A multidisciplinary review of the policy, intellectual property rights, and international trade environment for access a
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REVIEW
Open Access
A multidisciplinary review of the policy, intellectual property rights, and international trade environment for access and affordability to essential cancer medications Sangita M. Baxi1, Reed Beall2, Joshua Yang3 and Tim K. Mackey1,4,5,6*
Abstract In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middleincome countries rely on the EML, as well as the children’s EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum. Keywords: Model list of essential medicines, EML, Pharmaceuticals, Access to medicines, Cancer, Patent status, World Health Organization, International Agency for Research on Cancer, Model Cancer list
Background In February 2016, the slogan “We can. I can.” kicked off World Cancer Day 2016, accompanied by a 3 year campaign aimed at improving access to cancer care [1]. A key message was the need for collective action to “Improve access to cancer care”, and calls for countries to have a National Cancer Control Plan (NCCP) that “should cover access to … supportive and palliative care, high-quality cancer medicines * Correspondence: [email protected] 1 Pardee RAND Graduate School, Santa Monica, CA, USA 4 Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA Full list of author information is available at the end of the article
and effective cancer treatment modalities” while concomitantly addressing affordability [1]. These goals are especially relevant for certain regions (e.g. Africa, Asia, and Latin America and the Caribbean) where 62% of new cases and 71% of cancer deaths occurred in 2018 [2]. By 2040, 65% of the wor
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