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for all countries. The new fund would shift the focus of anaemia, chronic diarrhoea, malnutrition, infertility and blind-
pharmaceutical research from the health needs of developed ness,24 25 and decreasing susceptibility to tuberculosis, malaria
countries, where pharmaceutical industry is located,6 to a global and HIV/AIDS.26–29
level. This approach would better meet the health and economic Our approach would also support the private public partner-
needs of all countries. In rewarding pharmaceutical research for ships (PPP) promoted by the WHO Global Plan to Combat
actual health gains, it would focus the business interests of Neglected and Tropical Diseases as a solution to promote
pharmaceutical companies on resource-poor settings where research for neglected diseases.1 It would make these partner-
there is the highest scope for health improvement.21 In this ships central to sustainable business interests in the long run. A
way, it could incorporate the health needs of resource-poor global fund would also support participation in other public or
countries into global research agendas, while simultaneously commercial partnerships to make drugs for neglected diseases
continuing to support the research needs of developed countries, affordable.4
such as treatment for the epidemic of chronic, non-communic- Thus, our approach meets the requirements of beneficence,
able diseases.22 23 promoting multiple opportunities for innovative, effective and
Focusing business interests on resource-poor settings would affordable drugs at a global level and increasing the access to
also prompt the pharmaceutical industry to find the most these medicines of individuals across the whole social spectrum.
affordable therapeutic solutions to decrease morbidity and
mortality in these countries. For example, they could cooperate SOCIAL JUSTICE
with smaller pharmaceutical companies to produce generic A fund to reward global pharmaceutical research can promote
drugs that will be more accessible for people living in resource- social justice because it supports human rights in all countries.
poor areas.4 In turn, open markets would allow OECD countries We are using a human rights framework in this section because
access to effective and affordable therapies developed in poorer it provides the main political tool to assess policy from an
countries and this would decrease their healthcare costs. ethical perspective at the international level.30 First, we argue
Pogge14 has argued that, in the absence of the current that this approach removes conflicts between the collective
patenting system, medicines for diseases such as impotence or health and economic rights of different countries. Thus it
acne may disappear because their treatment can add little to the promotes health and economic freedom and avoids discrimina-
reduction in the global burden of diseases. In our view, tion. Second, we explore the relation between individual rights,
medicines for these diseases will not disappear because a global such as the right to health and property rights, and argue that
approach would increase the number of people with these this approach removes the conflicts between rights.
medical conditions. In addition, collaborative approaches such A global fund can promote collective health and economic
as those already mentioned may increase the capacity of rights in all countries, because it reconfigures international
pharmaceutical companies to make these medicines viable by cooperation as global social justice, rather than only as
increasing their biological effectiveness and by marketing them humanitarian assistance to vulnerable countries. In our view,
at affordable prices to reach patients from all social groups. an emphasis on promoting shared economic and health value
The fact that this approach would reward innovation means provides better political arguments for developing pharmaceu-
that more expensive drugs with a very low index of innovation tical research as a global public good rather than an emphasis on
and which produce little improvement in health status may national interests. A focus on national interests requires
disappear because this approach would give pharmaceutical balancing the national interests of developed countries and
manufacturers an incentive to develop the most effective developing countries13 towards promoting pharmaceutical
therapeutic solutions. A fund that rewards real gains in research as a global public good because its costs will be
community health, measured through decreases in morbidity supported by developed countries in the first instance.
and mortality, would expand the scope for innovation in Ex ante and ex post arguments underlining the national
pharmaceutical products. It would promote the health needs of interest of developed countries to support global pharmaceutical
individuals in all social groups while, at the same time, offering research have been made.14 31 Ex ante, it is in the interests of
the greatest benefits for the worst-off social groups. developed countries to control infectious disease in the
This redistribution effect is desirable from a beneficence developing world to prevent epidemics in their own countries
perspective because it has the potential to promote shared in the context of increased global mobility. Ex post, it is
responsibility on the part of countries, communities, research legitimate to compensate developing countries for deficits in
organisations and pharmaceutical companies for people’s health and economic rights brought upon them through unjust
health. It would also support collaborative and multidisciplinary actions in and by developed nations.31 For instance, the brain
research focused on finding creative and comprehensive drain from developing to developed countries resulting from
biological, culturally sensitive and affordable solutions to specific policies in developed countries to recruit much sought
increase the access of different social groups in different after professionals such as doctors and nurses from developing
communities around the world to newly developed medicines. countries has created a rights-deficit in developing nations. In
Through all these pathways a fund that rewards global our view, these arguments, although they might be correct, are
pharmaceutical research would focus research interests on not enough to justify the market failure observed in global
resource-poor countries and on the worst-off social groups pharmaceutical research. First, both ex ante and ex post
globally. In our view it would highlight neglected diseases as a arguments cannot inform policy with respect to the amount
global research priority in several ways. It would make the of resource allocation. For instance, it may be difficult to assess
required funds for neglected diseases available through direct the retrospective harm produced by developed nations in some
contributions from all countries, instead of mainly OECD countries to quantify the amount of actual allocations that may
countries. In addition, it would focus research interests on be needed as compensation. Second, because this balance of
neglected diseases because eradicating these diseases would be interests between countries is litigious in nature it may
associated with significant health gains at a community level, in undermine the collaborative approaches needed by this mechan-
part through minimising the impact of co-morbidities such as ism to reach its full benefits.
