In this latest article, Rachel Payne profiles early-stage efforts by Binghamton University’s Nicole Hassoun to put public pressure on pharmaceutical firms to do more for people living in poverty. Read more of our Impact Interviews.
Nicole Hassoun, Associate Professor of Philosophy at the University of Binghamton, is leading an ASAP-supported initiative to harness the power of socially conscious consumers to motivate pharmaceutical companies to meet the health needs of people in poverty. She has recently created an index that ranks drug companies according to their positive impact on global health. By informing consumers of which companies are making a difference and which are not, she hopes to stimulate demand for products linked to global health impact.
Hassoun’s Global Health Impact index ranks pharmaceutical companies by estimating the collective health impact of their malaria, TB, and HIV/AIDS drugs and comparing it with that of other companies. In Hassoun’s model, a drug’s health impact is equal to need * access * efficacy—that is, the global amount of death and disability resulting from the disease the drug treats (need), the proportion of people who receive the drug out of those who need it (access), and the estimated effectiveness of the drug (efficacy).
The index is constructed so that companies have an incentive to invest in the development of medicines for neglected diseases and ensure that there is widespread access to and proper use of their products. Those companies with the best ranking would be entitled to display a Global Health Impact label, which would appear on all of their products—“everything from vitamins to cold medicine,” in Hassoun’s words. Like the Fair Trade label, the Global Health Impact label is intended to draw consumers towards more socially responsible companies.
Globally, one third of all deaths—18 million a year—are linked to poverty. People living in poverty often lack access to medicines both because they cannot afford them and because pharmaceutical companies lack adequate financial incentives to develop treatments for diseases that primarily affect poor people. Hassoun hopes that the Global Health Impact label will create a serious financial incentive for companies to make their products available to people in poverty and to invest in the development of new treatments for neglected diseases. She writes that if products with the Global Health Impact label capture just one percent of the market for generic and over-the-counter medicines, then there will be a $360 million incentive for companies to achieve Global Health Impact certification.
There are a number of other proposals for how to improve access to medicine for poor people, including grants to pharmaceutical companies to develop treatments for neglected diseases, funding to deliver medicines to poor people at reduced prizes, and Thomas Pogge’s Health Impact Fund. The proposal that comes closest to Hassoun’s is the Access to Medicines Index, an initiative funded by the Bill and Melinda Gates Foundation and the governments of the UK and Netherlands, which ranks pharmaceutical companies on the basis of their efforts to improve access to medicines. This index takes into account a variety of activities carried out by pharmaceutical companies, including research and development, lobbying, patents and licensing, pricing, donations, public policy and market influence, and capacity building for product distribution.
Hassoun says that she is encouraged by the success of the Access to Medicines Index and adds that her own model has distinctive benefits. She argues that by focusing on the actual impact of pharmaceutical companies’ key innovations on the global burden of disease, using the best data available, her index gives a rigorous assessment of the extent to which companies’ drugs are improving the health of poor people.
Possible next steps for Hassoun’s project include a sensitivity analysis of the index and a pilot of the Global Health Impact label in grocery stores. In the pilot, Hassoun would measure the effect of the label on sales.
Hassoun put forward the idea of the Global Health Impact index in her 2012 paper, “Global Health Impact: A Basis for Labeling and Licensing Campaigns?”, which appeared in the journal Developing World Bioethics. In an article for the Council on Foreign Relations, Hassoun described the Global Health Impact project as presenting a middle path between condemnation of globalization on account of new global rules and institutions that, like the TRIPS Agreement, perpetuate poverty, and uncritical acceptance of globalized trade. Hassoun writes: “there are many coercive international institutions, like the International Monetary Fund and World Trade Organization, that should be doing much more to help people avoid severe poverty, which requires changing many international policies. But there is also a role for individual consumers and companies to play in improving people’s lives.”
Hassoun says that she was motivated to take on the project of ranking pharmaceutical companies because believes philosophers are in a position to contribute to the debate on measuring health impact, by virtue of their training in logic and critical analysis. When she first came up with the idea for the index, she imagined that someone else would carry out the project and presented the proposal to graduate students studying health policy, hoping that one of them would take it on. However, she says she quickly discovered that these students tended to have their own ideas for improving health access and that if she was to see the project executed in the way she wanted, then she would have to do it herself.
Asked about the challenges of carrying out an impact-focused project as an academic, she said that she had been surprised by how much work it has taken to realize her plan for the index. Nevertheless, she says she hopes more students and young academics will attempt to put the ideas they write about into practice. Asked to give a piece of advice for people at the beginning of their academic careers, she suggested asking a lot of questions. Unless you make a point of learning from people working in the field that interests you, she warned, it’s easy to wind up far from the work that you had hoped to do.