A comment piece by the redoubtable Ellen t’Hoen in this week’s Lancet illustrates exactly the bind that the pharma industry finds itself in when trying to improve access to medicines in poorer countries.

The piece reviews a judgement by the Indian Patent Office to reverse an earlier decision and grant the U.S. company Gilead a patent for Sovaldi (sofosbuvir), an antiviral for hepatitis C which achieves very high cure rates. t’Hoen does point out that Gilead has licensed out Sovaldi to generic manufacturers to cover 100 low- and middle-income countries, thus allowing those countries to get the medicine at a very low price. However, she then says that the licensing agreement “prohibits the generic companies from supplying these drugs to a number of middle-income countries with a high burden of HCV disease” and suggests that such countries use compulsory licences to access Sovaldi at the same cost as poorer ones.

Access to Medicines

She ignores the existence of by far the biggest hepatitis C treatment programme in the world, where Gilead is supplying Sovaldi to the Egyptian government at a cost of $900 per course of treatment – only about $400 more than the cost of generic sofosbuvir in India. Clearly Gilead is prepared to discount deeply if there is a large volume of patients available – Egypt has the highest prevalence of hepatitis C in the world, with 14.7% of the population infected. The government’s goal is to use this treatment programme to get that figure below two percent. Is it not fair that a middle-income country such as Egypt should pay a little more than a low-income one?

‘t Hoen then predictably criticises the pricing of Sovaldi in high-income countries, while never mentioning that NICE, the UK pricing authority, has said that Solvadi (at its current UK price of ~£40,000 for a course) is cost-effective, saving tens of thousands in long-term health costs associated with management of cirrhosis and liver transplants.

A classic example of how industry is damned if it does try and improve access, and damned if it doesn’t.