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Leveraging university research to advance global health.

THE WORLD’S DESTITUTE SICK FACE A PERILOUS DISADvantage in accessing essential medicines. The crisis stems from 2 related problems. First, for the billion people affected by neglected diseases such as trypanosomiasis and cholera, few safe and effective treatment options exist. Because these neglected diseases predominantly affect the poor, they attract little research and development funding, leading to a paucity of therapies. Second, for other diseases, several interlinked factors impede access to medicines that do exist: high prices, underfunded and uncoordinated health care systems, and drug formulations ill-suited to resource-poor settings. Generic competition has lowered the price of antiretroviral therapy for human immunodeficiency virus (HIV) from more than $15 000 per patient-year 6 years ago to $99 today. Concomitant with this decrease in prices has been an increase in funding and political will to address the HIV/AIDS pandemic. This has shifted the debate from whether antiretroviral therapy is possible in resource-poor settings to how to strengthenhealthinfrastructuretoprovidecomprehensivecare. Despite the progress demonstrated for antiretroviral therapy in poor countries, there is, as yet, neither a comprehensive nor a lasting solution to ensure that patients in poor countries pay less for medicines than patients in rich countries. Even antiretrovirals, generally heralded as a success story for differential pricing, show the evanescence of any progress that has been made. Implementing new first-line HIV treatment guidelines from the World Health Organization would cost 5 times more per patient-year than the older, first-line treatment regimen; second-line therapies are even more expensive. Meanwhile, major generic-producing countries like India must now enforce product patents to comply with the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement. The US government is pushing further still for expanded intellectual property protection by systematically negotiating so-called TRIPS-plus provisions into bilateral free-trade agreements. Taken together, these developments threaten to undermine gains for the health of the underserved that have been made by reforms to the international intellectual property system.