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Review
. 2019 Sep 18;15(1):57.
doi: 10.1186/s12992-019-0497-3.

A multidisciplinary review of the policy, intellectual property rights, and international trade environment for access and affordability to essential cancer medications

Sangita M Baxi  1 , Reed Beall  2 , Joshua Yang  3 , Tim K Mackey  4   5   6   7
Affiliations
Review

A multidisciplinary review of the policy, intellectual property rights, and international trade environment for access and affordability to essential cancer medications

Sangita M Baxi et al. Global Health. .

Abstract

In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middle-income countries rely on the EML, as well as the children's EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum.

Keywords: Access to medicines; Cancer; EML; International Agency for Research on Cancer; Model Cancer list; Model list of essential medicines; Patent status; Pharmaceuticals; World Health Organization.

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Conflict of interest statement

This was not an industry supported study. SMB is currently a doctoral fellow at the Pardee RAND Graduate School. She conducted this study prior to her employment relationship with Pardee RAND Graduate School and RAND Corporation as a graduate student in the joint master’s degree program in health policy and law at UC San Diego - California Western School of Law. Her employer did not provide funding and has had no input on the research and content of this manuscript. The other authors have indicated no financial conflicts of interest. All other authors report no conflict of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1
Search Strategy for Literature Review
Fig. 2
Fig. 2
Patented medicines for noncommunicable diseases on the WHO EML, 2011-2019. The number above each bar reflects either the total number of medicines or the number of medicines with active medicines on the EML for the year listed
Fig. 3
Fig. 3
Expiry Dates of Patented Cancer Drugs on the 19th, 20th, and 21st Editions of the WHO EML (2015–2019)
See this image and copyright information in PMC

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