On Tuesday, 6 March 2018, Cristina Pucarinho, the Deputy Permanent Representative of Portugal to the United Nations made the following intervention at a UN briefing on Promoting Innovation and Access to Health Technologies in the Context of the Agenda 2030 in New York.
Portugal’s intervention on transparency in New York echoed the statement Portugal delivered at the World Health Organization’s Executive Board in January 2018 – a sterling model of policy coherence.
Transparency is a fundamental value of modern, open and democratic societies. However, lack of transparency prevails throughout the pharmaceutical value chain. As the report very rightly points out, and I quote, “lack of transparency regarding costs of production, research and development, and prices paid by other Member States and procurement agencies, results in a lack of power to negotiate and a reliance on mechanisms for comparison such as international reference pricing, which is likewise opaque” (end of quote). I would add that lack of transparency stimulates corruption, bad governance and allows for abuses such as the very high prices that are currently being imposed for some innovative medicines, notably for cancer, Hepatitis C or some new gene therapies.
The full statement is reproduced below.
Statement by Cristina Pucarinho,
Deputy Permanent Representative of Portugal to the United Nations
UN briefing on Promoting Innovation and Access to Health Technologies in the Context of the Agenda 2030
United Nations, New York, 6 March 2018
“I congratulate UNDP, WHO, UNAIDS and the Executive Office of the UN Secretary General for this initiative to discuss the pressing issue of access to health technologies in the context of the implementation of the Agenda 2030, and its goal 3 in particular.
I would like to address an issue that affects millions of people worldwide: the access (or lack of access) to quality and affordable medical products.
We all understand how access to quality and affordable medical products is a fundamental element for the realization of the human right to health and of universal health coverage. And the fact is that people in all regions of the world are confronted with insufficient access to medical products. Some large parts of the population never had access to those products and this must be reversed; some other large segments of the population, even in wealthy countries, are affected by the more recent dramatic increase of prices of new innovative medicines, which turned them unaffordable and threatening to the sustainability of health care systems. Address these issues also means addressing inequalities and unbalances and not to leave anyone behind.
All this goes along with the appearance of new diseases, more resistant bacteria and the high risk of new epidemics, which require a continuous high level of costly investment in R&D. The response to these challenges must be one that strives for the right balance between these realities if we are to, as we must, achieve the Agenda 2030.
Against this background, we welcome the recent WHO report on the global shortage of, and access to medicine and vaccines. It looks at the whole pharmaceutical value chain, has a comprehensive approach to health systems, extensively analyses the multiple barriers on the access to medicines, and prioritizes actions to improve access to medicines.
I would just like to focus on three intertwined aspects contained in the report which we consider key to improve access to medicines: transparency, fair pricing and joint public procurement.
Transparency is a fundamental value of modern, open and democratic societies. However, lack of transparency prevails throughout the pharmaceutical value chain. As the report very rightly points out, and I quote, “lack of transparency regarding costs of production, research and development, and prices paid by other Member States and procurement agencies, results in a lack of power to negotiate and a reliance on mechanisms for comparison such as international reference pricing, which is likewise opaque” (end of quote). I would add that lack of transparency stimulates corruption, bad governance and allows for abuses such as the very high prices that are currently being imposed for some innovative medicines, notably for cancer, Hepatitis C or some new gene therapies.
R&D is costly but is highly needed and must be stimulated. However, it must be known how costly it is to understand if it is fairly being reflected in the final price of the medicine, especially, but not only, when R&D is financed by States. This is an issue of good governance, of respect for tax payer’s money and ultimately of respect for human rights.
Finally, we fully support WHO’s proposed actions to support and develop policies to promote transparency throughout the value chain, including procurement prices, as well as fair pricing. We also strongly encourage collaborative approaches for strategic procurement, which offer possibilities to improve negotiation and to obtain better prices for medicines. The Valletta Group, to which Portugal is part, along with several other European countries, aims precisely at exploring areas of cooperation, such as joint procurement and at promoting integrity, efficiency in procurement and supply chain management, as well as corruption-free procurement.
We also welcome WHO´s review of the recommendations of UNSG High Level Panel Report on Access to Medicines against the activity already developed by the Organization. Such an approach, looking at the recommendations from an objective and unbiased manner, is a very good way to contribute to building consensus around this document and to benefit from the positive elements contained therein.
This is an issue that should not only be dealt with in Geneva and at capital level as the Report has specific recommendations for the UNGA and UNSG and there are important ongoing and future discussions in the UN General Assembly in New York – including the upcoming UN High Level Meetings on TB and Non-Communicable Diseases – where we hope ambitious and impactful strategies to improve both innovation and access to medicines and other health technologies will also be pursued.
To conclude, I would reiterate that access to quality, safe and affordable medicines must be seen from human rights and public health perspective as it is an essential element of universal health coverage and of the right to health. There is no other way to tackle the current complex challenges than work together to ensure policy consistency between all relevant interests at stake, here too, leaving no one behind. The interests at stake are not necessarily contradictory and must be pursued jointly and in a balanced manner.
I thank you.”