To date, Merck has issued a license to Aspen Pharmacare, and also to Thembalami, a joint venture of Adcock and Ranbaxy. But
when Thembalami dissolved, observers expected Merck to issue the two parent companies licenses—that has not happened. Merck
will be under increasing pressure to issue voluntary licenses because several generic companies recently lowered prices on
efavirenz in an agreement with the Clinton Foundation. Making those price cuts widely available may require additional licenses.
Novartis may make a significant contribution to the fight against neglected diseases with its Novartis Institute for Tropical
Diseases (NITD), a public-private drug-discovery partnership between Novartis and the Singapore Economic Development Board,
which is aimed at major tropical diseases. Other areas of research score high as well: It played a leading role in developing
antimalarial FDCs, including Coartem, and has developed two of the three products in the multi-drug therapy used in WHO's
strategy to eliminate leprosy.
Novartis is committed to providing the leprosy treatment for free, and is planning no-profit pricing for drugs resulting from
NITD research. However, it is unclear if NITD-developed drugs will be licensed, since the research is still in early stages.
But, given the promise of this venture, the company should explore licensing and technology transfer as tools for developing
essential patented medicines beyond ARVs.
Pfizer has immense resources which could bring research-based and market-based solutions to bear on the issue of medicine
access. However, the firm is heavily dependent on traditional philanthropic approaches to health problems and conducts little
research for the developing world. Given Pfizer's disproportionate influence on the industry, these issues are especially
Pfizer's most notable program is its Diflucan donation program. Pfizer now gives the anti-fungal medication to 21 countries
with an HIV prevalence above one percent without a time limit on the donation. However, critics argue that differential pricing
and licensing would have been superior alternatives. The Diflucan effort specifically has been criticized for its red tape,
narrow focus, and insufficient geographic reach. The company also has employee-volunteer programs and supports healthcare
infrastructure development in Uganda. There are no further neglected-disease drugs in the company pipeline. However, Pfizer
clearly sees a core business case for action, since it has devoted immense PR resources to addressing issues surrounding access
to medicine in the developing world.
Roche manufactures several ARVs, and is heavily invested in HIV research. However, it has not worked with other companies
to create FDCs—particularly for Fortovase, which should be taken with Norvir. The company has even stayed away from blister
packaging its products, citing IP and liability issues. It also produces other drugs, like Fuzeon, the first fusion inhibitor—a
twice-daily subcutaneous injection that costs $20,000 per year—which is not even remotely accessible to patients in the developing
Roche has clear patent policies, and has pledged not to file patents on ARVs or malaria drugs in the least-developed countries.
Recently, Roche announced a technology-transfer initiative to provide local manufacturers with the technical expertise to
produce Invirase, a WHO-recommended treatement.
Roche must also be commended for its predictable, transparent pricing in both LDC and middle-income countries. However, some
critics express concern that prices remain way too high in middle-income countries, and that the disparity between pediatric
and adult formulations is too great.