Table of contents  


 1. The context

Significant improvements in the health status worldwide are universally recognized, but such gains are to be measured against the widening health inequalities among and within countries created by a largely dysfunctional global economic system. Health and scientific knowledge have tremendously increased over the last decades, but the benefits of science are very unequally distributed, and they may not be sustainable if economic development is not pursued together with social justice. The precedence of public health interests over commercial and economic ones is far from being established and the need to strike a proper balance still has to be seriously addressed. Millions of people in low and middle-income countries have no or little access to the health services and tools that would allow them to address their priority needs. Among other key factors, this is a consequence of inadequate health systems and uneven distribution of resources in countries. In particular, the lack of availability and accessibility of essential medical tools poses a major barrier to the realization of people’s right to health and enjoyment of the benefits of scientific progress, at a time when the scope of health challenges for low and middle income countries grows even wider, as a result of epidemiological transition.

In recent years, the international community has acknowledged the problem. There is today an unprecedented mobilization towards providing incentives and support so as to enhance the accessibility of life saving drugs and other essential medical products in low and middle-income countries. Yet, 20 years after the analysis of the 1990 Commission on Health Research for Development, the 10/90 gap persists. Focus primarily placed on certain chapters of the research agenda keeps diverting attention from other and equally crucial issues for overcoming the gap. Often neglected, the building up or strengthening of efficient and sustainable national health systems is key to bringing the benefits of health research to people in need.
The structural linkage between health and biomedical innovation and access to essential health tools was established in the report of the WHO Commission on Intellectual Property Rights, Innovation and Public Health (CIPIH Report, April 2006): innovation is meaningless if its results are not reaching those in need . This strategic link forms the conceptual basis of the Global Strategy on Public Health, Innovation and Intellectual Property (GSPA, WHA61.21), the first consensual instrument negotiated and agreed upon by the international community to seriously tackle the 10/90 gap.
The comprehensive strategy and plan – articulated around 8 elements and guided by the central concept of needs-driven essential health research and development – provide an essential policy umbrella that contains guiding principles and globally accepted objectives. The ambitious policies and goals delineated in these documents need now to be translated into meaningful actions at country and regional level not to lose momentum. The timeline ahead is short: results from the GSPA are to be demonstrated by 2015.

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