Obviously, this majority is mainly in developing countries. Chart 3 shows the contrast between per capita spending on drugs in several developed and developing countries. Thus Japan shows per capita spending which is several hundred times that of India or Bangladesh.

Chart 3 >> Click to Enlarge
 
This inequality helps to understand why research and development for diseases found in developing countries is not only insufficient, but has almost disappeared since the 1970s. Between 1975 and 1997, out of 1,223 new chemical entities, only 13 (1%) were for the treatment of tropical diseases. And of these, only 4 were the result of R&D activities of the pharmaceutical industry. This is despite the fact that infectious diseases currently kill 11 million people annually in developing countries, and half of those killed are children.
 
The importance of purchasing power in affecting not just the development of a drug but even its continued production is dramatically illustrated in the case of eflornithine (Ornidyl) which is a drug to treat sleeping sickness. This disease, which is transmitted by the tsetse fly, is currently estimated to kill 150,000 people every year, mainly in Africa. The treatment was developed by the American firm Merell Dow in 1985, but the price was so high that it was beyond the reach of those most seriously affected. Therefore the production of the drug was subsequently abandoned.
 
The new post-merger owner of the drug, Aventis, finally agreed to transfer marketing rights to the World Health Organisation (WHO). But the WHO lacks the resources to manufacture it, and sponsors are still being sought to finance the production of this drug. By contrast, the fastest growing segments of world drug production are non-essential drugs such as Viagra and anti-depressants.
 
One of the problems with the current international regime is that it discourages national policies that are designed to regulate drug prices and drug access. Yet it is now clear that the presence of successful national drug policies was a major factor in lowering drug prices. This becomes even more clear when such policies are changed. Thus, the enforced deregulation of domestic drug sectors in Latin America led to a substantial increase in drug prices in Mexico and Brazil in only 4 years, as Chart 4 shows.

Chart 4 >> Click to Enlarge
 
The difficulty of ensuring even a minimum degree of democratic to life-saving drugs is compounded by the high degree of concentration in the international drug industry. Table 1 describes the situation in 1998, when the top ten companies controlled 36 per cent of the market and the top twenty companies controlled 57 per cent of world sales. Since then there have been more mega-mergers which have made the industry even more concentrated. Thus, Glaxo Wellcome has merged with SmithKline Beecham, Pfizer merged with Warner Lambert, and the companies Hoechst-Marion, Merrell and Rhone-Poulenc merged to form Aventis.

Table 1 >> Click to Enlarge