Beyond access to medicines: eliciting high-income country support for a new global health research and development paradigm.

In recent decades, debates surrounding access to medicines have moved on to discussions on new ways of conducting research and development (R&D) to ensure equitable access from the outset. The market failure in the current R&D system and the need for new models has been apparent for decades [1,2]. A new framework for research and development to address health gaps primarily affecting low– and middle–income countries (LMICs) is currently one of the most contentious issues being debated at the World Health Organization (WHO). While WHO member states agree that urgent action is needed, deciding upon models, implementation mechanisms and funding commitments has proven difficult [3]. The report of the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG), published in 2012, marks the most recent milestone in the search of a new RD a more sustainable and efficient funding source for RD and direct benefits through the products of R&D into new antibiotics and vector borne diseases. Box 1 The Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) WHAT The CEWG was established by the 63rd World Health Assembly in 2010 and consisted of professionals with a wide variety of expertise. The final report was published in April 2012 and included a set of key recommendations to address the gaps in health R&D [1,4]. WHY Securing access to affordable health technologies in low– and middle income countries continues to be among the greatest challenges in global health. Underpinning the challenge is a systematic market failure in health R&D which leads to an underproduction of public goods. Incentives such as intellectual property (IP) rights have traditionally been used to address this underproduction. However, the IP model, which incentivises private industry to invest in health R&D provided they get a monopoly on the end product, has failed to provide incentives for the development of health technologies addressing diseases that primarily affect the poor. KEY RECOMMENDATIONS Approaches to R&D: – Open knowledge innovation, equitable licensing and patent pools should be embraced Funding mechanisms: – Countries should commit to spend 0.01% of GDP on government funded R&D to meet the health needs of the poor Pooling resources: – 20–50% of the funds raised should be channelled through a pooled mechanism Coordination: – A global health observatory under the auspices of WHO should be established [5,6] Implementation: – A binding global instrument for health R&D and innovation should be implemented – Formal negotiations on an international convention should be initiated. CHALLENGES All member states agree that the market failure in health R&D is a pressing global health challenge. However, member states, in particular high–income countries, have been reluctant to support concrete, binding commitments. The most contentious issues have been the financing commitment of 0.01% of GDP and the suggested implementation through a binding convention.