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The Health Impact Fund

Jeremiah Norris

Letter to the Editor

Amitava Banerjee and colleagues (Jan 9, p 166)1 propose that a US$6 billion annual Health Impact Fund is needed as an incentive to drug manufacturers because “intellectual property rights provide little incentive for innovation in the diseases of low-income countries”. This statement ignores the record of product development, absent from such a fund.

In 1969, a drug manufacturer developed oral rehydration therapy for diarrhoeal diseases, which WHO proclaimed as “possibly the most important advance of this century”.2 In the 1980s, this same manufacturer developed Mectizan (ivermectin), for river blindness, contributing it at no cost. Although both products were patented, the manufacturer never challenged generic suppliers that entered the market. The costs of product development were soon eclipsed by distribution costs. These were borne by the World Bank, WHO, USAID, UNICEF, the UK’s Department for International Development, and the Carter Center.

In 2009, the US President’s Emergency Plan for AIDS Relief celebrated the 100th antiretroviral drug on WHO’s Prequalification Programme certified as a true generic by the US Food and Drug Administration (FDA). Most applications came from manufacturers in India. Since the files represented drugs covered by patents, the FDA had to extend to right-holders the legal opportunity to challenge every application. None did so.

These examples all show that drug manufacturers need no incentive to develop drugs for hundreds of millions in poor countries, nor are intellectual property rights a barrier to their access.

I declare that I have no conflicts of interest.


1 Banerjee A, Hollis A, Pogge T. The Health Impact Fund: incentives for improving access to medicines. Lancet 2010; 375: 166-169. Full Text | PDF | CrossRef | PubMed
2 Rubin RH. A comparative analysis of some drugs on the EDL: a discussion paper on the issues raised by a WHO resolution vis-à-vis US trade interests. Boston: Harvard Medical International, 1996.

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