After the compulsory licensing episode last month, the Indian government has made another blatantly pro-people and pro-local industry move by allocating a massive $5.4 billion to provide free essential medicine to its people. Under the new policy, doctors will be limited to a generics-only drug list and face punishment for prescribing branded medicines. From city hospitals to tiny rural clinics, India's public sector doctors will soon be able to prescribe free generic drugs, vastly expanding access to medicine in a country with 40 per cent population living below the poverty line. Initial funding for the policy implementation has already started to flow. Let’s put this in perspective: $5.4 is equal to five years of turnover of pharmaceutical industry in Pakistan. But, what are essential medicines and why is it important to have them for free in the health system? Simply put, essential medicines are the much shorter list of safer ones amongst the lot of the thousands of those out there and are proven to save lives and improve health when they are available, affordable, of assured quality and properly used. Still, lack of access to essential medicines remains one of the most serious global public health problems. Access to health care, and therefore to essential medicines is part of the fulfillment of the fundamental right to health. In fact about 30 per cent of the world’s population lacks regular access to essential medicines; in the poorest parts of Africa and Asia, including parts of Pakistan, this figure rises to over 50 per cent. In our low-and middle-income countries, public medicine expenditure has traditionally not covered the basic medicine needs of the majority of the population. In these countries 50 per cent to 90 per cent of medicines are paid for by patients themselves. Improving access to essential medicines today is perhaps the most complex challenge for all actors in the public, private and NGO sectors involved in the field of health care. This Indian initiative to spend such a colossal amount on essential medicines is without doubt a game changing policy with far reaching consequences. While it can change the lives of hundreds of millions of patients, it is also going to hurt the Big Pharma as a ban on branded drugs stands to cut them out of the windfall in one of the world's fastest-growing drug markets. Big Pharma has already started to react negatively to this decision calling it "a considerable blow to an already beleaguered industry, recently the subject of several disadvantageous decisions in India," (Chris Stirling, the European head of Chemicals and Pharmaceuticals, the reference here is made to the recent decisions of compulsory licensing awarded to generic manufacturers against the Big Pharma in India). This story from India had me reminiscing of the generics policy of Pakistan of 1972, which had noble intentions behind it, and the reasons of its failure. I am wondering if the Indians had in mind what brought down the generics legislation in Pakistan and how might they do better with the hazards and pitfalls on the way. Pakistan was one of the first countries, in 1972, to introduce the Generic Drugs Act. The policy brought out by the government of Zulfiqar Ali Bhutto’s People’s Party was politically motivated and poorly designed. Soon after its promulgation, the parties hurt by the new policy (doctors lead by the Pakistan Medical Association and the Big Pharma), got together and started to conspire against the policy. They lead a ferocious campaign against it alleging generic drugs were of poor quality and low efficacy. Unfortunately, the subsequent lack of regulation or control of generics led effectively to the market being flooded by poor quality drugs, and the scheme needlessly failed a couple of years later. Though Indians indeed are no amateurs at this kind of wrangling with the traditional opponents of healthy policies, the recent access to medicines policies followed in India are a good proof of their abilities to deal with such opposition, but nevertheless, my advice to them is to watch out on this one. Talk about promoting generics and indeed any real policy initiative to prefer generics over branded patents run a spear deep into the heart of the Big Pharma and their cronies in the medical profession and they will do everything possible to fail any policy promoting generics.
Ayyaz Kiani is a public health specialist. He heads Devnet – a network of development consultants. Based in Islamabad, he has travelled around the world and continues to do so to meet fellow travelers.
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