Abstract

High prices can significantly restrict access to medicines and may have an impact on health equity. There is no clear understanding of what the social responsibilities and rights are of those involved in the development, production and distribution of medicines. This technical report explores how social contract theories, the global public (health) goods discourse and international human rights can be employed to sketch the broad contours of the responsibilities and rights of key stakeholders - particularly governments and pharmaceutical companies. These three approaches ascertain that stakeholders have specific responsibilities to assist in increasing access to high-priced medicines, yet they remain vague about the precise nature of actions stakeholders should perform to promote access to medicines. This report builds particularly on international human rights, and identifies specific obligations that, if properly implemented, should contribute to better access to medicines.

Contents

• Acknowledgements
• Abbreviations
• Executive summary
• 1 Introduction: social contract, social goods and human rights approaches
  • 1.1. Context: how high prices limit access to potentially life-saving medicines
  • 1.2. Challenge of accessing high-priced medicines: lessons from COVID-19
  • 1.3. Ensuring medicines are safe and effective: value of transparency
  • 1.4. Consequences of limited access to life-saving drugs
• 2 Actors/stakeholders
• 3 Social contract theory: rights and responsibilities
  • 3.1. Rights and responsibilities of governments towards citizens
  • 3.2. Limitations of social contract theory
  • 3.3. Ensuring good health: an obligation under social contract theories
• 4 Health GPGs: rights and responsibilities
  • 4.1. Health, health care and medicines as GPGs
  • 4.2. GPGs in the more restricted economic meaning of the term
  • 4.3. Implications of the GPG approach
  • 4.4. Conclusion: GPGs and high-priced medicines
• 5 Human rights law: duties and responsibilities
  • 5.1. International human rights law and access to medicines
  • 5.2. Government obligations for ensuring access to medicines
  • 5.3. Responsibilities of pharmaceutical companies and PPPs
  • 5.4. Contributions of others
• 6 Classifying various obligations and responsibilities
  • 6.1. Stakeholders
  • 6.2. The objective: increasing access to effective, novel, high-priced medicines
  • 6.3. Potential obligations and responsibilities of various stakeholders
• References

Suggested citation:

Lemmens T, Ghimire KM, Perehudoff K, Persaud N. The social contract and human rights bases for promoting access to effective, novel, high-priced medicines. Oslo Medicines Initiative technical report. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.

Oslo Medicines Initiative

Established in 2020, the Oslo Medicines Initiative (OMI) is a collaboration between the WHO Regional Office for Europe, the Norwegian Ministry of Health and Care Services and the Norwegian Medicines Agency. The OMI aims to provide a neutral platform for the public and the private sectors to jointly outline a vision for equitable and sustainable access to and affordability of effective, novel and high-priced medicines.

In line with the Regional Office's European Programme of Work 2020-2025 - “United Action for Better Health”, equitable and sustainable access to quality medicines is critical for universal health coverage and for achieving the Sustainable Development Goals. The OMI provides a strong focus on equity and on leaving no one behind, and is underpinned by three pillars: solidarity, transparency and sustainability.

The OMI has commissioned a series of technical reports to summarize relevant evidence and to provide policy considerations as a basis for discussion to inform its work. These reports are also in line with the implementation of World Health Assembly resolutions, in particular, resolution WHA 72.8 on improving the transparency of markets for medicines, vaccines, and other health products.

ISBN 978-92-890-5826-1

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Suggested citation: Lemmens T, Ghimire KM, Perehudoff K, Persaud N. The social contract and human rights bases for promoting access to effective, novel, high-priced medicines. Oslo Medicines Initiative technical report. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.

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