Bitter Pills:Medicines & The Third World Poor | Page 35

RICH WORLD CONTROL
We have seen the extent to which the world distribution of drugs is skewed in
favour of the rich. There is a similar imbalance in drug production. About 70%
of world drug production (by value) corresponds to drugs manufactured in
Western industrialised countries. A further 19% of total production is located
in Eastern European and other centrally planned economies. As little as 11 % of
pharmaceutical production takes place in the Third World as a whole. (4>
The imbalance is even greater in the control of world trade in Pharmaceuticals.
The US, France, West Germany, Britain, Switzerland and other rich industrialised
nations dominate 90% of drug shipments. About two-thirds of these are controlled
by just 50 European and US-based transnational companies. (5)
Production has remained largely concentrated in the major industrialised countries
because some (but not all) stages in the manufacturing process require sophisticated
and costly technology. The image of monolithic difficulties in all areas of drug
production is false. It serves to reinforce the poor world's dependence on the rich.
No country can be entirely self-sufficient in drug production without a fine
chemicals industry to provide chemical intermediates which are the starting point
for producing most modern drugs. But a chemical industry is not essential.
Switzerland, one of the world's leading drug producing nations, does not produce
its own intermediates, but imports them for processing into bulk drugs. (6)
The technology needed to produce some bulk drugs from imported chemical
intermediates is relatively straightforward, with the necessary technical knowhow and resources. (7) But some bulk drugs production can be particularly
difficult. For example, the fermentation plants needed to produce antibiotics are
expensive and uneconomic without large-scale production. There are also varying
degrees of difficulty in the third stage of processing the bulk drugs into
formulations or finished dosage forms (i.e. the actual tablets). For example, it
is complicated to manufacture ampoules for injections because sterile conditions
are essential, but relatively simple to produce tablets and capsules. The final stage
of packaging or repackaging finished drugs is easy and requires minimal
equipment. This cost-saving processing is well within the technical capacity of
even the least developed countries. <8)
But most Third World countries either have no manufacturing facilities at all,
or local manufacture consists of little more than repacking and simple formulation
of some bulk drugs. Forty-five of the world's smallest and poorest nations are
totally dependent on imports of finished drugs. They are mostly in Africa which
accounts for only 0.5% of world production (compared with 5.61% of world
production in Asia and a further 5.26% in Latin America in 1977). (9)
In countries with local production, there is a wide variation in how much each
country continues to rely on imports of finished drugs. For example, Kenya and
Nigeria respectively import about 75% and 90% of finished drugs consumed
locally, whereas Bangladesh imports under 20% and Colombia only 5%. But all
these countries share a heavy dependence on foreign suppliers for large quantities
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