A confluence of factors has got me thinking a great deal about questions of access this morning. The first is that I attended the book launch party last evening for Michael Reich and Laura Frost’s new book on access to health technologies. The second was Jessica Pickett‘s response to Alanna Shaikh‘s posting on the appropriateness of donated medicines for global health issues. The third was Bill Gates’ comments in his annual letter about his renewed commitment to the development an effective microbicide despite the failure to develop one so far. Finally, Bill Brieger had an interesting posting this morning about a cherry-flavored version of Coartem that has been developed by Novartis for pediatric use in Africa.
Michael and Laura use the following definition of access in their book:
“And end-user’s abiltiy to consistently obtain and appropriately use good quality health technologies when they are needed.”
Compare that with the comment made by Novartis Chief Executive Daniel L. Vasella in the WSJ article that was referenced in Bill Brieger’s posting:
“In the end the only drug that matters is the drug that is swallowed.”
While these quotes are saying slightly different things, I think what both of these quotes are getting at is the idea that just having a drug does not mean that it will be used. Of course, this is simply concluding the obvious, but it does raise the question of where should efforts be concentrated to improve access.
I think that it will all depend on the context: what drug, what disease, what country, what end user? There needs to be the ability for more exploration and experimentation to figure out what works and in what context. Bill Gates and Novartis has been innovators with regards to the development of new products. Will making Coartem cherry flavor really improve access, in particular in a part of the world where children probably have never even tasted cherries? APOC has been an innovator with regards to delivery mechanisms. Would the community-directed delivery strategy be effective for delivering other commodities such as bed nets (by the way, early operation research supported by APOC suggests that it might)?
It is this experimentation process that is what is going to lead to improved access. It may be a process of trial and error, but we are so far from knowing what works, that there needs to be the ability to allow new things, to study why things succeed or fail, and to learn from these mistakes.