Time to make essential cancer drugs more affordable
Governments can do more to pressure makers to bring down prices
Since 1977, the World Health Organization has managed and updated a list of drugs it calls “essential”. They ask governments, particularly in developing countries, to make these medicines widely available. Adding a drug to the list is controversial, because it can expand access but also places new demands on healthcare budgets.
This week the WHO added 12 medicines for five cancer treatments to its list, including several that are new and highly priced.
In the past, WHO’s Essential Medicines List has focused almost entirely on cheap off- patent medicines. In recent years, first with drugs for HIV, and more recently for hepatitis, cancer and autoimmune diseases, there are pressures to include new drugs, some of them extremely expensive. This presents challenges for government healthcare budgets because their use can potentially divert resources from more cost-effective therapies.
Yet, as we have seen from HIV and hepatitis treatments, governments can bring down the price of medicines through voluntary licensing of the patent rights from commercial drugmakers, or more coercively through compulsory licensing or price controls.
My partner and my co-author’s partner are alive because of access to effective cancer drugs. One of those medicines was only this week added to the WHO list. Two other drugs my partner used were rejected, even though they are seen as effective treatments.
We urge the WHO to develop a second list of medicines — those that would be labelled “essential” if they were available at affordable prices.
Some of the newly added essential cancer medicines are available at relatively low prices in some countries, or they can be manufactured cheaply. The production cost of afatinib, which is used to treat lung cancer, has been estimated at $8.85 per month, and lenalidomide, for the treatment of multiple myeloma, is $2.55 per month.
Patents will block competition and thwart the entry of low-priced drugs in many countries. But governments can and should remove those barriers. Previously when authorities have shown they are willing to use compulsory licensing, drug companies have responded by offering voluntary licensing through the UN-backed Medicines Patent Pool.
But this has rarely happened outside the field of infectious diseases such as HIV, tuberculosis and hepatitis. In 2016, Andrew Witty, then GSK chief executive, said the company would consider submitting patents on new drugs to the MPP, but his successor has not followed through with cancer medicines.
Our plea for making these new essential cancer medicines affordable in the developing world is bound to spark concern that the low prices will deter research and development spending for new drugs. But most of today’s drug sales are in high income countries, and returns from developing countries for many cancer drugs are inconsequential.
These concerns over innovation incentives do not require us to tolerate high prices and unequal access. They could be addressed through other measures that delink R&D spending from drug prices, including research grant programmes or “market entry rewards” that provide payouts for the development of drugs that meets specific needs.
We also call on the WHO to change its approach to drugs that treat metastatic cancer. The essential medicines committee rejected the inclusion of two important medicines used in the treatment of metastatic breast cancer, saying this was not considered a priority.
This is at odds with evidence that cancer is often diagnosed late in lower income countries, when cancer has progressed further. Also, as first line treatments improve and extend lives, that creates a need for treatment for cancer that has metastasized.