This is a debate between Hubbard and Love on the one hand and Hollis and Pogge on the other. Hubbard and Love support a mandatory system, while Hollis and Pogge propose a voluntary one.
The following table represents the arguments made by these parties about each option:
| Advantages | Disadvantages | |
|---|---|---|
| Non-voluntary | Likely to gain more support from consumers of medicines1 | Politically unattractive to innovators2 Requires full overhaul of the system3 |
| Voluntary | Inbuilt adjustment mechanism for payment levels4 Firms will focus on high-impact low-profitability drugs5 Only needs to be efficient in its own right to be successful, rather than a comprehensive solution6 It expands innovators’ ability to make money, and so is attractive to them7 |
More expensive as rewards need to be competitive with patents8 The problems of the patent system remain where innovators choose the patent system9 |
First of all, it is worth noting that of course the disadvantages of one system could be listed along with the advantages of the other, and vice versa. The table presents evaluations as they were made by the respective authors, without attempting to duplicate measures.
A number of particular observations can be made. For example, the claim that a voluntary system would have to compete with patents is only partially true. In the case of Type III drugs which currently have next to no market, a voluntary system would provide the only possible route, and so the reward levels under the patent system would be irrelevant. Another individual point is that of course, one could regard expanding innovators’ capacity to make money as a disadvantage, given the huge profits currently reaped by the pharmaceutical industry.
However, it seems that these detailed points are dominated by the current lack of evidence on the technical feasibility of a remuneration rights fund. Given this situation, it seems clear that a pilot is needed. It would seem unwise for such a pilot to be compulsory, given our evidential uncertainty about the practicability of either system. It also seems highly likely that an optional fund would be much more feasible to implement politically. Therefore, regardless of the ultimate theoretical benefits of voluntary or non-voluntary systems, for the purposes of this project, a non-voluntary system is the only feasible option.
Hollis, Aidan, and Thomas Pogge. The Health Impact Fund: Making New Medicines Accessible for All. Incentives for Global Health, 2008. http://healthimpactfund.org/wp-content/uploads/2015/12/hif_book.pdf.
Love, James, and Tim Hubbard. “The Big Idea: Prizes to Stimulate R&(and)D for New Medicines.” Chicago-Kent Law Review 82 (2007): 1519.
