Patents and the Health Sector: IP strategies that might help alleviate the Global Health Crisis in the Colombian Context

Hello, everyone: 

One of the questions of my final exam y the Patent X Course, was to reccomend IP strategies that might help alleviate the Global Health Crisis in my country (Colombia). For providing a context, the strategies studied in this course included the following: 

1) Improve the procedures in low and middle-income countries [LMICs] for processing applications for marketing authorization;

2) Deploy better systems for detecting and eliminating substandard and falsified medical products [SFMPs];

3) Enable and encourage pharmaceutical firms to employ both international and intra-national differential pricing more often;

4) Facilitate increased use of voluntary licenses;

5) Employ apprenticeship, procurement policies, and limits on clinical trials to increase local production of vaccines and medicines in LMICs;

6) Impose compulsory licenses on the patents pertaining to crucial medical products;

7) Tighten the inventive-step and enablement requirements of patent law in LMICs;

8) Avoid or repeal extensions of the duration of patents on pharmaceutical products;

9) Advise judges in LMICs to minimize the use of injunctions in patent-infringement suits involving pharmaceutical products;

10) Extend the duration of patent protection and/or data-exclusivity protection in upper-income countries [UICs] for (a) vaccines; (b) neglected diseases; and (c) breakthrough drugs of all sorts;

11) Adjust the doctrines of claim construction, equivalents, and remedies in the patent laws of UICs to augment incentives to produce (a) vaccines; (b) neglected diseases; and (c) breakthrough drugs of all sorts;

12) Increase the use of governmental and philanthropic grants to support research and development for vaccines and medicines pertaining to neglected diseases;

13) Impose stricter conditions upon governmental and philanthropic grants of all sorts to increase the availability of their fruits in LMICs;

14) Increase the use of governmental and philanthropic prizes to support research and development for vaccines and medicines pertaining to neglected diseases;

15) Require pharmaceutical firms to achieve each year a social-responsibility index.

Which of them I consider more promising? My response for the Colombian case (that I want to shere with all of you) was as follows: 

One of the lessons learned from the COVID-19 crisis, is that our country needs to recover its ability to produce vaccines. For more than a century, Colombia was an avid vaccine producer and exporter (yellow fever, cholera, rabies, diphtheria, tetanus, whooping cough, typhoid fever and tuberculosis), but as a result of several factors (the economic crisis of 1990s, deterioration of the labs belonging to the National Institute of Health – INS) it stopped production in 2002 (of yellow fever vaccines) (Asociación Nacional de Industriales - ANDI, 2021).

Only as of 2022, the Ministry of Health, the Ministry of Science, Technology & Innovation, in alliance with local authorities of Bogotá and Antioquia, and the private sector (the Colombian Sura Group, and the Chinese pharmaceutical giant Sinovac), started preparations to operate their plants of production by 2027, in order to become self-sufficient (Canal Capital, 2023). Intended for producing vaccines against COVID-19, chickenpox and hepatitis A (BogotáBio, the first lab, located in the capital city) (Canal Capital, 2023), and COVID-19, dengue fever, chikunguña, yellow fever, influenza and Sika (in VaxThera, another plant based on Rionegro, Antioquia) (Portafolio, 2023).

On the other side, the Colombian pharmaceutical sector faces a challenging year 2024, characterized by the uncertainty about the future of the Social Security System in Health, the need to strengthen regulatory institutions, and the search of solutions for drug shortages. All of it in a rising inflation scenario, with effect on prices and production costs (Cambio, 2024). Nevertheless, as of June 2023, the installed capacity rose to 35%, thanks to Good Manufacturing Practices and the interest to install new plants for producing vaccines and other strategic drugs and biological substances (Rodríguez, 2023).

Our National Pharma sector is composed of almost 1200 companies, affiliated to three Associations (ANDI, AFIDRO and ASINFAR). With a balance of Imports and Exports (year 2022) of US$3.951 million and US$418 million respectively (with exports to Ecuador, 28.7%; Perú, 11.3%; Panama, 9.3%; and Chile, 6.9%), the combined growth of the sector was 7.6% between 2014 and 2018 (Moreno Mattar, 2024), and of 2.25% in 2023 (Solano Betancourt, 2023).

