10.4 Access to essential medicines and health equity

Access to essential medicines is crucial for global health equity. The World Health Organization's essential medicines list guides countries in selecting vital drugs, while generic alternatives make treatments more affordable. Drug donations and global health initiatives further improve access in low-income nations.

Intellectual property rights and trade agreements impact medicine availability. The TRIPS Agreement sets global standards, but compulsory licensing and parallel importation provide flexibility. Universal health coverage and addressing social determinants of health are key to reducing disparities in access to care.

Access to Essential Medicines

Essential Medicines and Generic Drugs

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• Essential medicines list created by WHO guides countries in selecting vital medications
• List updated biannually includes around 350 drugs addressing priority health needs
• Generic drugs offer more affordable alternatives to brand-name medications
• Generic drugs contain same active ingredients as brand-name counterparts
• Generic drugs undergo rigorous testing to ensure bioequivalence (same therapeutic effect)
• Generic drugs typically cost 80-85% less than brand-name equivalents
• Increased availability of generic drugs improves access to essential medicines in low-income countries

Drug Donations and Global Health Initiatives

• Drug donations involve pharmaceutical companies providing medications to countries in need
• Drug donation programs address specific health issues (HIV/AIDS, malaria, neglected tropical diseases)
• World Health Organization Good Donation Practices guide responsible drug donation practices
• Global health initiatives coordinate efforts to improve access to essential medicines
• Global Fund to Fight AIDS, Tuberculosis and Malaria provides funding for treatment and prevention
• GAVI Alliance focuses on increasing access to vaccines in low-income countries
• President's Emergency Plan for AIDS Relief (PEPFAR) supports HIV/AIDS treatment and prevention globally

Intellectual Property and Trade

TRIPS Agreement and Compulsory Licensing

• TRIPS Agreement (Trade-Related Aspects of Intellectual Property Rights) sets global standards for intellectual property protection
• TRIPS Agreement requires WTO members to provide patent protection for pharmaceuticals
• Compulsory licensing allows governments to produce patented drugs without patent holder's consent
• Compulsory licensing used in public health emergencies or to address unmet medical needs
• Countries must negotiate with patent holders before issuing compulsory licenses
• Compulsory licensing helps balance intellectual property rights with public health needs
• Brazil and Thailand have used compulsory licensing to increase access to HIV/AIDS medications

Parallel Importation and Doha Declaration

• Parallel importation involves importing patented drugs from countries where they are sold at lower prices
• Parallel importation allows countries to access more affordable versions of patented medications
• TRIPS Agreement allows countries to determine their own rules for parallel importation
• Doha Declaration affirms countries' right to protect public health and promote access to medicines
• Doha Declaration clarifies flexibilities in TRIPS Agreement for developing countries
• Doha Declaration extends deadline for least developed countries to implement pharmaceutical patent protection
• Doha Declaration facilitates use of compulsory licensing and parallel importation to address public health crises

Health Equity

Universal Health Coverage and Access to Care

• Universal health coverage aims to ensure all people have access to essential health services
• Universal health coverage includes financial protection against catastrophic health expenses
• Countries implement universal health coverage through various models (single-payer, multi-payer, national health service)
• Universal health coverage improves access to essential medicines and health services
• Thailand's Universal Coverage Scheme provides comprehensive health coverage to 75% of population
• Rwanda's community-based health insurance program covers over 90% of population
• Universal health coverage addresses barriers to care (financial, geographical, cultural)

Health Disparities and Social Determinants of Health

• Health disparities refer to differences in health outcomes between population groups
• Social determinants of health influence health disparities (income, education, housing, environment)
• Low-income populations often face greater barriers to accessing essential medicines
• Rural populations may have limited access to healthcare facilities and essential medicines
• Ethnic and racial minorities experience disparities in health outcomes and access to care
• Addressing health disparities requires multifaceted approach (policy, education, community interventions)
• Initiatives to reduce health disparities include targeted outreach programs and culturally competent care