Think Globally, Prescribe Locally: How Rational Pharmaceutical Policy in the U.S. Can Improve Global Access to Essential Medicines

I. INTRODUCTION Improving access to essential medicines in low- and middle-income countries (LMICs) has become a critical health policy issue. Millions more people die each year in poorer countries from diseases that are treated by pharmaceutical agents currently available in higher income nations. 1 Recent medical innovation has tended to focus on problems affecting populations in developed countries and avoid those found exclusively or predominantly in LMICs. The etiology of these disparities is multifactorial, and can include high costs of products, 2 inadequate cooperation between governments and aid agencies, 3 rigid protection of intellectual property rights, 4 and poor local health leadership regarding dissemination of products. 5 Over the past two decades, there have been growing efforts to reduce global disparities in availability of essential medicines. At the forefront of these efforts have been international agencies such as the World Health Organization, 6 or groups like Medicins Sans Frontieres 7 and Partners in Health, 8 which have helped set international health priorities and sought to improve local health care delivery systems. Other non-profit organizations have also emerged, such as the Institute for OneWorld Health, a pharmaceutical company that produces drugs for neglected diseases in LMICs. 9 Some commentators have also suggested changing the incentive system for pharmaceutical research and development by creating prizes for research into so-called "neglected diseases" 10 or establishing Advance Market Commitments to promote demand for development of certain products. 11 Most such efforts are based in LMIC environments or focus on the operation of ...