Global Health Institute

According to the Organization for Economic Cooperation and Development (OECD), Palestine or the Palestinian territories of Gaza and the West Bank are considered highly fragile. This fragility comes from the absence of territorial, economic and political sovereignty due to the ongoing Israeli-Palestinian conflict. The political conflict in the Palestinian territories as well as the territorial fragmentation of the West Bank make an integration of basic health care services a very difficult. In investigating the association between political instabilities/humanitarian crises and the re-emergence of infectious diseases I have seen how many historical epidemics have been associated with political conflicts. For instance, in 2016 there was a devastating cholera outbreak in Yemen as a result of the ongoing war and the Saudi Arabian-led intervention against the Houthi movement. Airstrikes targeted and damaged hospital infrastructure as well as water supply. Furthermore, I attended the 2017 Harvard National Model United Nations Conference, where I represented the Republic of Botswana at the Special Summit on Terrorism. During the conference, I learned about the re-emergence of wildtype poliovirus that occurred during the Syrian Civil War, which was declared a public health emergency by the World Health Organization (WHO). Another example is the recent outbreak of the Ebola virus in the Democratic Republic of the Congo, a country that has been affected by various political conflicts and the widest interstate war in modern African history.

As a fellow with the Georgetown Global Health Initiative, I am working as a research assistant with Dr. Wolfgang Rennert, MD, DMSc, DTM&H, at MedStar Health. The project focuses on the safety and immunogenicity of ROTAVAC, a rotavirus vaccine, in the Palestinian territories of Gaza and the West Bank. Rotavirus is considered the most common cause of severe diarrheal disease accounting for up to 45 percent of hospitalizations for children under the age of three. The high poverty rates and the limitation of movement of goods and people between the territories continue to worsen the status of the disease in Gaza and the West Bank. Furthermore, the Gaza strip is suffering from a devastating water crisis; 97 percent of drinking water is unfit for consumption by international standards. This collapse of water infrastructure has led to a sharp rise in various pathogens, among which are rotavirus, cholera and salmonella. "When you have political instability, public health always suffers," Jeremy Farrar, PhD, an infectious disease expert at the University of Oxford.

It is interesting to note that low-income countries often tend to have better access to vaccines than middle income countries. Low-income countries receive global support from organizations such as Gavi, the Vaccine Alliance.  While the Palestinian territories are very poor, they do not receive Gavi support. According to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), 53 percent of Palestinians in Gaza live in poverty. This means poverty has increased by 14 percent in a six-year period. “Palestine is very poor. But unfortunately, Palestine is not even seen as a country,” Dr. Rennert. Palestine can be safer and healthier if it is fully recognized as an independent state.

One of the main health challenges that poses global concerns is the fact that public health threats, health emergencies and infectious diseases do not recognize or respect political borders. The safety and well- being of the Palestinian territories are essential for the safety and well-being of the State of Israel as well as the Global community. 

Mohammed Jibriel (G’20) is a graduate student at the Department of Microbiology and Immunology studying Biohazardous Threat Agents and Emerging Infectious Diseases and a student fellow with the Global Health Initiative.

At noon on Thursday, February 7, 2019, I stood near Congressman Lloyd Doggett (D-Texas) on Capitol Hill as he gave a press conference on a bill that would address the prescription drug affordability crisis in the United States: the Medicare Negotiation and Competitive Licensing Act. This bill would authorize the secretary of health and human services (HHS) to negotiate drug prices covered by Medicare's prescription drug benefit with drug companies. Under the bill, the secretary of HHS could issue a competitive license to a company that is willing and able to produce the generic version of a medication if drug companies refuse to negotiate in good faith. The bill was introduced in Congress later that Thursday.

One might understand why access to medicines remains a problem in low-income countries where some people live on less than $2 per day. But access to medicines is also a problem in the United States: research indicates that one-third of Americans skipped medication or split pills last year because they could not afford them. The United States also pays more for medicines than other high-income countries, even though the U.S. government funds more research and development (R&D) than other developed countries. According to Congressman Lloyd Doggett , between 2010 and 2016, all medicines developed and marketed by pharmaceutical companies received government funding. 

The reasons for this are manifold. First, drug manufacturers in the United States, unlike in other high-income countries, are free to charge the highest price the market can bear on medicines. The same medication in the same packaging costs way more in the United States than in neighboring Canada and Mexico, according to a study by Monali Bhosle and  Rajesh Balkrishnan. Second, while it is true that R&D is expensive, research indicates that only about 20 percent of the amount that pharmaceutical companies claim as R&D costs is spent on R&D, while 70 percent of that amount is spent on marketing and advertising. These costs are shifted to and borne by consumers, resulting in higher cost of medicines here in the United States. Third, three-quarters of the medicines introduced to the market in the last decade are recycled or repurposed existing medicines, patented as though they were new, creating patent thickets. The patent system allows pharmaceutical companies to obtain patent protection over new formulations and other minor changes to existing medicines. They also commercialize them at high cost while investing very little in developing these ‘me too’ medicines.

Although the current bill, if voted into law, would allow the secretary of HHS to issue a competitive license if pharmaceutical companies refuse to negotiate in good faith, other measures should be envisaged by the U.S. government to provide a lasting solution to access to medicines in the United States. Some of these measures include: modifying the patent laws to ensure that patents and/or other forms of monopoly are only available for medicines with added therapeutic value to patients and not ‘me too’ medicines, so as to compel pharmaceutical companies to spend more on R&D; restrict advertisements which cause patients to favor expensive brand medicines over generic substitutes; prohibit price increases on existing medicines; prevent secondary patents and patent thickets; ensure transparency in agreements between pharmaceutical companies to ensure there are no pays for delays on the launch of generics.

Joelle Ofimboudem (LL.M.'19) is a graduate student in the Global Health Law LL.M. program at the Law Center, and a student fellow with the Global Health Initiative.