By contrast, a focus on shared economic and health values because it removes market exclusivity, our approach expands
focuses on the points of intersection between countries’ business opportunities for pharmaceutical companies.
national interests promoting ex ante relational justice. It
emphasises that solidarity between countries could expand
CONCLUSIONS
their health and economic freedom. First, this fund would avoid
We have argued that an emphasis on international cooperation
the current division of research and development in two
devoted to promoting countries’ shared health and economic
separate markets: one lucrative and the other of no interest to
value can support research for neglected diseases as a global
companies, with the inherent health and economic discrimina-
priority. We have built our argument on Thomas Pogge’s
tion against people living in low income countries.
proposal4 to develop a global fund to reward global pharma-
Second, the proposed mechanism has the potential to be
ceutical research based on community health gains measured in
Pareto-efficient32—there would only be winners and no losers
terms of decreased morbidity and mortality. We have argued
on the consumer side—because it establishes an instrumental
that this approach is beneficent because it has the potential to
relationship between the economic and health opportunities of
improve global health through rewarding the development of
different countries. For instance, by promoting health in innovative, effective and affordable therapies in all countries. At
resource-poor countries our approach would expand the the same time, this approach offers the greatest benefits to the
opportunities for effective and affordable therapies in OECD worst-off social groups within countries and decreases global
countries. This would focus research on areas with the greatest inequalities in health.
scope for health and economic improvement and, through this, We have also argued that such a global fund can promote
lead to reductions in the global gradient in health. It would also social justice at the global level by shifting international
avoid health and economic discrimination because it does not relations away from an emphasis on national interests and
take anything away from better-off countries. Thus it would toward shared economic and health values via increased
have the potential to increase the solidarity between countries, solidarity between countries. It focuses on the points of
prompting them to nourish their relationships to expand each intersection between countries’ health and economic interests,
others’ opportunities and indirectly to maximise their interests. instead of on conflicts between national interests. Thus it has
This shift from promoting national interests to promoting the potential to promote solidarity between countries to
shared value is significant for research ethics in resource-poor decrease global health inequalities. At the individual level this
settings. It would decrease the tensions between pharmaceutical approach can both increase human freedom and avoid
research interests and access to outcomes of research for low- discrimination.
resource communities which participate in research. Although a To some the proposed mechanism may sound utopian and it
recent guideline33 has stressed the importance of fair benefits for could be argued that it challenges the current reliance of
participating communities in developing countries, several governments and international organisations on market forces
authors have emphasised the difficulties to find adequate tools to regulate research and development of pharmaceuticals.
to assess the level, allocation and priority setting for funding However, in the existing system governments in many
development.8 This approach does not solve these distributive countries hold monopsony power in the pharmaceutical market
problems but it can help to decrease the public burden by and use it to extensively regulate pharmaceutical licensing,
making these benefits accessible, increasing responsibility on the pricing and reimbursement. Adding a new policy instrument to
part of pharmaceutical industry to ensure that communities redress market failure in driving innovative drug development is
have access to research outcomes. therefore not utopian but in the interest of both societies in
Our approach would also invert the relationship between the developed countries and global society overall.
collective right to health and the commercial rights of
pharmaceutical companies. Currently, market exclusivity sub- Competing interests: CAG has received research support, travel grants and
speakers’ honoraria from the pharmaceutical companies Janssen Cilag, Eli Lilly,
ordinates community health needs to the property rights of Aventis, Novo Nordisk, Laboratoires Biocodex, Roche Diagnostics and
shareholders of pharmaceutical companies. Our approach would GlaxoSmithKline.
remove this tension by subordinating the commercial rights of Provenance and peer review: Not commissioned; externally peer reviewed.
pharmaceutical companies, which are institutional rights, to
community health needs. This approach is justified because the
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These include:
References This article cites 26 articles, 5 of which you can access for free at:
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Notes