Access to Global Health Care - Problems and Progress

Access to health care is too basic a human right, too vital to life to be left to the mercy of the free markets, say social activists. That’s why in the last fifteen years many ICCR members have challenged the reality that drugs and medical treatment are, too often, commodities reserved for those who
can afford them. They have questioned injustices that seemed imbedded in the system.

For example, pharmaceutical companies rolled out more than 1,500 new drugs between 1975 and 2004, but of those, just twenty-one compounds treated tuberculosis or the tropical diseases so common in the developing world.

“If you have a headache, or hay fever, or arthritis, there are so many choices of drugs that you can’t count them. But there haven’t been new approaches for malaria or TB. There’s no money in it because many people who have those diseases don’t have money,” said Donna Meyer, system director for Community Health Services of Christus Health. “Yet, just from a pure public health standpoint, the world is too small to say that a disease will stay in Mexico, China or India. If it is there, sooner or later, it will be here. Because these diseases migrate so quickly, we have to think about helping everyone in every nation.”

ICCR members have introduced scores of shareholder resolutions on these and other health issues over the years. The resolutions have been as varied as challenging
Walmart to allow more employees to qualify more quickly for health insurance, to asking pharmaceutical companies to lower their prices and to do more about providing access to AIDS drugs in the developing world.

The discussions weren’t easy, especially at first. But they evolved.

“For several years we used the approach of wanting the companies to use restraint in their prices. Not surprisingly, they opposed all of that, and it didn’t bring enough support from other shareholders. In the course of the conversations, we got into other issues. We were talking to them about orphan diseases and the whole question of expensive HIV drugs, which obviously many couldn’t afford. There are still conversations going on,” said Margaret Weber, coordinator of corporate responsibility for the Adrian Dominican Sisters and the Basilian Fathers of Toronto. “In some cases it feels like banging your head against the wall. It’s been both slow and encouraging.”

But there are signs that corporations are listening. Some believe it took the HIV/AIDS crisis in Africa to bring drug companies around.

It wasn’t so long ago that the drug regimen to treat AIDS was complicated, and financially prohibitive, costing thousands of dollars a year, with few generic drugs available for use in treatment. Pharmaceutical corporations’ arguments on behalf of strict patents, protecting both intellectual property and healthy profits, paled before the reality of millions dying in part because cost was an insurmountable barrier. Corporate reputations suffered as a result. “Religious shareholders were among the first to bring these issues to the pharmaceutical companies,” said Judy Byron, coordinator for the Northwest Coalition for Responsible Investment. “Other NGOs were working on this too, like Oxfam and Doctors Without Borders. The pharmaceutical companies came around to the idea that they need a different business model in the developing world.”

One success story, she said, is Gilead Sciences Inc., whose responses included issuing licenses on two key HIV/AIDS drugs that allowed the manufacture of generic equivalents, lowering their cost dramatically. “With generics, AIDS
can be treated on 40 cents a day. When you realize that some people live on $1 a day, it’s still significant, but governments or foundations can provide the drugs,” Byron said.

ICCR members argue that making medicine affordable and accessible to poor countries is not only the moral thing to do, but a smart business strategy.

“The business model that pharmaceutical companies have built their fortunes on is based on catering to the North American and European markets. We understand the model, and we also understand why drugs are so much more
expensive in the U.S. But then, how are the Haitis of the world ever going to get access?” said Seamus P. Finn, of the Missionary Oblates of Mary Immaculate. He and others engaged with Eli Lilly, asking the company to commit millions towards making drugs available for diseases found less in developed nations than in, say, sub-Saharan Africa.

In 2003, Lilly created an effort to help prevent and treat multi-drug-resistant tuberculosis. Two million people die of TB every year, nearly all of them in the developing world. “The treatment of TB is complicated, and the drugs are complicated to manufacture,” said Rob Smith, Lilly’s director of corporate
responsibility. The cure includes four medicines that must be taken daily for six to nine months. Yet, too often, patients don’t complete the regimen, which has increased the incidence of drug-resistant TB. Of the 9 million new cases of TB that occur every year, 450,000 are resistant to drug treatment.

Lilly developed two antibiotics to treat drug-resistant TB and agreed to transfer technology to companies in countries where TB is common for local manufacture.

“This has to be more than about charity,” Smith said. “We can’t just write a check and walk away. It has to be about collaboration. [The approach] will strengthen our long-term competitiveness.”

That’s a message that many activists wish more companies would embrace.

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