In the age of rapid medical advancement, developing life-saving treatments for all should be a global priority. Yet, for millions in low-income countries, access to these treatments—and even the continued development of viable drugs—remains distant. While the issue of drug affordability and availability is largely well known, the root cause goes unnoticed. Factors such as corporate interests, economic barriers, and global inequities present massive hurdles for poorer nations in both creating and accessing new medications.
Drug development is often hailed as one of the most important advancements, but it is an incredibly complex process that is very time-consuming and expensive. As an impatient and restless student who wants to develop drugs, learning that it can take at least 10–15 years and $2.6 billion to get one drug to market made me question one of my most personal goals. For people living in high-income countries, this seems like an inevitable hurdle to overcome. In fact, it’s seen as one worth the price. But for those in low-income countries, where these treatments are desperately needed, access to even basic medication is out of reach. This problem is not simply one of distribution. The system itself—how drugs are discovered, developed, and priced—is all stacked against impoverished countries.
Corporate Control
One of the biggest obstacles in drug development is the control that multinational pharma companies have over the process. These corporations essentially decide which diseases are prioritized for drug R&D. Unfortunately, their decisions are largely driven by profit. A lot of the world’s pharmaceutical R&D goes toward diseases affecting high-income countries, like cancer and heart disease, because they promise bigger financial returns. Meanwhile, diseases like malaria, tuberculosis, and other tropical diseases that affect millions in lower-income countries are ignored. This is because they have low market potential. Lower-income countries cannot afford expensive treatments, so companies tend to overlook
them.
This is often referred to as the 10/90 gap—only 10% of global health research funding is spent on diseases that affect 90% of the world’s population. As The Lancet puts it, “The industry’s profit-driven model leaves low-income countries vulnerable, prioritizing research for lucrative markets over global health needs.”
Economic Barriers
Even when low-income countries want to participate in drug development, the economic barriers are staggering. The cost of developing a single new drug is astronomically high—$2.6 billion, according to the Tufts Center for the Study of Drug Development. It’s not just about affording the research; these countries often don’t have the infrastructure needed to support it. Laboratories, trained personnel, and regulatory systems—all the things that make drug development possible—are often lacking. The World Health Organization highlights this problem, stating, “Low- and middle-income countries lack the resources and infrastructure to support early stages of drug research and development, leaving them reliant on external aid.”
This leads to a frustrating cycle where low-income countries depend on donations or external help from wealthier nations and organizations, but these solutions are short-term. There’s little investment in building up these countries’ capacities to develop and produce drugs themselves. A major part of the problem is that low-income countries spend far less on research and development—often less than 1% of their GDP, compared to a global average of 2.4%.
However, it’s worth noting that low-income countries do have some advantages when it comes to clinical trials. The global burden of disease is higher in these regions, meaning there are often faster rates of patient recruitment for clinical trials compared to high-income countries, where diseases are less prevalent. Additionally, labor costs in low-income regions are lower, which can lead to potential cost savings during the trial phases. But these advantages don’t outweigh the overwhelming barriers created by a lack of infrastructure and funding.
Intellectual Property Laws and Access to Affordable Medications
Even if low-income countries were able to develop their own drugs, the intellectual property system creates a significant roadblock. Pharmaceutical companies are granted patents on new drugs, giving them exclusive rights to sell the product—often at extremely high prices—for up to 20 years. This means that low-income countries can’t make or import cheaper, generic versions of life-saving drugs until the patents expire, namely under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). This agreement, which governs patents for pharmaceutical products, often results in higher drug prices due to extended monopolies. Although TRIPS includes flexibilities such as compulsory licensing—which allows governments to bypass patents in health emergencies—and parallel imports—which enable the resale of medicines purchased at lower prices in other countries—these mechanisms are difficult for low-income countries to implement. The barriers come from legal complexities, external pressures, and the lack of domestic production capacity in many low- and middle-income regions.
James Love, director of Knowledge Ecology International, asserts that this system shuts out the poorest countries: “Patents allow pharmaceutical companies to charge exorbitant prices, locking out millions from accessing affordable treatments” (Love, 2018). While there are provisions for compulsory licensing—which would allow countries to produce generic drugs during public health crises—these provisions are incredibly hard to enact. When Thailand issued compulsory licenses for HIV/AIDS medications in 2007, it faced intense backlash from pharmaceutical companies, who even threatened legal action (Ford, 2018). This power imbalance makes it difficult for low-income countries to prioritize public health over corporate profits.
Global Health Governance and the Role of Wealthier Nations
The barriers to drug development are compounded by the lack of representation that low-income countries have in global health governance. Decisions on global health priorities are often dominated by high-income nations that prioritize their own people over others. According to a study in Global Health Governance, “Global health priorities are often set by wealthy donor countries, leaving the health needs of low-income regions marginalized” (Yamey & Ooms, 2019). This imbalance means that diseases affecting poorer nations are underfunded as well as under-researched.
Even international aid and philanthropy, while helpful, can’t fix the root issue. The Bill and Melinda Gates Foundation has invested billions of dollars in tackling diseases like malaria and tuberculosis in low-income regions, but that’s still not enough to address the broader problem. Professor Amir Attaran argues, “Philanthropy can’t replace the need for local capacity. True progress will come when these countries are empowered to develop their own drug R&D systems” (Attaran, 2020).
What Needs to Change
To fix the massive disparities in drug development and access, we need to take a multi-faceted approach. Firstly, pharmaceutical companies should be incentivized to invest more in diseases that disproportionately affect low-income countries. This could be done through tax credits, subsidies, or public-private partnerships that focus on neglected diseases. Second, the global community must invest in building up scientific infrastructure in these poorer regions. According to the WHO, “Strengthening research capacity in low-income countries is crucial for developing sustainable solutions to their public health challenges.” By funding education, establishing research institutions, and improving healthcare systems, we can help low-income countries take control of their own drug development and not be forced to pay for unnecessarily expensive treatments from Western corporations. Finally, we need to reform the global IP system. It’s important to strike a balance between protecting innovation and ensuring that life-saving treatments are accessible to everyone, not just those who can afford them. The United Nations Development Programme (UNDP) suggests revising international trade laws to allow for greater flexibility in producing generic drugs when public health is at stake.
A Global Responsibility
As someone who cares deeply about global health, I find it impossible to ignore the glaring inequalities in drug development. Low-income countries shouldn’t have to wait decades for access to life-saving treatments that are available in wealthier nations. Addressing the corporate, economic, and legal barriers that stand in the way of drug development in these regions is not only a matter of ethics but also of justice. Everyone deserves the chance to access the treatments they need—regardless of where they live!
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