On May 3, 2017, 29 civil society organizations and 33 health professionals, activists, and economists — including Nobel Prize laureate Joseph Stiglitz — asked delegates to the World Health Assembly (WHA) to support a feasibility study on the progressive delinkage of the costs of research and development from the price of cancer medicines. The groups and experts sent a letter to the delegates [1].
The letter asked the delegates to “be open to alternative R&D models that do not rely on unaffordable medicine prices as the predominant way to fund cancer drug innovation,” and cited the high prices of cancer medicines and the resulting limited access.
On May 4, 2017, delegates from around 20 to 25 countries met in informal, off-the-record negotiations on a proposed WHA resolution on cancer control and prevention, where a feasibility study of delinkage was proposed. Some countries were opposed to any mention of delinkage in the cancer resolution. The negotiations resulted in a new text that had several bracketed sections, conflicting objectives, and had reduced the ambition for delinkage to a report, and even that was in brackets.
The working group will continue to meet ahead of the WHA, with their next meeting scheduled for the week before the World Health Assembly. The question is now whether the concept of progressive delinkage will be retained in the cancer resolution, and if the issue can be advanced further with a feasibility study, at the upcoming World Health Assembly (May 22, 2017 to May 31, 2017).
A note on the term “delinkage”
At the negotiation, some objected to the delinkage study on the grounds that “prices already have nothing to do with R&D costs, so there is no linkage.”
The notion that drug prices are already delinked from R&D costs is only true if you ignore the only rationale for high prices in the first place, or the objections typically offered to measures that result in low prices. We certainty don’t think prices reflect R&D costs incurred, but we all should acknowledge that the whole reason for patents, orphan drug exclusivity, rights in test data, etc., is to provide an incentive to invest in R&D. And, we should also acknowledge that whenever a compulsory license or even a modest effort to roll back prices is considered, the industry counters, with some truth (at least qualitatively), that this will depress R&D. So what we are looking for is to examine getting rid of the monopolies and high prices, while still having systems to ensure that R&D is funded, including when it involves investors responding to incentives. There are probably other ways to describe this, like “funding R&D without time limited legal monopolies,” but the term delinkage, even though it does not work for everyone, it being used as shorthand.