The Global Right to Healthcare

By Kiran Mazumdar Shaw
Chairman & Managing Director, Biocon Limited.

Marijn Dekkers, Chief Executive Officer of Bayer, shocked the advocates of affordable healthcare by candidly stating that, “We did not develop this medicine for Indians, we developed it for western patients who can afford it.” He was referring to a new cancer drug developed by his company.

Dekkers’ words are by far the most honest admission of the business model that seeks to alienate a section of the patients by discriminating against them on the basis of nationality, race and economic status. Rather than wanting to save lives around the world, what Bayer is interested in is maximizing its profits by selling expensive drugs to “western patients who can afford it.” And those who can’t, well, it is a dead end for them as they have to do without Bayer’s lifesaving drugs.

Some might say that it’s a perfectly reasonable position — after all, Bayer and other pharmaceutical companies are for-profit concerns. But, never in the past, were they so dismissive of the humanitarian concerns.

Here’s what George Merck, who became the president of his father’s eponymous chemical manufacturing company Merck & Co. in 1929, had to say on the subject: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.” It is a reminder to the corporates in the pharma industry of their responsibility towards the needy patients.

The question is: Should a drug be described a “blockbuster” by a billion dollar label or a billion patients’ label? If drugs are developed only for those who can afford them, but not for those who need them, wouldn’t that be morally unethical? Yes, there is no ground to justify otherwise. Not only that, it is also a violation of the right to health enshrined in the constitution of the World Health Organization (WHO). According to the world body, the highest attainable standard of health is a fundamental right of every human being. And, non-discrimination is a key principle in human rights.

In 2012, USFDA approved 39 drugs. Of the 12 for cancer, 11 cost $100,000 a year and most recently, a breakthrough Hepatitis C pill won approval with a $1,000-a-day price tag. Yes, drug innovation is expensive and an inordinately long drawn out process which must be compensated through market mechanisms that allow pharma companies to recoup such investments. But the question is how much should this return on investment be? By putting a price on a drug, we are putting a price on life. And what we see in the price of many drugs is that life, and, by extension, health is therefore unaffordable to most people in the world.

Generic producers in India have brought down the prices of life saving drugs used to treat diseases such as HIV, TB and cancer by as much as 90%. In the 1990s, HIV/AIDS drugs cost $12,000 per patient a year which saved patients in the US but not in Africa. The world seemed to accept the unacceptable until in 2001, an Indian pharma company produced a three-in-one HIV/AIDS treatment for one dollar a day.

Today, most of the antiretroviral medicines purchased by the United States’ global AIDS programme come from India, and more than 80% of the HIV drugs that Medecines Sans Frontieres, UNICEF and the Clinton Foundation uses are generics from India. Michel Sidibe, Executive Director of UNAIDS, best summed up India’s ‘human’ role in global healthcare when he said, “Millions will die if India cannot produce the new HIV/AIDS medicines in the future –it is a matter of life and death.”

India is a vital producer of affordable medicines and the world’s largest producer of generic drugs. The Indian pharma industry accounts for 20% of the world’s pharma industry in value terms and constitutes a significant 80% in volume terms which is how it should be if we are to claim our rightful place as the “Pharmacy of the World”.

Indian generics account for a 30% share of the US market and are critical to President Obama’s affordable healthcare programme. Data from the 2013 Generic Drug Savings in the US report shows that generic pharmaceuticals saved the US health system and patients $217 billion in 2012 and a staggering $1.3 trillion dollars in the most recent decade.

India’s contribution to affordable healthcare goes much beyond being a pharmacy to the world. It extends to affordable innovation which goes to the core of ensuring a global right to healthcare. Helped by a significantly lower cost base that supports a large talent pool of scientists and engineers, India’s research engine is now driving a new model of innovation that adds the condition of affordability. With returns on investment plummeting to unsustainable levels in the West, companies are now rapidly leveraging India’s ‘affordable innovation’ platform through outsourcing, risk-sharing, and co-development partnerships. GE’s Research Centre in India has developed a number of low cost bio-medical equipments from scanners to ultrasounds as has Bristol Myers Squibb developed a number of promising novel drugs at its partnered research center with Biocon in Bangalore. India is therefore now a laboratory for the world that can deliver affordable innovation and a growing number of collaborative efforts are succeeding in delivering products and services that can go a long way in ensuring that the right to healthcare becomes truly universal.

And it is not just the country’s drug makers, a few remarkable Indians like cardiac surgeon Dr. Devi Shetty are striving to make access to quality healthcare non-discriminatory. The founder of NH Healthcare, has successfully leveraged technology and economies of scale to make medical care accessible and affordable to the masses. It is common knowledge that his hospital in Bangalore offers heart surgery at a fraction of the cost in developed countries, and is a medical Mecca for patients from Africa, South & South East Asia and Middle East.

Today technology and globalization are creating a world that is a boundary less bazar of equitable opportunities interconnected and supported on a shared platform of knowledge. I truly believe that the world will surely belong to those who learn how to share knowledge and equity in an inclusive way and thereby provide the global right to healthcare.

Originally Published on LinkedIn on June 3, 2014.

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