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Small doses: our new report on making medicines for children

If I’m unwell, I go to the clinic and expect that someone there will be able to prescribe me the medicine I need to get better. I take it for granted that there’ll be something for me to take.

Or at least I used to.

A few years ago while living in New Delhi, I went for a run one morning and came back to find myself feeling far more tired than usual. I took a shower and laid down to rest for what I expected would be an hour or so. It wasn’t. Three hours later I woke up in a daze. Even for summer in Delhi, I was sweating profusely and feeling hallucinatory with fever. My bones felt like they were shattering. The only thing I remember from those two days is the contour of the ceiling fan that I looked up at while moving in and out of sleep, barely able to move.

The next day I felt better, but the following day I felt even worse. I got up but fell into the bed and asleep right away. A few minutes later, I heard a knock on the door. My friends had managed to find out I was sick and had come to take me to their house. They had me meet with their neighbour who was a doctor and he made me go get a blood test. Turns out I had had dengue fever.

It took me nearly six weeks to convalesce. For the first few days, I could barely bring myself to walk to the bathroom and slept about 20 hours a day. In the weeks after, while I had gone back to work, I was listless and barely able to make it through the day. Ultimately I recovered, but was so fortunate to have people to look out for me.

Now, in my story there are different health system failures, many of which could and should have been avoided. But the one thing that there wasn’t and still isn’t is a way to treat dengue. The same is true for so many conditions, like Ebola, that primarily affect people who live in low- and middle-income countries. Millions of people still die every year from preventable infectious diseases and other conditions, and many more are left to suffer the lifelong debilitating effects of untreated illnesses because they are excluded from the benefits that medical research and development can bring.

Save the Children has just published a new report, Small Doses: Finding and making the medicines children need, on what must be done to make sure that the medicines, vaccines and diagnostics that the world’s most excluded children need end up being made.

Why don’t medicines and vaccines so many people need get made?

Developing new products is expensive and takes time. In order to ensure companies can both recoup investment costs and generate profit, under the current global model, countries reward them a period of market exclusivity in the form of intellectual property rights, specifically patents. This allows these companies to be the only producer of the medicine on the market and thereby theoretically able to set the highest price possible.

The simple explanation for why medicines and vaccines don’t get made for conditions that mostly affect low- and middle-income countries is that companies do not see a large enough market to justify investment. This problem is often called ‘market failure’. Even where the necessary health technologies do exist, they are often not developed in versions suitable for LMICs or for children, and they can be prohibitively expensive, due to a host of factors, including intellectual property barriers.

What needs to be done to solve the problem?

First, if the market can’t generate incentives, governments have to step in with the necessary resources. Governments have a human rights obligation to do this and companies have a corresponding responsibility to invest more in these areas and do whatever they can to facilitate access.

Second, a large pool of funding alone doesn’t automatically mean that the medicines that people need will be made, so the international community has a responsibility to coordinate the use of these funds to best address the conditions for which health technologies are not currently being developed.

Third, it is obviously pointless if products are developed but are too expensive for anyone to afford. All R&D, especially that which uses public funds, must ultimately result in maximum access and this means mechanisms need to be based on three key principles:

  • Delinkage: As most of the costs of a medicine result from the R&D investment that’s made, alternative models that ‘delink’ R&D costs from the price of the product, like prizes, need to be used.
  • Open innovation: Without sharing of information – both intellectual property and other kinds of information, such as technical expertise and manufacturing know-how – the development of new products will be limited.
  • Licensing for access: Where there are proprietary rights over discoveries, they should both be licensed and pooled in order to allow other companies to sell these products for less and produce new formulations and combinations that can be used by children and in different contexts.



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