Wednesday, July 30, 2014
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全球卫生状况的突破性机会

纽约—每年都有数百万人因可防可治的疾病而身亡,特别是在穷国。在很多情形中,救命药可以以低廉的成本大量生产,但售价却让需要者望而却步。更有许多人的死仅仅是因为缺少治疗或疫苗,而造成这种情况的原因是用于为穷人治病的世界宝贵研究人才和有限资源太少。

如此状况反映了经济学和法律方面急需得到修正的失灵。好消息是现在改变的机会已现,主要是通过一项由世界卫生组织牵头的国际计划,该计划将开始修正造成廉价药品开发和难以获得问题的知识产权制度漏洞。

如今,药品之所以难以获得,主要是拜两大问题所赐。其中之一是药品成本太高;或者,更正确地说,是药品要价太高,而生产成本只是要价的一小部分。第二个问题是药品开发的着眼点是利润最大化,而不是社会效益最大化,这使得药品开发倾向于创造对人类福利至关重要的品种。而穷人根本没有多少钱可花,因此,在现有安排下,制药公司根本没什么激励研究折磨穷人的疾病。

事情本不必如此。制药公司指出,要价高是必要的,这是为了给研发提供资金。但是,在美国,大部分卫生相关研发活动的实际出资者是政府——或是通过公共支持(美国国家卫生研究院、国家科学基金会等)直接提供资金,或是通过药品公共采购(如医疗保险和医疗补助计划)间接提供资金。不能获得政府融资的部分也不是传统市场;许多个人的处方药支出都能获得保险赔付。

政府之所以为卫生研究提供融资,是因为改善药品是一种公共品。由此带来的知识进步能防止传染病、减轻常见病的经济和人身伤害,从而让每个人都受益。要获得高效,就必须在获得知识进步后尽可能快地共享之。托马斯·杰斐逊曾将知识比作蜡烛:用一根蜡烛点燃另一根蜡烛,并不会减弱前一根蜡烛的光辉。相反,这样能使所有东西都变得更亮。

但是,在美国以及世界大部分地区,药品价格依然高得离谱,知识的传播则受到了严格的制约。这是因为我们所创造的专利制度给了创新者对其所创之物的暂时垄断权,这促使创新者对知识敝帚自珍,唯恐助了竞争者一臂之力。

这一制度使得创新有利可图,从而确实为某些类型的研究提供了激励;但制药公司也因此得以坐地起价,它们获得的激励与社会回报不一定相容。在卫生领域,致力于研究“仿造”药可能比开发一种另辟蹊径的疗法更加有利可图。专利制度甚至可能对创新起到反作用,因为研究的最重要输入变量是领先的思想,而专利制度却在鼓励彼此保密。

要价高企和研究方向偏差问题的解决之道是用政府奖励基金代替现有模式。在奖励制度下,创新者将因新知识而受到奖赏,但不再获得新知识使用的垄断权。这样一来,竞争性市场的力量将能保证只要药品被开发出来,就能以尽可能低的价格(而不是大大膨胀的垄断价)为患者所获。

幸运的是,一些美国立法者已对这一方法产生了浓厚兴趣。参议员桑德斯(Bernie Sanders)提出、并获得国会通过的艾滋病奖励基金法(Prize Fund for HIV/AIDS Act)只是一个开始。桑德斯的法案包括了一个旨在鼓励开源研究的重要部分,将促使现有研究模式从保密转向共享。

但是,从全球角度看,我们的创新制度还需要做出大得多的变化。世界卫生组织旨在促进国际层面的广泛改革的努力非常关键。今年春天,世界卫生组织公布了一份报告,其中提出了一项类似于桑德斯法案的解决之道——只不过世卫组织的方案是全球水平的。

有一点很重要,这份题为《用研发满足发展中国家的卫生需要》(“Research and Development to Meet Health Needs in Developing Countries)给出了一个完整的方法,包括来自政府的指令性发展中国家卫生研究资金分配;优先卫生项目和实施的国际合作;以及监测最紧迫需求的全球观察组。5月底,国际社会将由机会在世界卫生组织大会上开始实施这些想法,这将是世界公共卫生的希望时刻。

改革创新制度并不仅仅是一个经济问题。在很多情况下,它是个事关生死的大问题。因此,将研发激励与药品价格脱钩、鼓励更多的科学知识分享至关重要。

对美国来说,桑德斯法案是一次重大进步。对全世界来说,世卫组织的建议可谓修正长期存在的卫生不平等性恶疾的千载难逢的良机(从更广的角度讲,也是设立与全球化时代相适应的全球公共品治理新模式的良机)。我们决不能坐视这个机会从手中白白溜走。

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  1. CommentedDavid Joseph Deutch

    If only the Congress and the Senate had more members willing to do what is truly right for people, rather than bickering and blocking.

  2. CommentedMarianne Doczi

    I think this is a very pragmatic and achievable approach to incentivising R&D to create the necessary drugs. It also enables the benefits of open innovation to be applied, namely that experts from diverse disciplines will provide suggestions/solutions. It will also encourage more collaboration. It frees up experts from their institutional settings to set up syndicates to apply their knowledge.

  3. CommentedNatalia Ciausova

    I wonder whether the governments of developing countries are expected to contribute to the reseacrh of their countries' health needs? Or, as usual, they are expected to wait till others (so called "developed") come and solve their problems. It never worked before and it never will.
    The division into "developed" and "developing" is outdated and should be replaced with a "collective global responsibility".

  4. CommentedZsolt Hermann

    As any other aspect of the global crisis, like politics, economics, financial institutions or education, global health inequalities are also simply symptoms of the main disease: our inherent selfish, greedy nature.
    Trying to pick the problems one by one, attempting to solve them individually will only deepen the problem, as we can see for example how people try to solve the Eurozone crisis simply concentrating of finances, causing even deeper crisis with every move, because they refuse to explore the true underlying cause.
    Humanity's only chance of solving all of our interconnected crisis situations (since as an example to the health problems of the developing world we could add all the human induced health problems of the developed world resulting from our excessive, unhealthy lifestyle) is to adjust human nature and attitude, to change ourselves from 100% subjective, self calculating individuals to 100% mutually responsible, considerate global citizens.
    And while obviously we could wonder where we could take the motivation for such a fundamental change the deepening crisis, and real existential questions for the whole species can be forceful enough to at least raise questions about our present direction, and if we also take into consideration the numerous, objective, scientific publications describing our global, integral human network of the 21st century, and how we could turn our present crisis into a fruitful cooperation using our interconnections in a positive way, we have both negative and positive reasons to initiate the change.

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