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Universal Access to Essential Medicines

From Elisy
Essential Medicines Access


Essential medicines – treatments that satisfy the priority health care needs of populations – remain inaccessible to nearly two billion people worldwide. This preventable gap leads to millions of avoidable deaths from treatable conditions. Proven solutions exist, and realistic systems reforms can ensure lifesaving treatments reach everyone who needs them. This article shows how humanity can achieve universal access through smarter pricing, local manufacturing, intelligent distribution, community delivery, reformed innovation incentives, and integration into universal health coverage.

The Problem

Approximately two billion people lack regular access to essential medicines.[1] Primary barriers include unaffordable prices (sustained by patent-based monopolies), fragile distribution with frequent stockouts, inadequate infrastructure and financing, and delayed entry of generics due to intellectual-property barriers and regulatory bottlenecks.[2]

Possible Solutions

Universal Pricing Reform

A global norm where essential medicines are priced near manufacturing cost (plus reasonable margins) rather than monopoly value would transform access. Evidence from competitive generic entry shows typical price declines of ~70–90% within a few years; in specific therapeutic areas (e.g., antiretrovirals) reductions exceeded 95%.[3][4][5]

Concept rationale: Current pricing often reflects monopoly power, not cost. Redirecting incentives away from high launch prices and toward health impact enables universal affordability while preserving innovation through alternative reward mechanisms.

Possible path to achieve:

  • Systematic use of TRIPS flexibilities and the Doha Declaration for public health (including compulsory licensing and the Article 31bis export mechanism).[6][7]
  • Regional pooled procurement and volume-guarantee contracts to drive down prices.
  • Expansion of patent pools beyond current disease areas; voluntary licences with clear, access-oriented terms.[8]
  • Impact-prize funds and advance market commitments that require near-cost pricing.[9]

Decentralized Manufacturing Networks

Local and regional pharmaceutical manufacturing, supported by technology transfer and strong quality systems, can reduce fragility and build sustainable access.

Concept rationale: Heavy concentration of production creates systemic risk. Regional hubs and standardized tech-transfer packages (including for biologics) strengthen resilience, cut delays and transport costs, and build skills and jobs. Emerging modalities (continuous manufacturing; selected 3D-printed dosage forms) can enable flexible, smaller-scale production where safe and appropriate.[10]

Possible path to achieve:

  • Build out WHO-coordinated technology-transfer programmes (e.g., the mRNA Technology Transfer Programme led with MPP/Afrigen/Biovac) with turnkey documentation, validation and training.[11]
  • Create shared regional facilities through economic communities; align good-manufacturing and regulatory standards via reliance/mutual recognition to reduce duplicative approvals.
  • Invest in pharmaceutical-science education and national quality-control labs; pilot continuous manufacturing lines and scale after validation.

Intelligent Distribution Systems

Advanced logistics that combine predictive analytics, automated inventory control and diversified last-mile delivery can eliminate “empty shelf” failures even when national warehouses are stocked.

Concept rationale: Facility-level stockouts are often distribution, not supply, failures. In Zambia, an integrated logistics model reduced stockouts from ~48% to ~13%.[12] Drones have also cut stockouts 21–51% in African pilots by accelerating urgent deliveries.[13]

Possible path to achieve:

  • National, real-time LMIS with automated re-ordering and demand forecasting (seasonality, outbreaks, historical usage).
  • Route optimization, cold-chain telemetry, and tamper/temperature logging; progressive rollout starting with high-volume districts.
  • Drone corridors for remote areas (initially for time-critical medicines, blood and diagnostics), with safety/airspace protocols.

Community-Based Delivery Models

Trained community health workers (CHWs), with decision-support tools and essential-medicine kits, extend effective care to households beyond facility reach.

Concept rationale: CHW programs measurably reduce mortality and improve coverage; integrated community case management has achieved large disease-specific gains (e.g., pneumonia mortality reductions up to ~70% in program evidence).[14]

Possible path to achieve:

  • National CHW cadres with standardized training, supervision, referral pathways and digital decision-support.
  • Pre-positioned kits and reliable resupply; remuneration models suited to context.
  • Tight integration with primary care and data systems to track outcomes and adherence.

Reformed Innovation Incentives

Reward pharmaceutical innovation based on health impact, delinking R&D costs from end-user prices.

Concept rationale: Patent-exclusive pricing excludes billions and under-incentivizes neglected diseases. Prize funds, AMCs and directed public R&D can maintain innovation while mandating near-cost pricing.[15]

Possible path to achieve:

  • Multilateral impact-prize funds (e.g., 0.01% of GDP contributions) paying out by QALYs/DALYs averted, with access-licensing requirements.
  • AMCs to de-risk priority products while capping prices.
  • Public-funding conditions that require equitable licensing; transparent cost-effectiveness and budget-impact appraisal.

Universal Health Coverage Integration

Embedding essential medicines in universal health coverage (UHC) – with pooled public financing and evidence-based formularies – guarantees access as a right rather than a commodity.

