Publication: Pharmaceuticals in Latin America and the Caribbean: Players, Access, and Innovation Across Diverse Models
Loading...
Date
2022-01-03
ISSN
Published
2022-01-03
Author(s)
Editor(s)
Abstract
Pharmaceutical products have contributed to longer life expectancy and better quality of life in Latin America and the Caribbean. However, they often account for a significant share of household expenditures, especially among the poor and those facing catastrophic health shocks. And they are not always accessible, as dramatically exposed by the Covid-19 pandemic. This mixed record can be linked to the workings of the pharmaceutical sector, an issue that has not received much attention in policy discussions. This paper identifies the sector’s key domestic and foreign players, and analyzes its local output, international trade, and price levels. It also documents government policies, including intellectual property rights, regulatory oversight, and public procurement. An important contribution of the paper is to show the significant scientific capacity of the region, especially in relation to biological products - including vaccines - whose intrinsic heterogeneity challenges intellectual property rights protection. Based on this diagnosis, the paper flags three sets of issues for policy makers to consider. Relatively uncontroversial measures include strengthening regulatory authorities, promoting the use of generics, and upgrading public procurement. Other areas, such as supporting R and D and regulating prices, involve tradeoffs. Finally, there are strategic choices to be made, with some countries in the region favoring stringent intellectual property rights, while others support national champions or rely on state entrepreneurship.
Link to Data Set
Citation
“Vargas, Veronica; Rama, Martin; Singh, Rucheta. 2022. Pharmaceuticals in Latin America and the Caribbean: Players, Access, and Innovation Across Diverse Models. © World Bank. http://hdl.handle.net/10986/36871 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Exploratory Study on Active Pharmaceutical Ingredient Manufacturing for Essential Medicines(World Bank, Washington, DC, 2009-09)Active Pharmaceutical Ingredients (API) of good quality is core to the manufacturing of effective and safe essential drugs. The price of APIs is the main cost driver for manufacturing. Only a limited number of large manufacturers of finished pharmaceutical products have their own API manufacturing capabilities, and none of them can make all required APIs in-house. The majority of manufacturers, including all those located in Sub-Saharan Africa (with the exception of one company in South Africa) have to buy all APIs in the open market. The paper tries to make the structures of the API market more transparent, trying to determine how difficult it is for small manufacturers in developing countries to navigate the global API market and ensure that they get a quality product at a fair price. It also looks into the competitiveness of the market, trying to assess the risk that manufacturers or traders monopolize parts of the API market for essential medicines with low commercial attractiveness. The author confirms the initial assumption that the API market provides a challenge in particular to small manufacturers, who have limited means to verify the quality of the APIs they are buying. One potential way to address this problem would be to broaden the World Health Organization (WHO) prequalification system to include APIs for drugs that are on the WHO model list for essential medicines.Publication Pharmaceutical Patents and Prices : A Preliminary Empirical Assessment Using Data from India(World Bank, Washington, DC, 2012-05)The enforcement of stringent intellectual property rights in the pharmaceutical sector of developing countries generates considerable controversy, due to both the extensive research investment and the public policy importance of this sector. This paper explores the likely effects of enforcing product patents on prices and utilization of drugs in the Central Nervous System market in India. The Central Nervous System segment is the second largest therapeutic category in terms of retail sales in the world and is one of the fastest growing segments in India. Using information on product patents granted by the government and panel data on pharmaceutical prices and utilization from 2003-2008, the paper finds limited evidence of overall price increase following the introduction of product patents. However, there appear to be heterogeneous effects on prices by the type of product patent granted on drugs, implying the need for a careful examination of the product patent portfolio.Publication Information and Communication Technologies at the Service of the Rural Poor of Latin America and the Caribbean(World Bank, Washington, DC, 2005-11)This study reviews recent experience applying ICTs in the fight against rural poverty and identifies ways in which donor interventions can make effective use of ICTs to improve the living conditions of rural communities in Latin America and the Caribbean and help reduce poverty.Publication Assessment of Governance and Corruption in the Pharmaceutical Sector : Lessons Learned from Low and Middle Income Countries(World Bank, Washington, DC, 2010-01)Pharmaceuticals are a critical input for the health sector. At the same time, the drug business sustains many individual and corporate livelihoods and produces handsome returns for those involved in the trade. Good governance is critical for the sector to maximize returns for public health and minimize risks for patients from ineffective or contaminated drugs. Given the large financial volume of the market, the potential for corruption is significant. Vulnerable points are those at which decisions about market access and purchasing are made. This includes institutional functions such as licensing, inclusion into formularies and public procurement as well as the individual prescriber, who selects drugs for a specific patient. Given the political and institutional resistance against more transparency from the beneficiaries of the status quo, assessment of governance and corruption in the sector is not a straightforward exercise. The authors