Our National Health System (which has almost universal coverage of 51.7 million of affiliates, 98.46% of the population), functions as a managed free competition model of two regimes (contributory, with 23 million of users, for affiliated with formal employment or self-employed; and subsidized, for the rest of population, 26.5 million), financed by the ADRES as the public administrator of resources (originating from taxes and subsidies), managed by the EPS, and operated by a web of (public and private) Health Providers of Service (IPS), being possible to use a private Health Insurance, without resign to the affiliation to an EPS (Cueto, 2024).

The system faces serious difficulties of financial sustainability, with the pressure of an increased demand, the need to remove entry barriers for users and to guarantee access to health as a fundamental right, and difficulty on access to new technology with heavy costs (Restrepo Zea, 2024).

Since October 2022, we are experiencing drug shortages in more than 1200 active principles like acetaminophen, amoxicillin, calcium and dexamethasone, caused by the increase of the demand for health prevention against COVID-19; rising conversion rate, collapse of supply chains and increase in the cost of supplies (90% of active principles and excipients are imported); and delays on administrative approval procedures by the National Institute of Vigilance on Food and Drugs – INVIMA, among others (Rodríguez, 2023).

Worst of all, as of today, the Colombian Health System is passing through a critical moment, with some Health Promoting Enterprises (EPS) considering their voluntary retirement or liquidation (Compensar EPS, with 2 million of affiliates), while others (Sanitas EPS and Nueva EPS, the last one with 10 million of affiliates) are facing imminent State interventions (Muñoz, 2024). These three actors comprise 18.7 million of users (37.5% of total affiliates) (Forbes, 2024). As of October 2023, the accumulated debt of EPS was of COP$11.3 billion, due to delays on payments to IPS and drug suppliers (Sánchez Romero, 2024), combined with a poor calculation of the Payment Unit of Capitation – UPC (a payment done by ADRES to the EPS per affiliate), the technological pressure, inflation, conversion rate, and an excessive rise of frequency of use by affiliates due to the ample coverage of the Health Benefit’s Plan (PBS), plus the aforementioned accrued debt (Ortiz Álvarez, 2024).

In such a difficult context, for recovering its sanitary sovereignty while fighting to avoid the collapse of the Health System, Colombia needs to work heavily on the following two strategies (Ministerio de Ciencia, Tecnología e Innovación - MinCiencias, 2022):

(a) To create an adequate infrastructure (vaccine production plants); and

(b) To train workers to fill/finish Pharma manufacturing (the integrated process, from sterilizing and filling vials with vaccines, biological and other pharmaceutical drug substances, to finishing the packaging process for distribution) (Chemtech International, 2022).

Accordingly, I recommend three strategies for their relevance in the current Colombian scenario:

(a) Improve the procedures for processing applications for marketing authorization. It is widely recognized that the filing process for the approval of Health Registration before the INVIMA is far much longer (Vanegas, 2023) than the 180 days laid down by law as of 2019 (Aguirre Vargas, 2019). Another strategy in that sense is to establish an indefinite duration of the Health Registration, in spite INVIMA’s power to revoke it in case of violation of the law or sanitary risk (Contreras Ríos, 2023).

(b) Enable and encourage pharmaceutical firms to employ both international and intra-national differential pricing more often; in order to reduce the gap between brand-name and generic drugs in the Colombian market, which during the period 2010 – 2015 was the second more expensive in Latin America, after Brazil (Álvarez & González, 2020), a situation that still exists as of today.

This is important, because the price difference between a brand-name drug and a generic one (with denomination of origin) is about 70%. The difference between the final price of an imported drug and an equivalent nationally produced is at least 8,1 to 1, making clear that strengthening local production of generic drugs with denomination of origin is a key strategy for generating more sanitary sovereignty, leveling trade balance and mitigating drug shortages (Rodriguez, 2023).

(c) Facilitate increased use of voluntary licenses. It is the logical proposal, considering the subjacent dependency of the Colombian market on imports, for drugs, active principles and other inputs for local production. So, in spite of being laid down by the Andean Decision 486, 2000, our Communitarian law (Amaya Rodríguez, 2021), to impose compulsory licenses on the patents pertaining to crucial medical products, authorizing either local production or importation of the products in question is not precisely a desired option, unless specific cases (Roa Ortiz, 2021).