Possible path to achieve:

  • Progressive expansion of pharmaceutical benefits (start with highest-impact lists); revenue via general taxation, earmarked health taxes, or income-linked contributions.
  • HTA-driven formularies; centralized/pooled procurement; generic substitution where appropriate.
  • PMIS to track utilization/outcomes, enabling iterative formulary updates.

What You Can Do

Through Expertise

  • Clinicians: direct care (2–6-month missions) or remote telemedicine (1–2 h/month) via established NGOs.
  • Pharmaceutical scientists, supply-chain and logistics experts: quality assurance, GMP support, LMIS design, and tech-transfer advisory.
  • Policy researchers: patent reform, pricing transparency, procurement and UHC policy.

Through Participation

  • Community education, materials translation, rational-use outreach.
  • Advocacy: submissions to public consultations, engagement with elected representatives, support for equitable licensing on campuses (UAEM).

Through Support

  • Donate or contribute skills to organizations with strong evidence of impact (below).

FAQ

What are "essential medicines"?

Medicines selected for priority health needs based on public-health relevance, efficacy, safety and cost-effectiveness. WHO maintains the Model Lists, updated every two years. As of September 2025: 523 medicines (adult list) and 374 (children’s list).[16]

Could alternative innovation systems really work without monopoly pricing?

Yes. Prize funds and AMCs have real-world precedents; public R&D funding underpins many approved drugs (e.g., NIH-linked research contributed to 99% of FDA approvals, 2010–2019).[17]

Why don’t generics alone solve the access problem?

They do when competition is enabled – but patents, regulatory delays, quality-assurance capacity and procurement failures can block or slow entry. Solutions must accelerate generic licensing/approval and fix distribution, QA and financing barriers.

What would a fully realized access system look like?

Near-cost global pricing; distributed, quality-assured manufacturing; zero-stockout logistics; CHWs covering every community; innovation rewarded by health impact; and UHC guaranteeing medicines as a right.

Conclusion

Universal access to essential medicines is achievable. Competitive supply and patent-pool licensing have delivered massive price reductions and treatment scale-up; tech transfer is building regional capacity; digital logistics and CHWs close last-mile gaps; UHC financing guarantees access at the point of care. What remains is coordinated implementation at scale, guided by evidence and equity.

Organizations Working on This Issue

Gavi, the Vaccine Alliance – https://www.gavi.org/

  • What they do: Expands vaccine access via innovative finance, pooled procurement and system strengthening.
  • Concrete results: 1.1 billion children immunized; 18.8 million future deaths averted since 2000; 69 million children supported for vaccination in 2023.[18]
  • How to help: Health professionals via partner pathways. Donate

The Global Fund to Fight AIDS, Tuberculosis and Malaria – https://www.theglobalfund.org/

  • What they do: Mobilizes and invests resources for HIV, TB and malaria in 100+ countries.
  • Concrete results: 70 million lives saved since 2002; in 2024 – 25.6 million people on ART in GF-supported countries; 79% of people living with HIV in these countries on ART; combined death rate from AIDS, TB and malaria down 63% since 2002.[19]
  • How to help: Support replenishment advocacy. Donate

Drugs for Neglected Diseases Initiative (DNDi) – https://dndi.org/

  • What they do: Non-profit R&D delivering affordable treatments for neglected diseases.
  • Concrete results: 13 new treatments since 2003, incl. first all-oral cure for sleeping sickness; millions treated.[20]
  • How to help: Scientific collaborations. Policy support for delinkage. Donate

Medicines Patent Pool (MPP) – https://medicinespatentpool.org/

  • What they do: Negotiates voluntary licences enabling affordable generics and tech transfer for LMICs.
  • Concrete results: 52.19 billion doses supplied via licensees (141.55 million patient-years); US$ 2.3 billion savings; broad DTG access – 129 countries by end-2024.[21]
  • How to help: Legal experts can support licensing/scaling. Donate

Clinton Health Access Initiative (CHAI) – https://www.clintonhealthaccess.org/

  • What they do: Market shaping and system strengthening to reduce costs and expand access to medicines and diagnostics.
  • Concrete results: Documented major price reductions across HIV, hepatitis C, vaccines and more; see 20-year impact profiles.[22]
  • How to help: Opportunities for supply-chain and market-analysis professionals. Donate

UNICEF Supply Division – https://www.unicef.org/supply/

  • What they do: Largest single vaccine buyer; procures and delivers essential health supplies worldwide.
  • Concrete results: In 2024 delivered 2.787 billion vaccine doses to 99 countries; UNICEF supplies reach ~45% of the world’s under-5 children.[23][24]
  • How to help: Procurement/logistics roles via UNICEF careers/partners. Donate

Médecins Sans Frontières (MSF) Access Campaign – https://www.msf.org/

  • What they do: Frontline medical care plus global advocacy on pricing, patents and transparency.
  • Concrete results: Advocacy contributed to ~99% ARV price drop (≈$10,000 → ≈$70 pppy) and drastic hepatitis C price cuts; co-founded DNDi.[25]
  • How to help: Field roles (2+ months). Policy advocacy. Donate

Universities Allied for Essential Medicines (UAEM) – https://www.uaem.org/

  • What they do: Student-led movement for equitable university licensing and global-health-oriented research.
  • Concrete results: Landmark Yale case (30-fold ARV price reduction in sub-Saharan Africa); 80+ universities adopted equitable-licensing principles.[26]
  • How to help: Campus chapters, policy change, mentoring.

