Priority medicines and the world.

The initiative taken by the Government of the Netherlands in 2003 to develop a basis for a worldwide public health approach to the development of new medicines is welcome. Although new medicines have continued to enter the market during the half century in which public policies in this field have come to maturity, it is no secret that the development process has encountered grave problems and has been the subject of unresolved controversies. Of these, the most serious relates to the perceived divergence between the nature of the drugs reaching the market and the real health needs of populations. That divergence is evident even in Europe and the United States, where the research-based pharmaceutical industry is primarily established. Over six decades, there has been a series of true breakthroughs (such as the emergence of antibiotics to counter infection and several generations of new agents to treat cardiovascular or psychiatric disease); particularly in the last 20 years, however, far too many “new drugs” have been only insignificant variants on those already existing, and real breakthroughs have been virtually absent. This situation is serious enough in the industrialized world; the failure to make inroads on major disorders involving the people of developing countries is worse still. The Priority Medicines Project, sparked by the Netherlands in the hope of bringing about real improvement, reflected the belief that research funding by the European Union could be a major tool to this end; it was therefore bound to be attuned to an important extent to the problem of western populations. From the start, however, the need for global progress was recognized, and the study was therefore entrusted to experts nominated by WHO and conducted under the Organization’s auspices. The report Priority medicines and the world, issued in November 2004 provides a distinguished analysis of the problems and advances important proposals to solve them (1).