developed a more indirect approach that relies on a broader assessment of the functioning of the sector and detection of patterns that suggest governance or management problems. From a developmental perspective, the focus is on reducing the impact of bad governance (high drug prices, stock-outs, bad quality of drugs in circulation, irrational use of drugs) rather than identifying the actors and bringing them to justice. Even if the governance level cannot be touched due to political resistance, it may be possible to address the problem from a technical or management angle. For example, electronic procurement platforms and inventory management systems make manipulation more difficult and allow for a faster discovery of irregularities. The assessment framework was applied in eight countries, with adjustments based on client demand and political viability. In most cases, a follow-up after the assessment could be documented, showing that the data provided had relevance and impact in the national policy dialogue. Three of the eight countries signed up to a longer term program to increase transparency in the sector (medicines transparency alliance), others initiated specific projects to address issues that were presented as a result of the initial assessment. In summary, the authors work could demonstrate that it is possible to effectively address pharmaceutical governance issues in the context of a broader sector assessment an approach that may face less political resistance than an inquiry based on a "governance and corruption" labeled instrument.Publication Secondary School Madrasas in Bangladesh : Incidence, Quality, and Implications for Reform(Washington, DC, 2010-03)This report presents findings from the first ever comprehensive survey to document the incidence and quality of secondary madrasas in Bangladesh. Analysis also draws upon other publicly available administrative and household level datasets. Currently the authors have very little information on school quality in general due to no national learning assessment system and because schools from different streams are tested under different Boards. Thus it is always important to examine the quality of aided madrasas relative to aided secular schools. The report highlights new challenges: while gender equality in access has been achieved in both schools and madrasas, girls remain systematically disadvantaged in terms of learning outcomes. The female learning penalty remain is particularly pronounced in case of madrasas. Overall, the quality of mathematics and English learning is low in madrasas, but performance of students of mainstream schools is also unsatisfactory average quality remains poor across the range of rural institutions. Overall, this report represents an empirically grounded investigation into the hitherto undocumented changes Bangladesh has witnessed in the secondary madrasa school sector in the past two decades. Based on their analysis, the authors suggest a range of policy initiatives that cover the entire secondary education sector, not just the madarasa education. Given the wealth of data collected on secondary institutions and households during the survey, this report only represents the first of a series of rigorous empirical research and analysis which will be undertaken. It is hoped that the report will provide an impetus towards an evidence-based policy debate on madrasas and other critical issues in the education sector.
Users also downloaded
Showing related downloaded files
Publication World Development Report 2017(Washington, DC: World Bank, 2017-01-30)Why are carefully designed, sensible policies too often not adopted or implemented? When they are, why do they often fail to generate development outcomes such as security, growth, and equity? And why do some bad policies endure? This book addresses these fundamental questions, which are at the heart of development. Policy making and policy implementation do not occur in a vacuum. Rather, they take place in complex political and social settings, in which individuals and groups with unequal power interact within changing rules as they pursue conflicting interests. The process of these interactions is what this Report calls governance, and the space in which these interactions take place, the policy arena. The capacity of actors to commit and their willingness to cooperate and coordinate to achieve socially desirable goals are what matter for effectiveness. However, who bargains, who is excluded, and what barriers block entry to the policy arena determine the selection and implementation of policies and, consequently, their impact on development outcomes. Exclusion, capture, and clientelism are manifestations of power asymmetries that lead to failures to achieve security, growth, and equity. The distribution of power in society is partly determined by history. Yet, there is room for positive change. This Report reveals that governance can mitigate, even overcome, power asymmetries to bring about more effective policy interventions that achieve sustainable improvements in security, growth, and equity. This happens by shifting the incentives of those with power, reshaping their preferences in favor of good outcomes, and taking into account the interests of previously excluded participants. These changes can come about through bargains among elites and greater citizen engagement, as well as by international actors supporting rules that strengthen coalitions for reform.Publication World Development Report 2018(Washington, DC: World Bank, 2018)Every year, the World Bank's World Development Report takes on a topic of central importance to global development. The 2018 Report, Learning to Realize Education's Promise, is the first ever devoted entirely to education. Now is an excellent time for it: education has long been critical for human welfare, but is even more so in a time of rapid economic change. The Report explores four main themes. First, education's promise: Education is a powerful instrument for eradicating poverty and promoting shared prosperity, but fulfilling its potential requires better policies - both within and outside the education system. Second, the learning crisis: Despite gains in education access, recent