made by governments to Universal Health Coverage but achieving it will be a distant dream as long as the cost of medicines remains unaffordable,” says Shiba Phurailatpam, Regional Coordinator of the Asia Pacific Network of People living with HIV (APN+).

“Health care programs in our region are already struggling with the high cost of patented medicines. Whether we achieve UHC now, soon, or after 100 years will depend on how soon our governments bring in affordable generic medicines,” says Phurailatpam.

Achieve UHC? Tackle price and prejudice

Phurailatpam believes a dual-response is required, one which tackles both price and prejudice.

“Though the commitment to UHC exists in theory, marginalized communities in our region continue to struggle to access health care programs. Bringing UHC one step closer will only happen when people who are highly marginalized are put at the centre of all UHC related policies, programs and discussions.”

“We have a lot to learn from the HIV epidemic. The same drugs which used to be more than 10,000 US dollars per patient per year are now less than $100 because of generic production and competition. If we are serious about achieving UHC then we have got to sort out the issue of patented drugs and their high cost.”

Alma de León, ITPC’s Regional Director for Latin America and the Caribbean, agrees: “If we want to achieve universal coverage, drug patents must be eliminated,” de León says. She takes a hard line: “No more patent registration on life-saving drugs.”

De Leon also believes there is not enough take up of TRIPS flexibilities in order to prevent or challenge unmerited monopolies or other intellectual property barriers, something she is working on with civil society organizations in the region, to build on and change the medicine landscape.

Mykyta Trofymenko, Intellectual Property Counsel at 100% LIFE affirms that unmerited patents is also what’s stretching the health budget to breaking point in Ukraine. 

“Evergreening patents seriously obstruct access to medicines in Ukraine. According to 2017 data, one medicine monopolized by two secondary (evergreening) patents takes up a staggering 40% of the HIV budget and more than 10% of the whole state budget for procuring medicine.”

‘Intellectual property’ can at first seem a daunting topic to people without a technical or legal background, but Aissam Hajji, ITPC-MENA’s Advocacy Officer, explains why it’s essential for all health advocates to engage with this issue: “Experience has shown that action taken by civil society has a direct impact on stimulating competition,” he says. “It’s really important for civil society to understand the impact of monopolies on medicines and the important role they can play. Medicines no longer benefit from a status of ‘public goods’ [as Alma would like to see happen], instead they are mere products to profit from. With an absence of competition, these profits are unrestricted.”

It is clear from our work on access to medicines, that the ambitious health targets set cannot be achieved unless we tackle the patent problem. 

The commitments to UHC are being undermined by intellectual property barriers, especially in middle-income countries which are frequently excluded from pricing deals and licenses due to their income classification. However, this can change. Partners of the Make Medicines Affordable campaign are removing barriers and setting precedents to create long-term change.