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Public Health and the Free Market (Pandemic Influenza Preparedness Framework)

Here’s an excerpt from a discussion I had on the discussion boards of Epidemics, Pandemics and Outbreaks on Coursera. We were discussing the role of the free market in public health during epidemics. Other people said more interesting things, but alas I don’t have permission to copy what they said, so you’re stuck with my boring comment:

The market works for many things, but it does not necessarily result in better public health. This was illustrated in the development and patenting of antiretroviral medicines for HIV. Although they were based in part on publicly gathered/funded information and research, they were priced out of range for uninsured people in the United States and pretty much anyone in the developing world. It took the work of activists, governments and other “non-market” players to make antiretrovirals more widely available.

I don’t view pharma as holding treatments or vaccines for “ransom,” but rather trying to return as much profit as they can to their shareholders. The Framework seeks to balance that factor out by encouraging pharmaceutical companies that benefit from shared information to return some of that benefit (in the form of vaccines that aren’t priced out of accessibility) to the public. The Pandemic Influenza Preparedness Framework from the World Health Organization says:

6.10Access to vaccines in the inter-pandemic period for developing countries

6.10.1 Separately from measures to support the WHO PIP vaccine stockpile set out in section 6.9 above:

(i) Member States should urge influenza vaccine manufacturers to set aside a portion of each production cycle of vaccines for H5N1 and other influenza viruses with human pandemic potential for stockpiling and/or use, as appropriate, by developing countries; and

(ii) Member States should continue to work with each other, with the Director-General and with influenza vaccine manufacturers, with the 20 aim of ensuring that adequate quantities of vaccines for H5N1 and other influenza viruses with human pandemic potential are made available to developing countries at the same time as to developed countries, on the basis of public health risk and needs and at tiered prices (see 6.12 below).

6.11Access to pandemic influenza vaccines

6.11.1 Member States should urge vaccine manufacturers to set aside a portion of each production cycle of pandemic influenza vaccine for use by developing countries; and

6.11.2 The Director-General, consulting Member States and the Advisory Group, will convene an expert group to continue to develop international mechanisms, including existing ones, for the production and distribution of influenza vaccines on the basis of public health risk and needs during a pandemic, for consideration by the World Health Assembly in 2010.

6.12 Tiered pricing

As a measure to improve the affordability for developing countries of pandemic influenza vaccines and vaccines for H5N1 and other influenza viruses with human pandemic potential, and antivirals, Member States should urge influenza vaccine and antiviral manufacturers individually to implement tiered pricing for these vaccines and antivirals. As part of this approach, influenza vaccine and antiviral manufacturers individually should be urged to consider the income level of the country, and negotiate with the national authorities of the recipient country, in arriving at the price to be applied in the private and public markets of each country. In this context the vulnerability of the least developed countries should be taken into account.

By the way, Epidemics, Pandemics and Outbreaks is a decent course overall, though I got a little bored in week 3 and would have preferred a stronger medical focus. Although it’s already started, none of the deadlines for quizzes have come around yet, so it’s not too late to sign up. It’s a fairly light workload and could easily be completed in a week with an hour or two of commitment each day, though of course you’d get more out of it by spending more time and doing the optional assignments in addition to the required ones.

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