“Labour will tackle this. We will redesign the system (of access to, and pricing of, medicines) to serve public health - not private wealth - using compulsory licensing to secure generic versions of patented medicines. We’ll tell the drugs companies that if they want public research funding then they’ll have to make their drugs affordable for all. And we will create a new publicly owned generic drugs manufacturer to supply cheaper medicines to our NHS saving our health service money and saving lives. We are the party that created the NHS. Only Labour can be trusted with its future.”

The above statement may not be the most headline grabbing part of Jeremy Corbyn’s recent conference speech, but it is a radical proposal that is worth looking at in a bit more depth.

In effect, what Labour are proposing are three separate measures:

·       Compulsory licensing to effectively circumvent patent protection

·       Creation of a new publicly owned medicines manufacturing company to make generic medicines – including, potentially, the ones whose patents the government has overruled

·       Publicly-funded research coming with the requirement to make medicines ‘affordable for all’

This is the second of two blogs looking at the most controversial of the proposals. In part 1 I looked at the proposals to create a new pharma manufacturing company. In part 2, i will look at the proposal to introduce compulsory licensing.

Compulsory licensing for branded medicines

This proposal is potentially explosive and would be a major shock to the way in which medicines are researched and brought to market.

Patents exist to protect innovation and allow those who bring new ideas or inventions to benefit without others stealing them. It applies across the economy, not least in pharmaceuticals where it gives those who research and develop new medicines a period of exclusivity in which they alone can sell, and profit from, their new medicine; this allows them to recoup their costs and make a profit. This period of protection runs for 20 years but includes the time it takes to develop and trial the medicines, which means companies normally have around 5 to 10 years of exclusivity on a new medicine.

The ABPI, unsurprisingly are not in favour of this proposal, stating that the “…seizure of new research – is not the answer. It would completely undermine the system for developing new medicines. It would send a hugely negative signal to British scientists and would discourage research in a country that wants to be a leader in innovation.”

How practical this measure would be is hard to say, but it would almost certainly result in court cases and long, drawn-out disputes. There is a campaign to promote the compulsory licensing of some medicines - make medicines affordable -and while the intricacies and legalities of international trade and IP law are beyond my knowledge, it does suggest that governments do have the power, whether or not they want to use it.

As often with new medicines, it comes down to subjective assessments of what a ‘fair’ price is, what is or is not ‘affordable’. This is where it gets complicated, and the peculiarities of our NHS, which in this context is a highly rationed health system. Because of this, the NHS already gets some quite favourable deals with the pharma industry, who regularly provide significant, but highly confidential, discounts. 

There is no doubt that medicines are expensive and constituted a huge chunk of NHS spending, albeit not growing as a proportion of overall NHS spending. But prescribing medicines is also fundamental to modern healthcare, with benefits to patients and the NHS that are hard to dismiss.

There is an inherent tension in any buyer/seller relationship, where one wants to keep the price as low as possible and other wants it to be as high as it can be and still get the sale. When that balance cannot be found and patients are in the middle of such a dispute, it is incredibly difficult. Whether the Labour plan would help to end this with these proposals however is unclear. It may do, but equally it may make things worse if the current discounts enjoyed by the NHS were removed as a result of this move, to give just one potential scenario.

In a rationed system like the NHS, there will always be treatments that are not affordable, and there will always be patients who cannot get a specific treatment that they want. Whether this is due to costs being too high, or budgets being too low, will always be contested ground. The best solution is likely to remain a negotiated outcome in which both sides are content. Where that is not possible, the temptation for political intervention – either in a particular dispute or by changing the whole system as Labour suggest – will always remain.

To finish, it is worth making a wider point: that of realistic expectations. This is especially true when talking about medicines, where desperate people will understandably cling to any hope offered to them. Labour’s Medicines for the Many policy document points to things that it could do in government soon after being elected and others that will take longer. What it does not offer is a quick fix for those need a medicine now that the NHS cannot supply to them.

What is clear from examining the proposals is that the benefits, desirability and practical effects are far from simple to predict, and seldom does a policy work as well in reality as it does in the party conference hall. In response to the announcement, the Scottish Labour Health Spokesperson Monica Lennon MSP issued a statement that these proposals are:

“a brilliant new progressive policy that will transform the lives of patients…” and that “medicines should always be available to patients based on need, and not based on the whims and profit motives of pharmaceutical companies. Labour will guarantee patients access the drugs they need.”

Such bold statements belie the complexity of the issues. As always, the devil will be in the detail, both for patients and for prospective governments.