Limited access to essential medicines is one of the key barriers to health. This is particularly true for the majority of low-and middle-income countries (LMICs). The barriers are varied and include weak health systems, no or lack of proper infrastructure, insufficient numbers of health workers, insufficient knowledge among health workers, no surveillance systems, lack of diagnostics. Price of course is a key barrier.

The price of patented medicines is becoming an increasing challenge in all countries but in LMICs the proportion of healthcare spend on medicines is higher, at least a quarter and up to 67% of the entire healthcare budget, and this continues to increase. As a result, the price of medicines could make the implementation of Universal Health Coverage (UHC) unaffordable and beyond the reach of many.

The answer to this challenge is to make medicines available and affordable but the next question is how. A number of access models have been tried, including voluntary public health licensing, donation programmes, tiered pricing, bilateral deals between originators and generic companies, and as a last resort compulsory or government licensing. The appropriateness of each model will depend on the specific circumstances nevertheless each must be judged against the major public health standards of transparency, sustainability and benefit.

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“There are many, many actors involved in ensuring that access happens. Unless we all do this together, we won’t have access, and if we don’t have access to affordable medicines in low- and middle-income countries, frankly universal health coverage is just going to be a pipe dream.” – Charles Gore, Executive Director, Medicines Patent Pool, Switzerland

“When we talk about access, we think about access to essential medicines, but real access means access to trained health professionals, access to appropriate healthcare equipment and to organised health systems. Still, without access to essential medicines, universal health care will remain a mirage, and it’s not necessary to talk about UHC all day long if you are not able to enhance an effective access to essential medicines. UHC is meaningless without equitable access.” – Marisol Touraine, Chair of the Executive Board, Unitaid, Switzerland

“Access to safe, efficacious, quality and affordable medicines is a political choice. The inequities in health are fundamentally actionable And, that’s where universal health coverage comes in, because there’s a lot that the health sector can do to decrease the inequalities in health outcomes right now by doing the right health policies and ensuring there’s funding for that. We know, for example, 90% of the global population pays for medicines through out-of-pocket expenditures, and medicines are the second largest expenditure after food. So you fight inequities in health, and universal health coverage is an important strategy to do that.” – Dr. Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, World Health Organization, Switzerland

“One of the issues is how to understand the needs at the country level in the downstream and how to connect with innovation with the upstream. So, thinking about innovation is about simplification. It’s about acceleration, it’s about transformation. And in all the three buckets, the work that we have been doing with the Medicines Patent Pool and others makes a difference.” – Dr. Philippe Duneton, Executive Director, Unitaid, Switzerland

“I truly believe, and I see companies are moving. They’re moving actually from CSR to sustainable business model. Sustainable business model must include willingness of offering tiered pricing. It must include the willingness to do co-creation. IP is not a barrier. IP is an enabler. Most of the generic medicines, which are so important on the Essential Medicines List have originally been created by innovators. They are now way cheap by generics. Therefore IP also in terms of fast response to COVID-19 has enabled us to react fast, but we must make sure that IP is not the barrier to access. We must work together to improve access.” – Thomas Cueni, Director-General, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Switzerland

“There are clearly critical gaps between what happens in enlisting on the essential medicines list and achieving widespread access. But certainly, within the EML, there’s a welcoming of the move from the Medicines Patent Pool to expand its remit across essential medicines. And I think there are really good examples of good progress, particularly with small molecules that show us what can be achieved, although clearly more needs to be done. But there are clearly areas like biologics where we need greater efforts to narrow the gap.” – Prof. Dr. Graham Cooke, Imperial College London, United Kingdom; Chair of the WHO EML list

“Universal health services is a beautiful concept but it leaves out very significant populations. We still have in our countries populations that are criminalised, and therefore they are not accounted for in the public health domain. So when you have these people left out, then we are not reaching everyone. So we can’t really call it UHC. So I think in my takeout, I would say that universal health coverage should be equitable, it should be sustainable and it should be country-owned.” – Maurine Murenga, Executive Director, Lean on Me Foundation, Kenya

“We used to celebrate when we have a product that is approved on the market. I think our chance to celebrate should be when there’s local availability, really at the patient level. That’s something we need to end with.” – Dr. Jayasree K. Iyer, Executive Director, Access to Medicine Foundation, Netherlands