Rule of Law and State Capacity: Keys to Market Access in Developing and Resource-Constrained Markets
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LEADING ARTICLE
Rule of Law and State Capacity: Keys to Market Access in Developing and Resource-Constrained Markets D. Wayne Taylor1 • Christopher Ward1
Published online: 31 May 2016 Springer International Publishing Switzerland 2016
Abstract There is a healthcare crisis in developing and resource-constrained countries that is attributable to the burden of communicable diseases and the rapid rise of noncommunicable diseases. The first line of treatment for both communicable and non-communicable diseases is the use of pharmaceuticals. Almost all drugs deemed to be ‘‘essential medicines’’ by the World Health Organization are off-patent and available as generics and nearly all of the patented, brand-name essential medicines are deeply discounted in developing countries, often matching generic prices. However, despite this, one-third of the world’s population does not have access to essential medicines. There is no scientific evidence that patents or price are major barriers to market access, or causatively associated with worse health outcomes, in developing and resourceconstrained markets. The pharmaceutical industry, like almost all industries, uses differential pricing worldwide wherein prices are inverted to the elasticity of demand. The real barriers to access in these countries are money, power, politics, and ideologies, which manifest themselves in market failure, corruption, and the lack of political will to create stable, ethical, and law-abiding government administrations that will ensure products arrive where they are destined without delay, diversion, theft, or unnecessary tariffs. There is a need for infrastructure, roads, communications, health human resources, provider compliance, patient adherence, political stability, and professional regulatory structures and protections. Enhanced state capacity to serve indigenous populations and the rule of law— & D. Wayne Taylor [email protected] 1
The Cameron Institute, 1539 King St. E., Preston, PO Box 28043, Cambridge, ONT N3H 5N4, Canada
including harmonized intellectual property protection—are integral to promoting global health and healthcare, in which pharmaceuticals play a vital role. There are no quick-fix solutions.
Key Points The lack of adequate access to medicines in developing and resource-constrained countries is a major secondary determinant of health. Although many claim that this lack of access is due solely to the price of drugs and patent protection, this is not true. Market failures and, more importantly, the failures of states themselves with the corollary absence of the rule of law, and the resulting lack of infrastructure and resources, are just as much to blame, if not more so, for this lack of access.
1 Introduction There is a healthcare crisis in developing and resourceconstrained countries1 that has been made by humans and is solvable only by humans. The traditional scourge of communicable diseases, such as HIV/AIDS, hepatitis, malaria and tuberculosis, continues to exist, particularly 1
‘Resource constrained’ does not re
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