This measure has been adopted in Colombia, only as of October 2023, over Dolutegravir, an HIV drug, whose current price is COP$4.818.894, against a potential price of COP$173.893 for the generic version (Ángel D. , 2023). Declaration of public interest (the legal motivation for the compulsory license) was recently alleged in two other cases: Kaletra (another HIV drug) and Glivek (a drug for treatment of leukemia and other types of blood cancer) (Ángel D. , 2023).

Finally, it’s interesting to point out that Colombia (whose IP legislation has adopted the statutory and case law of the Andean Community of Nations), in spite of adopting the general rule that direct infringement is demonstrated by a literal interpretation of the claims (peripheral claiming), has not excluded infringement by equivalence (a doctrine not expressly contemplated by the Andean Decision 486, 2000, but also not expressly excluded). In a recent case (Telemetrik vs. Excelec), the Andean Court set the first precedent with respect to the applicability of the doctrine of equivalents in the Andean Community (Rincón & Portilla, 2023).



Referencias

Aguirre Vargas, V. (12 de December de 2019). ¿Registro sanitario de medicamentos en 180 días? Asuntos Legales: https://www.asuntoslegales.com.co/analisis/viviana-aguirre-vargas-2943274/registro-sanitario-de-medicamentos-en-180-dias-2943273

Álvarez, R., & González, A. (April de 2020). Análisis comparativo de los precios de los medicamentos en América Latina. Revista de la CEPAL(130), 29 - 43. https://repositorio.cepal.org/server/api/core/bitstreams/0ecc4046-2e6a-4d68-b0c1-e2a9a2d043ee/content

Amaya Rodríguez, C. F. (June de 2021). El régimen de licencias obligatorias en la decisión 486 de 2000. Superintendencia de Industria y Comercio - SIC: https://www.sic.gov.co/ruta-pi/junio-2021/jurisprudencia/el-regimen-de-licencias-obligatorias-en-la-decision-486-de-2000

Ángel, D. (6 de October de 2023). Declaración de interés público y licencias obligatorias a medicamentos en Colombia y Latinoamérica. Consultorsalud: https://consultorsalud.com/licencias-obligatorias-medicamentos-colombia/

Ángel, D. (5 de October de 2023). Dolutegravir a licencia obligatoria, declara el Minsalud ¿Un parteaguas para las patentes en Colombia? Consultorsalud: https://consultorsalud.com/dolutegravir-a-licencia-obligatoria-minsalud/

Asociación Nacional de Industriales - ANDI. (1 de July de 2021). Cuando Colombia hacía vacunas. Asociación Nacional de Industriales - ANDI: https://www.andi.com.co/Home/Noticia/16011-cuando-colombia-hacia-vacunas

Cambio. (30 de January de 2024). ¿Qué le espera a la industria farmacéutica en 2024? Cambio: https://cambiocolombia.com/contenido-especial/que-le-espera-la-industria-farmaceutica-en-2024

Canal Capital. (6 de September de 2023). ¿Cuáles son los retos de producir vacunas en Bogotá? Canal Capital: https://www.canalcapital.gov.co/bogota-region/produccion-vacunas-bogota-retos

Canal Capital. (8 de September de 2023). Historia de la producción de vacunas en Colombia. Canal Capital: https://www.canalcapital.gov.co/ahora-vote/historia-la-produccion-vacunas-colombia#:~:text=El%20Ministerio%20de%20Salud%20anunci%C3%B3,a%20finales%20de%20este%20a%C3%B1o.

Chemtech International. (2 de February de 2022). Fill/Finish Pharma manufacturing explained. Chemtech International: https://chemtech-us.com/fill-finish-pharma-manufacturing-explained/

Contreras Ríos, J. P. (15 de Septiember de 2023). Medicamentos con registro Invima tendrán cambio en tiempos de vigencia: será indefinida. El Tiempo: https://www.eltiempo.com/salud/medicamentos-con-registro-invima-tendran-cambio-en-tiempos-de-vigencia-sera-indefinida-806589

Cueto, J. C. (5 de April de 2024). Cómo funciona el sistema de salud de Colombia que Petro no logra reformar (y cómo se diferencia de otros países de América Latina). BBC News: https://www.bbc.com/mundo/articles/cxrz3prg06wo

