Against austerity in health policies and for transparency

Public hospital, social security, healthcare access for migrants, pensions: l’Observatoire de la transparence dans les politiques du médicament calls on ending all austerity policies, in particular those related to health, until transparency on all aspects of the medicines and health products R&D and production chain are implemented in France.

op-ed

The explosion in the price of medicines, diagnostic tools and other medical devices threatens our health system and its public finances. Yet, policy makers have never questioned the legitimacy and the rational of these prices. Even the most blatant abuses, such as the market approval of a Gilead’s hepatitis C medicine in 2014 for 40 000€ per cure, was not enough to incite the successive governments to take strong political measures in order to preserve the sustainability of our solidarity-based health system. On the contrary, for the first time since the creation of the Social Security in 1945, health authorities have first limited the access to this treatment for patients for purely economic reasons, and not medical ones.

Would these very high prices allow to fund innovation? In reality, the company Gilead, who bought a start-up who owned this promising molecule, sofosbuvir, recovered from its investments in less than twenty-four hours thanks to the increase of its share, without having sold any single medicine yet. And in 2019, we are still paying 30 000€ for this treatment, while it is now sold in generic formulations in various countries for less than 200€.

And as we were denouncing it at that time, to agree on such high prices would set precedents, that would be difficult to reverse later on for health authorities in the negotiations of drug prices with industrials. Thus, in 2019, the company Novartis demands two million euros per injection for a treatment developed thanks to French charity Téléthon’s, meaning thanks to our tax exempted donations.

Do we want more examples of public funding of research? Follow-up tools for viral hepatitis, partly developed thanks to French public research are now patented by private companies who have enjoyed more a decade of profits on the selling of these technologies, including to the Assurance maladie. Sanofi receives, only through research tax credits, at least 150 millions euros per year of public funding since 2009. In the meantime, since 2009, the company has cut more than 2800 positions of researchers, ended numerous researches, including on Alzheimer disease, in oncology and in infectious diseases, and has made the most hazardous choices in research and development. In parallel and as an example, Sanofi is currently trying to patent a combination of tuberculosis drugs, and to charge a high price for them, while they were developed… 60 years ago, and that the R&D to prove the efficiency of this combination was funded by public funding, through… Unitaid, an institution funded by the tax on air tickets, so by public funding again.

In the meantime, the major breakthrough in the tuberculosis world, bedaquiline, medicine that cures MDR-TB, is marketed in the U.S by Janssen for more than 20 000€, while studies show that its development was at least funded at 60% by public and philanthropic funding. Numerous are the examples that show that if the research failing risks are most of the time absorbed by the public sector, profits are exclusively privatized. We are paying several times for the same medicines and health products. 

Besides, the patent system is by nature dysfunctional. It allows for example a combination of two molecules known for decades to be patented until 2034. This is this opaque system and the indulgence of our political leaders who have been responsible, in particular in the past 20 years, of the inflation of the prices of medicines, which numbers in billions. Billions that we do not hesitate to save on the back of public hospitals, Social security, access to healthcare for migrants and pensions.

Twenty years of “out-of-pocket” spending that keep increasing, of “medical package” that oblige patients to pay more, in total contradiction with the spirit of the letter of the Social Security. Twenty years of challenging the principle of access to healthcare for all, including for migrants and immigrants, that culminates this year with an attack to the State medical aid, the health coverage for undocumented people, but also the healthcare access for asylum seekers, all at the prices of pathetic lies. Yes, in 2019 in France, we accuse people seeking asylum, who have crossed entire continents, war zones, of “sanitary tourism”.

Twenty years of budgetary cuts, compelling hospitals and emergency services to constantly reduce the number of beds and health workers, within the scope of managerial reforms such as the Price per Activity and culminating, despite the mobilization of health workers, with the vote of new savings, on December 3rd, 2019, with the adoption of the bill of social security funding for 2020 (PLFSS 2020). Twenty years of fatalistic speeches explaining that sacrificing our pensions is unavoidable while public dozens of billion euros only fund the profits of shareholders of pharmaceutical companies without the system that they enjoy being ever evaluated and questioned.

While ultra-liberal policies are proliferating, that public services are suffering more and more important cuts that are ineluctably aiming to the wanted, planned, orchestrated, privatization of public services, the Social security, the public Hospital and its emergency rooms, but also our pensions are among our last common goods, and we cannot accept to see them destroyed, while private interests, including those of pharmaceutical companies, are never questioned. A real public policy for medicines, would allow multinational to stop make the rules and to order policies that are against the public health interests for our country.

Within the scope of the same PLFSS 2020, and under the activist pressure, an amendment was adopted that compels pharmaceutical companies to disclose the amounts of public funding they received during the negotiation prices process. This first step is critical, but it is not enough. While waiting urgently for the implementation decree to be issued, the disclosure of other information (on the total spending on R&D, on patents, on real prices paid for drugs, for also for diagnostics, intermediary margins, origin of API, etc.) for a complete transparency, the government and the majority have to draw the necessary conclusions for this first measure : we cannot accept austerity measures to continue and to be extended, including those dismantling health care and social protection, until full transparency is made on the dozens of billions that we keep unduly depositing to the shareholders of pharmaceutical companies.

Le Club est l'espace de libre expression des abonnés de Mediapart. Ses contenus n'engagent pas la rédaction.