Will you support a patient-centred R&amp;D agreement?—Response from Flavia Bustreo
Authors: Flavia Bustreo
Journal: The Lancet Global Health (2017)

As outlined in The Lancet in October, 2016,1Horton R Samarasekera U WHO's Director-General candidates: visions and priorities.Lancet. 2016; 388: 2072-2095Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar my vision for WHO can be summed up in five words: equity, rights, responsiveness, evidence, and partnership. In this context, I am pleased to respond to the authors of the open letter in The Lancet Global Health,2Barber MJ Gotham D Muntanyà J Balasubramaniam T on behalf of 18 other signatoriesOpen letter to the candidates for Director-General of WHO: will you support a patient-centred R&D agreement?.Lancet Glob Health. 2017; 5: e135-e136Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar on the leadership role that WHO must play in tackling the high prices of health technologies and lagging innovation that impede people's access to quality health care. People must be at the centre of the discussion, and fulfilling their right to the highest attainable standard of health must drive our action. A central part of a rights-based approach to health is to ensure universal health coverage so that all people have access to quality health information, services, and products that they need throughout their life course and in all settings. We know that huge inequities exist and for millions of people around the globe, this right remains unfulfilled due to the crippling price of medicines, or the lack of diagnostics to identify their illness in the first place. This is especially true for diseases that have affected the world's poor for millennia, like tuberculosis, and new and emerging diseases like Ebola and Zika. There is a pressing need for a coherent, evidence-based, and equity-driven approach to access to medicines. As Director-General of WHO, early in my term, I will prioritise convening further discussions with Member States on a global agreement on research and development (R&D) for medicines, vaccines, and diagnostics. These discussions build upon over a decade of work, including the 2012 report of the Consultative Expert Working Group on Research and Development, and, more recently, that of the UN Secretary-General's High-Level Panel on Access to Medicines—both of which call for a treaty. I will bring my experience and commitment to accountability to bear, pushing for increased transparency on costs along the R&D pipeline in order to have a clearer idea of end prices, so there can be accountability at all levels—national governments, local governments, the private sector, and other partners. Price transparency and price referencing need to be an integral part of this agreement so that patients can make more informed choices about their health care. There is ample evidence that such measures help reduce health service costs. However, recognising that a treaty will not be agreed to overnight, we will continue to press ahead with other promising initiatives. As Director-General, I will redouble WHO's work with partners on a R&D blueprint to ensure that we target R&D that strengthens our response capacity to bring needed medical technologies to patients during emergencies. As Assistant Director-General I have already implemented changes that culminated in the breakthrough Ebola vaccine R&D that was led by the team under my authority at WHO. In my work with other organisations, including as Vice-Chair of GAVI, I have contributed to mobilising resources through diverse and innovative mechanisms and to ensuring equitable prices for, and access to, vaccinations. At GAVI we have used mechanisms such as the International Finance Facility for Immunisation, advanced market commitments, and social bonds to mobilise resources for global health. Under my leadership, WHO will continue to work closely with partners such as UNICEF and Médecins sans Frontières to deliver vaccinations to everyone who needs them, no matter who they are or where they are located. WHO's role as a knowledge provider and facilitator of knowledge sharing must be strengthened. The organisation must be able to meet the knowledge demands of countries. WHO must be able to facilitate global knowledge sharing, the synthesis of evidence, and response to policy needs in a timely and highly competent manner. To do this, WHO needs to expand its own knowledge base. For example, WHO needs to better understand the changing funding landscape, especially the growing role of in-country financing. I would develop closer relationships with ministries of health, national institutes of health, and other institutions responsible for health R&D. By doing so we can together standardise data across countries, share data ahead of publication, and develop effective products and technologies. Finally, WHO has an unparalleled convening power that it can use to bring countries together on R&D. There is a moral imperative to use this power, as the authors remind us,2Barber MJ Gotham D Muntanyà J Balasubramaniam T on behalf of 18 other signatoriesOpen letter to the candidates for Director-General of WHO: will you support a patient-centred R&D agreement?.Lancet Glob Health. 2017; 5: e135-e136Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar to achieve the right to health that is enshrined in our Constitution. Under my leadership, WHO will ensure that everyone has access to medicines and that no one is left behind. Open letter to the candidates for Director-General of WHO: will you support a patient-centred R&D agreement?Less than a year from now, a new Director-General will be elected to lead WHO.1 The next Director-General should commit to developing a global agreement on the research and development (R&D) of medicines, vaccines, and diagnostics of public health importance. This is critical in order to address the dual challenges posed by unaffordable medicine prices and a lack of innovation in neglected diseases, antimicrobials, and other public health priorities. Discussions at WHO on how to address failures of the current monopoly-based R&D system have been ongoing for over a decade, but R&D policy change is yet to occur and the will to address the root causes of the access and innovation crisis is still lacking. Full-Text PDF Open Access