Access to Technologies
Under the thematic “Access to Technologies” a number of important health policy and health systems issues require to be discussed.
The term technologies include medicines (pharmaceuticals and biologics), vaccines, diagnostics, medical devices, personal protective equipment, technologies used in public health. Increasingly it refers to digitization for different purposes- but we deal with this under the heading of public health informatics. It could include program design and even health systems- but we do not include it in the papers under this thematic area.
The problematics under the theme of access to technology could be further categorized as related to organization of health services, to choose of technology and to the problems of innovation, manufacture, regulation and new drug innovation. All of these issues came under intense scrutiny during the Covid Pandemic. A number of papers shared in this collection relate to the pandemic response and the issues under discussion in the ongoing Pandemic Agreement.
Innovation, Manufacture Regulation
We begin with this WHO-SEARO publication titled Intellectual Property and Access to medicines. Papers and Perspectives (2010): (1.1) This is a good introduction to Intellectual Property Rights. It was developed for capacity-building in the area of intellectual property and public health, the WHO Regional Office for Africa and the WHO Regional Office for South-East Asia and remains a useful text. Its publication is intended to facilitate the conducting of further courses on the implications of intellectual property rights on access to medicines.
For those who would like to go deeper, we provide four original official texts: These are:
- TRIPS Agreement – Text of the Agreement on Trade-Related Aspects of Intellectual Property Rights(1..2)
- Doha Declaration – Declaration on TRIPS Agreement and Public Health, 14th November, 2021(1.3)
- Guidelines for the Examination of Pharmaceutical Patents – Developing a Public Health Perspectives, Charles Correa, University of Buenos Aires, International Centre for Trade and Sustainable Development, 2012 (1.4)
- Indian Patent Act, 1970(1.5).
The last of these, the Indian Patent Act is an example of a very good alternative to the current WTO defined Intellectual Property Rights Regime. India had to replace this Act. We provide one paper on why such a shift from the earlier Indian patent regime to the new IPR Regime, did not work for low and middle income countries in this paper (1.6.) Innovation Patterns,, Limits to Learning and the pathway of neo-liberal globalization. Dinesh Abrol et al, 2013. We also attach an official document produced by The Sector Innovation Council for the Health Sector in 2013 ( Executive Summary 1.7 and Main Report 1.8). This report is one of those many official documents, prepared with great effort, but poorly circulated and little referred to. Placed here for reference.
Access To Covid Technologies
Many of the challenges of access to technologies came to a head during the Covid 19 pandemic. These included.
- Ensuring that the intellectual property regime and trade laws are aligned to public health goals and the above priorities.
- Reduce corporate monopoly in innovation, manufacture and supply chain management of essential technologies.
- Ensuring that LMIC regions and India in particular have a policy for access to technologies that is consistent with its health policy objectives and which ensures self-reliance, health security and health sovereignty.
- Ensuring geographically distributed manufacturing capacity internationally and within nation with a sub-theme dealing with public sector production.
- Effective regulation- certification, quality, clinical trials.
We begin by sharing a WHO document- ACT now, ACT together: 2020-2021 Impact Report (2.1) on the WHO Response to ensuring access to technologies.
We then share another document- on C-TAP or COVID 19 Technologies Access Pool, which was a proposed approach to enhancing global manufacturing capacities to face pandemics. (2.2)
We then share three policy briefs prepared by the Peoples Health Movement on its cautions regarding these developments and the alternatives it proposes. These are :
- PHM Policy Brief on the TRIPS Waiver (2.3)
- PHM Policy Brief on COVAX (2.4)
- PHM Policy Brief on Vaccine Equity ( draft) (2.5)
We then provide a detailed comprehensive article that discusses all the challenges and problems of the approach taken by global institutions for providing access to covid technologies. This was written by David Legge and Sun Kim : Equitable Access to COVID-19 Vaccines: Cooperation around Research and Production Capacity Is Critical.” (2.6).
We then share three media stories on the problems of access to covid vaccine in India. The first of these “COVID Vaccines- Challenge and Opportunity” was published in Frontline in January 2021,(2.7) and the other two were Times of India interviews on universal Covid vaccination in India, given in March and May 2021 on issues related to universal covid vaccination in India . (2.8 & 2.9). These discuss not only the problems of manufacture but also health services related problems.
We then include three reports which were part of a major intervention carried out by civil society globally to address these issues. The Project Report “Promoting Equitable Access to Essential Health technologies in the context of the Covid 19 Pandemic” documents a unique effort (2.10). The report includes a list of number of publications from activists for health equity. As part of this work there was also a country specific “ Situation Analysis Report from South Africa (2.11) on the way the crisis in access was playing out there and this report is shared.
Health Services Related: Ensuring right-based access requires
- Availability of essential drugs and other technologies free of cost at all public and publicly administered care facilities
- Procurement and quality assurance of all products in use.
- Price controls
- Prevention/reduction of irrational and hazardous use of technologies. Including ensuring rational and ethical marketing of technologies including comprehensive generic medicines policy covering labelling, prescription.
- Prevention of anti-microbial resistance
We have just introduced one paper on this theme in this collection so far (3.1). But more will follow.
Health Technology Assessment
This is an emerging discipline, which relates to choice and prioritising technologies for public health use. The relevant papers on this have to be put in place.