This was a session, a panel session, about inequal access to essential medicines for cancer in low- and middle-income countries. I was actually telling the success story from HIV/AIDS – in the year 2000 we had many people with HIV that were in need of treatment. Drug companies had a treatment of $7,000 and we needed more affordable treatments and it took us a long time before we could actually convince the drug companies that they should give away their monopolies and allow more affordable generic anti-AIDS medicines into Africa.

I would like to repeat that story. We wasted a little bit of five years in Africa before we achieved access to the generic affordable AIDS medicines. I think now with cancer, the new epidemic, I would like to do that faster and make sure we get access to all these good, new, innovative cancer medicines also in low- and middle-income countries.

Can you please explain the problem of excessive pricing of cancer medicines and how prevalent is it?

First of all, the medicines are expensive because the drug companies, of course, do a lot of research but even then, actually, they are actually asking a little bit too much. We see that in the high-income countries where they use a value-based pricing system that leads to a lot of high prices. There are also many cancer drugs coming to the market in my country, the Netherlands, and that’s good but we need to actually know if the additional benefit of those expensive cancer medicines is really value for society.

I would rather see a fair medicine price or a price that society could afford. In low- and middle-income countries this is even more dramatic. In low-income countries the products are actually not even registered; in middle-income countries they are sometimes registered but at a price that is not really affordable. That is basically the problem of access to the expensive cancer medicines.

What is the Fair Pharma Scorecard and can it be used in the context of cancer medicines?

When pharmaceutical companies develop medicines they actually have to adhere to the principles of human rights. There is a business and human rights agreement worldwide from the United Nations that companies have to respect. So during the Covid pandemic we were actually analysing the development of new Covid vaccines using 19 different criteria that are in this human rights principles. Unfortunately, drug companies did not score very well on many of these items.

We are now going to actually redo such an analysis but now on the difference of access to essential cancer medicines in the high-income, the middle-income and low-income countries over the next three years. We already know that access is dramatically different so the objective of this is to actually ask companies whether they would like to respect those human rights to access an essential medicine. Of course, drug companies have patents and then they can ask what they want but they should also respect that society must be able to afford this.

The prices are very high in the developing countries, obviously middle-income countries and low-income cannot actually afford that. So then companies have a choice either to go for an access programme like the ATOM programme, or if that is even not possible then maybe they should better give a licence to the Medicines Patent Pool who can then actually interest generic companies to make it in restricted markets and under the control of quality. The companies even get some royalties. This was a very successful project during HIV/AIDS and it actually led to millions of people in the world now having access to AIDS medicines. Cancer is now the next one that we should actually go for.

Why is it important to have equitable cancer care, and how does this process start?

Cancer is not a problem only of high-income countries, in fact there are already more people dying in low- and middle-income countries of cancer than in the high-income countries. People have human rights wherever they are and, of course, the duty of care is for the governments to provide that care but they need support from pharmaceutical companies to actually make the products available. That is done through registration first and then by offering them for a price that the countries can afford. People have human rights and it is unacceptable, in my view, that companies just let people die in millions whereas they have effective products that could actually help these patients.

I’m not saying it’s very easy to treat cancer and there are many complexities but definitely the first step for the drug companies is to register the product, make them available for a fair price or license them to the patent pool so that the generic companies can produce them more affordably.

Why is it important to have equitable cancer care?

First of all, a country needs to make a national cancer plan, a policy, so that’s political will. They need to put cancer as a priority in the country. We see hopeful signs that countries are doing that.

Governments, of course, need budgets for that, that’s a problem. They also need to have identified which medicines they would like to have in their country cancer programmes that they do by issuing an essential medicines list. They are guided by the World Health Organisation which already has 83 cancer medicines on the global essential medicines list. If the product is on the national medicines list of a country it means there is a political will for actually making that available and that should then be done in an affordable and consistent manner.

Now, apart from medicines you also need, of course, diagnostics, you need trained healthcare professionals, you need academic cancer centres for referrals. We need to do long-term follow-up to patients so it’s more difficult than during HIV/AIDS that I’m aware of. But it’s doable – in many middle-income countries already there are successful cancer programmes.

Do you have some examples of these obstacles being overcome?

In the past the drug companies had successful medicines that are really effective, like imatinib. I know that in some countries the prices were so high that governments or patients could not afford them. Now, it is so that governments can, in the interests of public health, actually put the public health interest higher than the business interest of a company. That means actually that governments have the power under national laws and international agreements to actually take away the patent if they are actually a block for access to public health. Several countries have done so in the past, I think Thailand has done a very important one on imatinib and that made it actually possible for generic companies to actually make the product. Actually the product itself is not that costly to make. So that actually dramatically increased the access to that product for CML, chronic myeloid leukaemia.

Is there anything else you would like to add?

I’m talking also to the pharmaceutical companies here. I think you have very valuable products, they are on the WHO essential medicines list, that means you can’t just sit still and sell them only in the high-income countries. Do register them in the low- and middle-income countries then actually make them available at a fair price. If your price is not possible then try an access programme like ATOM. If that is not working then the only and the best way to do it then is to provide a licence to the patent pool, the Medicines Patent Pool, and then generic companies can start competing and you also get still royalties for that. So it’s a win-win for everybody.

We have one company that actually was the first one to put a licence in the patent pool, Novartis with nilotinib, so I would say to all the other companies follow the good example by Novartis.