Access to essential medicines in the times of COVID-19: Messages from Mauritius
14th December 2020
Recent messages from the Prime Minister of Mauritius, presented at the Qatar-based World Innovation Summit for Health, can be taken as an indication of the anxiety which many nations are expressing regarding an equitable distribution of medications and, now, vaccines to assist in the response to Covid-19. He followed his initial statement with a call for COVID-19 vaccines to be ‘distributed fairly’, expressing fears that some nations might be left behind in the race for coronavirus immunity.
This anxiety stems from the statements made by other heads of government that any supplies of all such medications which are produced in their own countries or by companies based in those countries, whether or not the production actually takes place there, will be retained by their governments. The nations concerned, above all the USA, enjoy economic and political global predominance; some of them are currently governed by administrations and leaders with strong nationalistic tendencies and policies – the favouring or preferential treatment of already advantaged nations.
Such anxieties derive from existing global health inequalities and the continued inadequacy of public health infrastructures in many countries. This concern about universal access to medications and vaccines associated with the global Covid-19 pandemic reflects wider historical inequalities of access to essential medicines, a regular discussion point in the deliberations of the World Health Organization and the United Nations Office on Drugs and Crime. The core issues here are access and availability, with UNODC basing its work on restricting the availability of illicit drugs and the WHO basing its essential medicines work on increasing the availability of those essential medicines. This paradox is complicated by the fact that some substances fall into both categories. While the UN’s international drug control Conventions centre on reducing the production and use of and trade in illicit drugs, they also recognise the role of many narcotic drugs in medicine and the importance that their availability to health systems and professionals ‘should not be unduly restricted’.
Preoccupation with COVID-19 may deflect attention from the wider issue of access to and availability of essential medicines, where deliberations at an international level are both comprehensive and slow-moving. The WHO defines essential medicines as ‘..those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness’. The provision of essential medicines ‘within the context of functioning health systems at all times …..at a price the individual and the community can afford’ (WHO) now forms part of the UN’s Sustainable Development Goal 3 to ‘ensure healthy lives and promote well-being for all at all ages’.
Some of the principles did result from campaigns to combat HIV/AIDS, where access to commercially developed pharmaceutical products was initially restricted on the grounds of cost and the application of patent laws. The intervention at the start of this century of Indian manufacturers to make available generic products challenged and changed this situation,  as did the creation of the Global Fund to fight AIDS, tuberculosis and malaria in 2002. Alongside the medical and health aims were targets to increase international co-operation and collaboration, multilateral approaches which have broad but not universal support.
The Trump administration’s withdrawal of the United States from the WHO and its withdrawal of funding for WHO and other global institutions indicates the fragility of such international cooperation and its vulnerability to nationalist governments. The current consideration of a reduction of funding for development aid by the UK government, coupled with the merging of the formerly respected UK Department for International Development with the UK ministry for foreign affairs creates worries that the UK government – and others? – is retreating from internationalist and multilateral approaches to development aid, including health, and will return to the discredited bi-lateral approach of the 1960s where the principle beneficiaries of UK development aid were UK companies and balance of payments figures, not the recipient nations.
The campaigning for access to and availability of essential medicines has recently centred on analgesics and medications and practices which relieve pain. In the past decade, government have used their presence at international fora to attempt to restrict the availability and use of both ketamine and tramadol, important anaesthetic and analgesic medicines, especially in nations with poorly developed health infrastructures. This was done not because the medicines were ineffective but because the governments seeking the restrictions were experiencing significant domestic misuse of what were assumed to be ketamine and tramadol but which were often adulterated or falsified substitutes for ‘the real thing’. The nations most affected by such moves and other barriers to access are, in general, those with less voice and influence at international for a, often unable to finance permanent delegations, and with our indigenous pharmaceutical industries or production. They are disproportionately dependent on richer and more powerful nations, and their pharmaceutical industries, for access to essential medicines in what might be seen as a neo-colonial relationship.
As many in the less developed nations and in ‘western’ civil society and other agencies continue to argue (we hesitate to use the term ‘advocate’ because of its misappropriation by neo-liberals), the adequate, affordable and assured access to essential medicines should become an assured right to all nations and populations. One corollary is global leadership and coordinated response, often asserted, less often practised.
Blaine Stothard , Co-Editor Drugs and Alcohol Today journal.