learning assessments show that many young people around the world, especially from poor families, are leaving school unequipped with even the most foundational skills they need for life. At the same time, internationally comparable learning assessments show that skills in many middle-income countries lag far behind what those countries aspire to. Third, promising interventions to improve learning: Research from areas such as brain science, pedagogical innovations, or school management have identified interventions that promote learning by ensuring that learners are prepared, that teachers are skilled as well as motivated, and that other inputs support the teacher-learner relationship. Fourth, learning at scale: Achieving learning throughout an education system will require more than just scaling up effective interventions. Change requires overcoming technical and political barriers by deploying salient metrics for mobilizing actors and tracking progress, building coalitions for learning, and being adaptive when implementing programs.Publication Digital Progress and Trends Report 2023(Washington, DC: World Bank, 2024-03-05)Digitalization is the transformational opportunity of our time. The digital sector has become a powerhouse of innovation, economic growth, and job creation. Value added in the IT services sector grew at 8 percent annually during 2000–22, nearly twice as fast as the global economy. Employment growth in IT services reached 7 percent annually, six times higher than total employment growth. The diffusion and adoption of digital technologies are just as critical as their invention. Digital uptake has accelerated since the COVID-19 pandemic, with 1.5 billion new internet users added from 2018 to 2022. The share of firms investing in digital solutions around the world has more than doubled from 2020 to 2022. Low-income countries, vulnerable populations, and small firms, however, have been falling behind, while transformative digital innovations such as artificial intelligence (AI) have been accelerating in higher-income countries. Although more than 90 percent of the population in high-income countries was online in 2022, only one in four people in low-income countries used the internet, and the speed of their connection was typically only a small fraction of that in wealthier countries. As businesses in technologically advanced countries integrate generative AI into their products and services, less than half of the businesses in many low- and middle-income countries have an internet connection. The growing digital divide is exacerbating the poverty and productivity gaps between richer and poorer economies. The Digital Progress and Trends Report series will track global digitalization progress and highlight policy trends, debates, and implications for low- and middle-income countries. The series adds to the global efforts to study the progress and trends of digitalization in two main ways: · By compiling, curating, and analyzing data from diverse sources to present a comprehensive picture of digitalization in low- and middle-income countries, including in-depth analyses on understudied topics. · By developing insights on policy opportunities, challenges, and debates and reflecting the perspectives of various stakeholders and the World Bank’s operational experiences. This report, the first in the series, aims to inform evidence-based policy making and motivate action among internal and external audiences and stakeholders. The report will bring global attention to high-performing countries that have valuable experience to share as well as to areas where efforts will need to be redoubled.Publication The Role of Desalination in an Increasingly Water-Scarce World(World Bank, Washington, DC, 2019-03)The cost of desalination has been plummeting over the years. As a result, desalination has become a viable option for certain strategic uses. Today, over 20,000 desalination plants in more than 150 countries supply about 300 million people with freshwater every day. Initially a niche product for energy rich and water scarce cities, particularly in the Middle East, the continued decrease in cost and environmental viability of desalination has the potential to significantly expand its use - particularly for rapidly growing water scarce coastal cities. Desalination can be seen as one option in a portfolio water supply sources, including traditional surface water and groundwater sources as well as wastewater reuse, to meet growing water demand gap. Although still relatively expensive, desalination offers the potential to enhance system reliability. As renewable sources of energy such as wind and solar expand, and as advances in concentrate management techniques make discharges from desalination plants much cheaper and safer, the prospect of producing freshwater from the sea without increasing greenhouse gases and without significant damages to the local environment become more promising.Publication Global Economic Prospects, January 2024(Washington, DC: World Bank, 2024-01-09)Note: Chart 1.2.B has been updated on January 18, 2024. Chart 2.2.3 B has been updated on January 14, 2024. Global growth is expected to slow further this year, reflecting the lagged and ongoing effects of tight monetary policy to rein in inflation, restrictive credit conditions, and anemic global trade and investment. Downside risks include an escalation of the recent conflict in the Middle East, financial stress, persistent inflation, weaker-than-expected activity in China, trade fragmentation, and climate-related disasters. Against this backdrop, policy makers face enormous challenges. In emerging market and developing economies (EMDEs), commodity exporters face the enduring challenges posed by fiscal policy procyclicality and volatility, which highlight the need for robust fiscal frameworks. Across EMDEs, previous episodes of investment growth acceleration underscore the critical importance of macroeconomic and structural policies and an enabling institutional environment in bolstering investment and long-term growth. At the global level, cooperation needs to be strengthened to provide debt relief, facilitate trade integration, tackle climate change, and alleviate food insecurity.