HEALTHCARE INEQUITY IN CANADA: EXAMINING THE FEASIBILITY OF THE PUBLIC PRODUCTION OF MEDICINES

Background: As the global pharmaceutical industry continues to generate significant wealth, the demand for equitable access to medicine remains at the forefront of political and grassroots agendas. In recent years, poor drug coverage coupled with unaffordable drug prices have contributed to access issues for a growing number of Canadians (Morgan et al, 2015). Although the industry cites various reasons for an increase in cost, such as high-risk research, lengthy clinical trials and significant advances in technology (DiMasi et al., 2016; Ridley, 2005), there is a growing body of research that is contradictory to the industry’s reasoning for higher drug costs (Kohler et al., 2016; Siddiqui & Rajkumar, 2012; Light & Warburton, 2011). Whereas other initiatives to date focus on drug coverage, this work proposes the Canadian Government investigate the feasibility of the public production and distribution of pharmaceuticals. Thus, the research question addresses whether successful publicly funded pharmaceutical research and development initiatives, including production and distribution, could be applicable in the Canadian pharmaceutical sector where inequity is an issue. A scoping review was conducted to draw in all relevant literature on publicly funded research models pertaining to the research and development of pharmaceuticals. Methods: The research undertaken for this thesis is exploratory and comprised of qualitative work that is guided by the Arksey & O’Malley (2005) scoping review methodological framework. The data collected for the scoping review was analyzed with the thematic analysis method. Findings: Following the thematic analysis, three key themes were identified: Local Production, Public Private Sector and National Production. Although there have been some successes in low to middle income countries with regard to the local production of medicine, the likelihood of success is contingent on whether there is a need to import active pharmaceutical ingredients (API). With regard to the public and private sector, the pre-competitive sphere serves as the typical space for collaboration. The public sector typically conducts research, whereas the private sector oversees drug development. The national production of medicine is underpinned by government intervention, which is evidenced by the varied measures taken to increase access to medicine. The preliminary literature review revealed that an Advisory Council was created to assess the viability of Pharmacare 2020. This council may be used to conduct the necessary research to assess the feasibility and strategy of publicly producing pharmaceuticals in Canada. Conclusions: Healthcare inequity that is linked to unaffordable medicine is exacerbated by poor drug coverage. The findings revealed that considerable investment into infrastructure, a strong civil society that pressures the government to act, and a pharmaceutical sector characterized by high prices may encourage a government to produce medicine when faced with a health crisis. Further findings revealed that API production may prevent a country from feasibly producing medicine. Considering Canada’s standing as an industrialized and developed nation with access to state-of-the-art public infrastructure, in addition to a pharmaceutical market characterized by high drug prices and a strong civil society sector, the Canadian Government is in a likely position to produce medicine. However, the necessary research must be conducted to assess whether such an endeavour is feasible.

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