Forbes. (15 de April de 2024). Gobierno instalará mesas de trabajo con las EPS para buscar salida a crisis del sector salud. Forbes: https://forbes.co/2024/04/15/actualidad/gobierno-instalara-mesas-de-trabajo-con-las-eps-para-buscar-salida-a-crisis-del-sector-salud

Ministerio de Ciencia, Tecnología e Innovación - MinCiencias. (6 de April de 2022). Minciencias traza la hoja de ruta para la producción de Vacunas en Colombia. Ministerio de Ciencia, Tecnología e Innovación - MinCiencias: https://www.minciencias.gov.co/sala_de_prensa/minciencias-traza-la-hoja-ruta-para-la-produccion-vacunas-en-colombia

Moreno Mattar, O. (1 de March de 2024). Contexto para la inversión en el sector Farmacéutico en Colombia. NeuroEconomix: https://neuroeconomix.com/es/contexto-para-la-inversion-en-el-sector-farmaceutico-en-colombia/

Muñoz, C. F. (5 de April de 2024). El futuro del aseguramiento y de las EPS en Colombia: colapso, emergencia y posibilidades en el horizonte del sistema de salud. Consultorsalud: https://consultorsalud.com/el-futuro-del-aseguramiento-y-de-las-eps-en-colombia-colapso-emergencia-y-posibilidades-en-el-horizonte-del-sistema-de-salud/

Ortiz Álvarez, D. V. (7 de April de 2024). Así es la crisis del sistema de salud de Colombia: ¿qué salidas sugieren los expertos? El Tiempo: https://www.eltiempo.com/salud/la-reforma-ideal-del-sistema-de-salud-3331095

Portafolio. (10 de April de 2023). Cuándo empezaría la producción de vacunas en primera fábrica del país. Portafolio: https://www.portafolio.co/negocios/empresas/fabrica-de-vacunas-en-colombia-cuando-empezaria-la-produccion-581206

Restrepo Zea, J. H. (25 de February de 2024). ¿Viene un colapso del sistema de salud? Razón Pública: https://razonpublica.com/viene-colapso-del-sistema-salud/

Rincón, A., & Portilla, E. (24 de November de 2023). Colombia: Why a Robust Patent System is Leading to Litigation Wins. IAM: https://www.iam-media.com/review/the-patent-litigation-review/2024/article/colombia-why-robust-patent-system-leading-litigation-wins

Roa Ortiz, C. C. (January - July de 2021). Utilidad de las licencias obligatorias para el acceso a los medicamentos: Lecciones de Suramérica y análisis del caso colombiano. Revista de la propiedad inmaterial(31), 65 - 112. https://revistas.uexternado.edu.co/index.php/propin/article/view/7269/10182

Rodríguez, D. P. (20 de Junio de 2023). El país aumentó su productividad en el sector farmacéutico a 35% de su capacidad. La República: https://www.larepublica.co/economia/el-pais-aumento-su-productividad-en-el-sector-farmaceutico-a-35-de-su-capacidad-3640294

Rodriguez, D. P. (24 de April de 2023). Estas son cuatro razones que explican el fenómeno de la escasez de medicamentos. La República: https://www.larepublica.co/economia/estas-son-cuatro-razones-que-explican-el-fenomeno-de-la-escasez-de-medicamentos-3598286

Sánchez Romero, J. (6 de April de 2024). Con la crisis de las EPS, el Gobierno quedaría responsable de más de la mitad de los afiliados a la salud en Colombia. Infobae: https://www.infobae.com/colombia/2024/04/06/con-la-crisis-de-las-eps-el-gobierno-quedaria-responsable-de-mas-de-la-mitad-de-los-afiliados-a-la-salud-en-colombia/

Solano Betancourt, J. (8 de May de 2023). El sector farmacéutico se expandirá más de 2% este año liderado por Tecnoquímicas. La República: https://www.larepublica.co/empresas/el-sector-farmaceutico-se-expandira-mas-de-2-este-ano-liderado-por-tecnoquimicas-3609969

Vanegas, G. (24 de April de 2023). Por primera vez, el Invima reconoce el represamiento de los trámites de medicamentos en medio de los problemas de escasez. El País: https://elpais.com/america-colombia/2023-04-24/por-primera-vez-el-invima-reconoce-el-represamiento-de-los-tramites-de-medicamentos-en-medio-de-los-problemas-de-escasez.html

 

 


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