References

  1. ↑ World Health Organization (WHO) Regional Office for the Eastern Mediterranean. “Access to Essential Medicines.” https://www.emro.who.int/essential-medicines/strategy-access/
  2. ↑ Cameron, A. et al. (2009). “Medicine prices, availability, and affordability in 36 developing and middle-income countries.” The Lancet. https://pubmed.ncbi.nlm.nih.gov/19042012/
  3. ↑ IQVIA (2016). “Price Declines After Branded Medicines Lose Exclusivity.” https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/price-declines-after-branded-medicines-lose-exclusivity-in-the-us.pdf
  4. ↑ ASPE/HHS (2025). “Generic Competition and Drug Prices.” https://aspe.hhs.gov/
  5. ↑ MSF (2019). “Access Campaign: 20 Years of Advocacy.” https://stories.msf.ie/access20/
  6. ↑ WTO (2001). “Doha Declaration on the TRIPS Agreement and Public Health.” https://www.wto.org/english/thewto_e/minist_e/min01_e/mindecl_trips_e.htm
  7. ↑ WTO (2024). “TRIPS Agreement – Article 31bis (Practice).” https://www.wto.org/english/res_e/publications_e/ai17_e/trips_art31_bis_oth.pdf
  8. ↑ Medicines Patent Pool (2025). “Breaking New Ground: 2024 Annual Report.” https://medicinespatentpool.org/news-publications-post/breaking-new-ground-mpps-2024-annual-report-demonstrates-sustained-innovation-and-impact
  9. ↑ Hollis, A. & Pogge, T. (2008). “The Health Impact Fund: Making New Medicines Accessible for All.” https://www.healthimpactfund.org/
  10. ↑ Alhnan, M.A. et al. (2016). “Emergence of 3D Printed Dosage Forms.” Pharmaceutical Research. https://pubmed.ncbi.nlm.nih.gov/26563425/
  11. ↑ WHO (2023). “Global mRNA technology transfer hub.” https://www.who.int/initiatives/global-mrna-technology-transfer-hub
  12. ↑ Vledder, M. et al., summarized by The World Bank (2019). “Supplying better health for rural clinics can be as easy as 1-2-3.” https://blogs.worldbank.org/health/supplying-better-health-rural-clinics-can-be-easy-1-2-3
  13. ↑ William & Mary (2022). “Drone delivery cuts medical stockouts by up to 51 percent in Ghana.” https://news.wm.edu/2022/11/09/drone-delivery-cuts-medical-stockouts-by-up-to-51-percent-in-ghana/
  14. ↑ Exemplars in Global Health (2024). “Community Health Workers.” https://www.exemplars.health/topics/community-health-workers
  15. ↑ Hollis & Pogge (2008). “Health Impact Fund.” https://www.healthimpactfund.org/
  16. ↑ Reuters (2025). “WHO adds GLP-1 drugs … to essential medicines list.” https://www.reuters.com/business/healthcare-pharmaceuticals/who-adds-glp-1-drugs-diabetes-others-essential-medicines-list-2025-09-05/
  17. ↑ Cleary, E.G. et al. (2023). “Contribution of NIH funding to new drug approvals 2010–2019.” JAMA Health Forum. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2809737
  18. ↑ Gavi (2024). “Impact 2023: seven key statistics.” https://www.gavi.org/vaccineswork/gavis-impact-2023-seven-key-statistics
  19. ↑ Global Fund (2025). “Results Report 2025.” https://www.theglobalfund.org/en/results/
  20. ↑ DNDi (2024). “Treatments Delivered.” https://dndi.org/research-development/treatments-delivered/
  21. ↑ MPP (2025). “Breaking New Ground: 2024 Annual Report.” https://medicinespatentpool.org/news-publications-post/breaking-new-ground-mpps-2024-annual-report-demonstrates-sustained-innovation-and-impact
  22. ↑ CHAI (2024). “20 Years of Impact.” https://www.clintonhealthaccess.org/20-years-of-saving-lives/
  23. ↑ UNICEF (2025). “Supply Annual Report 2024.” https://www.unicef.org/supply/reports/unicef-supply-annual-report-2024
  24. ↑ UNICEF. “Vaccines | Supply Division.” https://www.unicef.org/supply/vaccines
  25. ↑ MSF (2019). “Access Campaign: 20 Years of Advocacy.” https://stories.msf.ie/access20/
  26. ↑ UAEM (2024). “Mission and Impact.” https://www.uaem.org/mvv

References and Inspirational Resources

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