The High Level Forum was organised by the OECD in collaboration with the Government of the Netherlands. The World Health Organization (WHO), being the global organisation mandated on health issues, played an important role in the preparations and proceedings. The Forum was addressed by Antoinette Sayeh, Minister for Finance, Liberia, Bert Koenders, Minister for Development Co-operation, the Netherlands and Angel Gurría, OECD Secretary-General. Her Majesty Queen Beatrix of the Netherlands attended on the morning of 21 June.
Why has the situation become critical?
Mainly because the markets in developing countries are not profitable enough. Under the current innovation framework, companies have few incentives to assume the costs and risks of launching a new medicine onto the market. Dysfunctional health systems in developing countries are another part of the problem. But the two major concerns are that research is simply not producing new medicines for infectious diseases and, to make things worse, policies in the health sector are not coherent. To counter this, more open innovation, coherent policies and support for developing country research and development (R&D) are needed.
The Forum provided a concrete step forward in this field. The foundations were laid for participants to create synergies between innovation, health, trade, science and technology, development co-operation and financial policies to improve the health of the poor in developing countries. This outcome is closely linked to, and complements, the work of the WHO.
The issues are complex and involve stakeholders from many sectors. Discussions among representatives from developed and developing countries’ health and development ministries, pharmaceutical companies, the research community and philanthropic foundations were action-oriented. In line with Millennium Development Goal No. 8, Noordwijk spearheaded the scaling-up of networks and partnerships with the pharmaceutical industry in order to produce basic medicines for the poor. It also gave a clear signal that there is a collective interest in finding solutions. As one representative put it: “A paradigm change has taken place, the diseases of the poor have a new platform.”
This common goal was laid out in the Noordwijk Medicines Agenda (NMA), which aims to create collaboration and policy coherence. It is hoped that scaled-up research will boost discoveries and counter emerging and neglected infectious diseases. Although not formally endorsed by OECD countries, the NMA represents a general agreement among participants about the problems, goals, and work that needs to be done in order to improve the availability of, and access to, much-needed medicines.
The NMA will explore the viability of a global drug development network, set up a platform to share information, evaluate different “for profit” and “not for profit” innovation models, and support and engage in R&D with developing countries to increase their capacity. Medicines need to be not only available but accessible. This means that developing countries need functional health systems backed up by coherent policies and actions and predictable, transparent funding. Linking innovation to better accessibility of medicines will be a challenge for future DAC work.
The Forum considered that policy coherence is crucial in three major areas:
Medical breakthroughs and progress must be complemented by efficient health systems in developing countries.
There is a need for policy coherence across developed and developing countries for R&D, health policies and beyond.
Aid policies must be coherent at all levels, to ensure that recipients’ needs are met. Over 100 countries have agreed to this principle by endorsing the Paris Declaration on Aid Effectiveness. And this is what the Millennium Development Goals seek to do, notably MDG 8.
Why does all this matter?
Although less than 1% of new drugs on the market since 1975 have been developed for neglected infectious diseases, according to WHO nearly one billion people suffer from them. They kill nearly 14 million people every year, mainly in developing countries. Malaria, for example, kills more than 1 million people a year and threatens 40% of the world’s population.
Tropical and diarrhoeal diseases entail huge economic, social and human costs. The annual cost of these diseases in Africa is estimated at nearly USD 12 billion and could slow down African economic growth by 1.3 % per year. Globalisation and international migration are extending the threat beyond developing country borders. However, these diseases are not a priority for mainstream R&D.
Most initiatives are focused on development, not discovery. The upstream, research and early proof of concept work that provide new leads and create a pipeline of possible health products are still weak. Approximately 70% of the new chemical entities approved between 1975 and 1999 were improvements to drugs already on the market.
What can be done?
Public-private partnerships and philanthropies have been working to minimise the costs entailed during development and trials, thus reducing some of the barriers to bringing inventions to the market. But there is still a need for innovative policies that create a new, more open, business environment for innovation; one that strikes a balance between stimulating innovation through patents and intellectual property rights and providing broader access to knowledge. The sharing of materials, data and know-how should be facilitated, sustained by networks that promote such sharing and form new collaborations. In this connection, the OECD’s 2007 Ministerial Council gave a strong mandate to embark on an ambitious “OECD Innovation Strategy”.
As OECD Secretary General Angel Gurría reminded the Forum, OECD countries carry a special responsibility to address these issues and to find solutions. They account for 80% of global GDP and 85% of global R&D. Both developing countries and the health innovation systems in OECD countries would benefit by resolving the failures in a system that prevents the discovery and delivery of medicines for infectious diseases to those who need them most.
The papers presented at the Forum will be published later this year in the Development Dimension series.