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  • Brendan Shaw and Siddhartha Prakash

UHC and medicine price transparency feature at 2019 World Health Assembly

The 2019 World Health Assembly in Geneva, the 72nd such meeting, as always covered many important health issues from around the world.

A quick look at the agenda for the 72nd WHA shows many issues were discussed including managing public health emergencies, the eradication of polio, the implementation of the 2030 Sustainable Development Agenda, environment and climate change, antimicrobial resistance, non-communicable diseases, preparing for influenza pandemics, fake medicines, improving patient safety, and ensuring the open availability of disease strains to develop new vaccines and medicines.

While issues discussed at the World Health Assembly in Geneva can sometimes seem esoteric and far removed from the day-to-day political, social and economic issues at national level, this year the debates were directly relevant to hot button health policy issues being argued about in many countries around the world.

Among these, several major issues of relevance to the life sciences industry included discussions on universal health coverage, financing UHC, and the transparency of medicine prices.

Universal health coverage

A major theme of this year’s WHA was how to achieve universal health coverage (UHC).

Universal health coverage is a system to improve financial protection for the community and reduce out-of pocket spending by patients.

The idea, according to the United Nations Sustainable Development Goals, is that by 2030 every person in the world should have financial protection and access to essential health care.

Several topics on the WHA agenda reflected this theme, such as preparations for the UN High Level meeting on universal health coverage later this year at the UN General Assembly in New York and the World Health Organization’s proposed access to medicines road map.

From the opening address of WHO Director-General, Dr Tedros, universal health coverage was a key theme for the Assembly.

The Assembly endorsed a political resolution on universal health coverage which included recognising the role of primary healthcare, recognising the role of community health workers, and a call for members states to accelerate the adoption of UHC.

One of the pleasing trends that is becoming more apparent is the growing political commitment from governments to implement universal health coverage.

From Kenya to Ukraine, from India to El Salvador, countries around the world are developing systems of universal health coverage to ensure that their citizens don’t miss out on health care for financial reasons or suffer catastrophic financial consequences if they do use health care.

The papers on the various agenda items at the WHA tell this story.

How to pay for UHC

Another major topic of debate both inside and outside the Palais des Nations was how to pay for universal health coverage.

This is a topic that is relevant to health policy debates in rich and poor countries alike.

At many events in Geneva there were earnest and constructive discussions on how the world is going to fund all this additional health care that it must do.

One of the big issues discussed in several forums was the need to engage finance ministries and heads of government in the debate on providing universal health coverage.

There is growing recognition that funding a sustainable system of universal health coverage requires a dialogue with economists, accountants and financiers in central government agencies to demonstrate the economic benefits of investing in health care.

Some of us have been having these arguments in our own countries for years, so it was encouraging to hear the level and sophistication of the debate in Geneva on this topic.

During the week it was noted on more than one occasion that for the first time in June this year, the health and finance ministers of the G20 countries will meet together in Osaka to discuss financing universal health coverage.

This is likely to be an important meeting as it will provide an opportunity for these ministers to find ways to work together on health care more and fight over funding less.

There was also recognition that it is critical to get heads of government leading the political momentum on universal health coverage.

There are several examples, such as in Kenya and India, where heads of government have gone to elections with promises to introduce universal health coverage.

Show me the money: medicine price transparency

The one big outbreak of disharmony was the showdown over the transparency of medicines prices.

Several countries, led by Italy, sponsored a resolution on transparency of medicine pricing.

An earlier draft of the resolution called on governments to publish the real prices of medicines in different countries and introduce regulations such that pharmaceutical companies had to reveal their internal commercial costs of developing and manufacturing each individual medicine.

Proposals like this are not only hugely complex and require careful thought, but also risk unintended consequences for patient access to medicines and could actually backfire by being anti-competitive and leading to higher prices.

The resolution on medicine price transparency was the culmination of months of campaigning by various national governments and NGOs, work by WHO and the recent Fair Pricing Forum in April in South Africa to push the pharmaceutical industry to reveal its internal commercial cost information and pricing decisions.

This draft resolution triggered days and days of behind-the-scenes negotiations as nations tried to negotiate an agreed text of the resolution.

It also triggered extended campaigning by activist groups during WHA including letters to national governments, social media campaigns, accusations that some governments wanted to maintain secrecy, complaints that the process was being railroaded to prevent proper debate, and even personal attacks on individual negotiators from some countries.

A final version of the resolution was approved on the last day, although not without controversy and opposition from several countries.

It calls on countries to publicly share information on net prices of medicines, (that is, prices minus any confidential discounts or rebates paid by companies) and to improve the availability of market data.

The implications of this could be significant.

However, given the lack of proper impact assessment, the long-term unintended consequences - including possible price increases in poor countries as pharmaceutical companies are forced to equalise global medicine prices - remain to be seen.

Thankfully, the most controversial proposal that pharmaceutical companies reveal their internal cost structures was abandoned. This is a good thing, as it risked leading to higher prices and possibly price fixing and anti-competitive behaviour from governments and companies alike.

Dialogue around WHA

While member states debated a gamut of global health challenges inside the closed doors of the World Health Assembly, over 50 side events allowed discussion in the public domain.

Health activists, NGOs, donors, universities, healthcare companies, think tanks, researchers and innovators met at various side events held in Geneva to showcase best practices and address emerging health challenges.

Patients were often at the heart of such events, sharing their experiences in navigating health systems. For example, victims of fake medicines in Africa described how they almost faced death.

Scientists shared experiences of young adults who died of rare diseases in Latin America because their immune system had become resistant to most types of drugs.

Diabetics in Asia shared their challenges in accessing information about the effects of the disease and lack of services for the prevention and management of lifestyle diseases.

The seminars also brought pioneers in addressing these challenges from all over the world to share their experiences.

They showcased how the use of digital technologies is transforming healthcare, ranging from the use of blockchain digital applications to counter fake medicines to the use of drones to deliver drugs to hospitals and health centres.

NGOs showcased the use of mobile applications to assist in healthcare, such as tracking missing TB patients in low income settings to ensure they remain treatment compliant.

Various discussions at events highlighted the role of WHO and pharmaceutical companies in improving affordability, as well as the need to move beyond pricing to address access to screening, diagnostics and counselling. This was somewhat ironic given the feverish negotiations going on in the background about price transparency.

A number of events showcased the opportunities and challenges of leveraging multi-stakeholder partnerships to strengthen health systems, reduce the trust deficit between public and private sectors and collectively achieve universal health coverage.

Serious collaboration

Contentious pricing proposals aside, the mood around Geneva was otherwise quite constructive as various stakeholders and experts undertook positive discussions on how to work with different partners, break down barriers and find innovative ways to deliver health care.

Several speakers in Geneva noted that the debate had shifted in the last 10 years, that it was now more constructive and that the private sector was being sensibly and responsibly engaged in the debate about how to provide universal health coverage to everyone.

The debate has matured somewhat, in that where once engagement with the private sector was a place where no one dared to tread, now there is robust debate between the private sector with other stakeholders about what its role in global health should be.

While sometimes this robust debate risks running off the rails, the price transparency debate being a case in point, generally it a sign that things are improving.

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