Harvard Medicine for the Poor?

From within the Harvard bubble, global health problems all too often seem remote. However, is it possible that our University’s policies could have a profound and direct impact on global public health?

According to the World Health Organization, approximately 10 million people, mostly in low and middle income countries, die each year simply because they are not able to access existing drugs and vaccines.

The sad reality is that those most in need of essential medicines are often those least likely to be able to afford them. Although weak health infrastructure and unreliable drug delivery systems are contributory factors to the current “access gap,” high medicine prices remain a primary barrier to treatment for the destitute sick. In Thailand, for example, an 18-fold reduction in the price of HIV treatment has allowed the Thai government to expand its national treatment program from 3,000 to 85,000 individuals in the past four years.

In the future, Harvard can ameliorate the access gap by pushing for “access-minded licensing,” insisting that generic drug companies be allowed to produce and distribute patented drugs originating from their labs for markets in the developing world. Patents are intended to encourage innovation, but innovation and public health are not mutually exclusive. Low- and middle-income countries together make up only five to seven percent of the global branded pharmaceutical market—and Africa only around one percent. Generic production of life-saving drugs in the developing world would result in minimal losses for big pharmaceutical companies while drastically lowering drug prices and increasing the supply locally. Generic production not only provides a more sustainable solution to the access gap than pharmaceutical donation schemes, but it also avoids excessive delays, limited drug supplies, and geographic restrictions.

Universities have the potential to influence pharmaceutical companies’ policies because they are crucial contributors to the drug development pipeline. It is estimated that more than half of basic science research in the United States takes place at universities. Yale, Emory, Duke, and the University of Minnesota hold patents to a number of key AIDS drugs, and the next generation of AIDS drugs is expected to continue to originate from universities.

Every university establishes its own policies on how to handle new research innovations, but they all have the moral responsibility to adopt policies that will promote access to the fruits of their research in the developing world. Universities are also major recipients of public funding, and as such, they owe a return on investment to their primary benefactors. Given their vast public support, why should universities continue to pursue profit-driven policies that impede access to medicines for the poor? Harvard, as the single most powerful academic institution in the world, has an opportunity to take a stand and lead in designing research policies that promote global welfare.

Furthermore, Harvard can take steps to promote the research of drugs for the developing world. The current research system is woefully unprepared to address the needs of the developing world. Tens of millions of individuals suffer from “neglected disease” for which there is insufficient market potential to attract private sector response. For example, the most widely used drug for sleeping sickness, Melarsoprol, was developed over 50 years ago. Arsenic-based, it is extremely painful to administer and is so toxic that it kills five percent of those who take it. Given Harvard’s intellectual capital and advanced technology, it could easily adopt financial and professional incentives to encourage its current faculty and attract new faculty committed to researching and developing new interventions for neglected diseases. From trypanosomiasis treatment to a malaria vaccine, our resources can play a key role in developing crucial medical interventions that will save millions of lives.

Last week, the national student advocacy group, Universities Allied for Essential Medicines, officially released the Philadelphia Consensus Statement on University Policies for Health Related Innovations, which calls upon universities to adopt research and technology transfer policies that promote global health. The growing list of signatories include Harold Varmus and three other Nobel laureates; Paul Farmer, Harvard Medical School (HMS) Professor and Co-Founder of Partners in Health; Jim Kim, Director of the Harvard School of Public Health (HSPH) Center for Health and Human Rights and Former Director of the World Health Organization (WHO) Department of HIV/AIDS; and Jeffrey Sachs, Director of the Earth Institute at Columbia University. This increasing support from both inside and outside the University further underscores the need for Harvard to address these issues.

As we have seen before, Harvard is looked upon by institutions around the world as an exemplar. The recent removal of Early Action illustrates how Harvard is unique in its ability to act as a solo mover. Similarly, any steps taken by Harvard in promoting positive research policies will likely spur ripple effects across the country. Just five years ago, the “Consensus Statement of Antiretroviral Treatment for AIDS in Poor Countries,” developed by Harvard faculty across the University, helped change conventional wisdom that AIDS therapy could not be successfully delivered to individuals in resource-poor settings.

Today, Harvard again has the opportunity to take the lead among universities around the world by adopting access-minded technology transfer policies and increasing its involvement in neglected disease research. As students, faculty, and alumni, it is our role to hold Harvard to its commitment to the public interest and push Harvard to set the right moral example on these issues of research and global health.

Connie E. Chen ’08 is an economics concentrator in Kirkland House. Matthew F. Basilico ’08 is a social studies concentrator in Mather House. Jonathan E. Soverow, a MPH candidate at the School of Public Health, is a member of Universities Allied for Essential Medicines. The Philadelphia Consensus Statement is available online at www.essentialmedicine.org/cs.