Background
With the COVID-19 pandemic, globally, we now face unprecedented challenges to access essential medicines and other health commodities. Drug shortages, hoarding of medicines and supplies, and the circulation of falsified health products have already exacerbated this once in a century global health challenge [1].
Pre-COVID-19, it was already estimated that 2 billion people lacked regular access to essential medicines [2]. Improving this gap is a long-standing global public health priority, associated with achieving Universal Health Coverage, a target in the United Nations’ Sustainable Development Goals. Despite decades of donor funding and international programs, availability of essential medicines remains wanting. High prices, lack of coverage, poor purchasing and distribution, uncertain product quality, inappropriate prescribing, and corruption are but some of the reasons why availability is undermined, whether it be in the United States or Malawi [3].
In anticipation of vital products to treat and prevent COVID-19, policy decisions about how to secure equitable access and affordability of these products globally need to happen in earnest. Simple questions about who will get access when a COVID-19 vaccine is developed, the price, how it will be paid for, who manufactures and distributes it, and ensuring the integrity of these products is protected from fake or substandard versions need meaningful deliberation now. Hence, the international debate about access to medicines has to be accelerated given the real-world needs of millions currently afflicted by COVID-19 and countless others who will in the future.
In the past, the importance of securing access to medicines for global health challenges, such as HIV/AIDS and hepatitis C virus, has been made abundantly and painfully clear [4, 5]. The basic questions of who gets access to what therapy, how, and when have been the subject of fierce debate and advocacy. Overlaying these questions is the fact that travel bans, trade-related retaliation, abuse of intellectual property (IP) rights, and other forms of protectionism have and may further limit supplies of needed therapies [6]. In fact, many countries have already banned or significantly limited export of protective equipment, medical devices, or medicines related to COVID-19 [7].
As a consequence of legitimate supply chains being blocked, the risk of falsified and substandard medicines grows [1]. Evidencing this risk, the European Medicines Agency and the World Health Organization (WHO) have issued warnings about the increase of falsified medicines and testing kits claiming to prevent, detect, treat, or cure COVID-19 [8, 9]. This includes online frauds involving the sales of suspect and unapproved products on e-commerce platforms, social media, and illegal online pharmacies [1]. Yet, the risk of falsified medicines is not limited only to products that may treat COVID-19, but extends to other drugs where shortages will persist [7].