Access to medicines, market failure and market intervention: a tale of two regimes

This study explores how an 'Intellectual Property Rights (IPR)/trade regime' has generated a particular set of problems regarding access to medicines despite patents on drugs being presented as economically necessary for reward and future drug innovation. These problems have also inspired and informed activities by so-called new actors in global health. This study argues that a parallel 'pro-access regime' has developed in order to correct some of the most high-profile issues associated with a dysfunctional global pharmaceutical market, especially problems regarding price and innovation that have been exacerbated by stringent global patent rights on new drugs. Therefore, the IPR/trade regime's basic role in global-health governance diverges from how it has been framed and understood, not least of all by its constituent agents and donors. The pro-access regime encompasses new actors in health such as Global Health Partnerships (e.g., GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria), major philanthropic foundations (e.g., the Gates and Clinton Foundations) and new access initiatives (e.g., UNITAID). The study problematises these actors' governance roles with respect to the overarching authority of the IPR/trade regime and makes a case that the two regimes should be understood as being closely connected with respect to the governance of access to medicines and the global political economy of pharmaceuticals

Characterisation and modification of optoelectronic substrate surfaces for enhanced adhesive flow control

Optoelectronics manufacturers are under continuous pressure for miniaturisation of optoelectronic modules. One route to further miniaturisation is to reduce the spacing between the optical and optoelectronic components in the optical path adhesively mounted to ceramic carriers. Flow control of the adhesives over the ceramic surface is then imperative. Uncontrolled wetting can lead to an excessive adhesive footprint which interferes in the application of other adhesives for subsequent components. However, insufficient wetting can lead to low strength bonds vulnerable to thermal fatigue and shear failure. The goal of the work was to minimise the potential for uncontrolled wetting while maintaining unmodified bond properties. In addition positional stability of adhered parts on cure and in-service must not be detrimentally affected. [Continues.

The European Bank Recovery and Resolution Directive: A market assessment

This paper provides evidence of the impact of the new European bank resolution regime on the sovereign-bank nexus. The implementation of the Bank Recovery and Resolution Directive (BRRD) is considered as an exogenous shock which provides the setting for a natural experiment. This investigation tests the financial markets’ perception of the effectiveness of the new rules in weakening the tight interconnectedness between sovereign and bank risk. A Difference-in-Differences (DiD) approach is adopted, building evidence from the Credit Default Swap (CDS) market for banks and nonfinancial corporates over the period 2011-18. The main findings do not indicate a significant weakening in the interaction between bank and sovereign CDS spreads, compared to the corresponding evidence for the non-financial corporate sector. An overall narrowing of the gap between bank and sovereign risk occurs, which initially implies a lack of credibility of the BRRD in financial markets. However, substantial cross-country variations are identified, particularly for Italy and non-euro area countries. These insights make a significant contribution to the policy debate on effective regulation of the sovereign-bank nexus, in the light of recent developments in the EU postcrisis reform agenda

Temporary writers’ residence

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Market reactions to the implementation of the Banking Union in Europe

How did announcements about the implementation of the Banking Union (BU) in Europe impact on financial markets? This paper investigates the effect of the overall bank regulatory reform, considering each associated individual announcement, on Credit Default Swaps (CDS), bank stocks and stock futures during 2012-14. Announcements related to the implementation of the supervisory mechanism, as well as those on the new resolution framework, led to a surge in bank CDS spreads, while having a detrimental effect on the wealth of banks’ shareholders. The CDS market response to sub-events associated with the ECB’s 2014 Comprehensive Assessment (CA) was positive and reflected in a decrease in bank CDS spreads. Furthermore, CDS of Global Systemically Important Banks (G-SIBs) demonstrated a significant reaction to the implementation steps in the BU. Banks’ stock prices reacted in a consistent manner with the CDS market. The stock futures market did not reveal any strong reaction to the changes in the European regulatory landscape. Cross-sectional analysis reveals that bank capitalization is positively associated with responses of G-SIBs’ CDS spreads, but is inversely related to responses of CDS spreads for other bank groups. Weak underlying credit quality is also a relevant factor in explaining abnormal increases in quoted CDS spreads. For the stock market, positive associations of the cumulative abnormal returns (CARs) with capital levels and with the business model orientation are revealed

New life in old frames: HIV, development and the ‘AIDS plus MDGs’ approach

There have been recent indications that the primacy of AIDS among global health issues may be under threat. In this article we examine one response to have emerged from the AIDS policy community as a result of this perceived threat: the 'AIDS plus Millennium Development Goals (MDGs)' approach, which argues that the AIDS response (the focus of MDG6) is essential to achieving the other MDG targets by 2015, stressing the two-way relationship between AIDS and other development issues. By framing AIDS in this way, the AIDS plus MDGs approach draws on an established narrative of a 'virtuous circle' between health and development, but at the same time makes some important concessions to critics of the AIDS response. This article - the first critical academic analysis of the AIDS plus MDGs approach - uses this case to illuminate aspects of the utilisation of framing in global health, shedding light both on the extent to which new framings draw upon established 'common sense' narratives as well as the ways in which framers must adapt to the changing material and ideational context in which they operate

Could international compulsory licensing reconcile tiered pricing of pharmaceuticals with the right to health?

BACKGROUND: The heads of the Global Fund and the GAVI Alliance have recently promoted the idea of an international tiered pricing framework for medicines, despite objections from civil society groups who fear that this would reduce the leeway for compulsory licenses and generic competition. This paper explores the extent to which an international tiered pricing framework and the present leeway for compulsory licensing can be reconciled, using the perspective of the right to health as defined in international human rights law. DISCUSSION: We explore the practical feasibility of an international tiered pricing and compulsory licensing framework governed by the World Health Organization. We use two simple benchmarks to compare the relative affordability of medicines for governments - average income and burden of disease - to illustrate how voluntary tiered pricing practice fails to make medicines affordable enough for low and middle income countries (if compared with the financial burden of the same medicines for high income countries), and when and where international compulsory licenses should be issued in order to allow governments to comply with their obligations to realize the right to health. An international tiered pricing and compulsory licensing framework based on average income and burden of disease could ease the tension between governments' human rights obligation to provide medicines and governments' trade obligation to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights

Epoxy adhesive behaviour on ceramic surfaces in commercial optoelectronic assemblies

Chemical and physical variability in the as-received state of aluminium oxide and aluminium nitride ceramic substrate materials used in optoelectronic modules currently leads to a process yield less than 100% when adhesives are used for assembly and interconnection. The phenomenon of epoxy bleed is a contributing factor to this yield and steps are not yet taken in the industry to control or inhibit the undesirable wetting. Standard surface texture measurement techniques, XPS and contact angle measurements were implemented to characterise and compare commercial as-received samples. The quality controls currently in place are assessed and additional analysis methods in the QC stage are suggested for increasing yield. Commercially available conductive and thermally conductive adhesives, also used in optoelectronic module manufacture, were studied along with the surfaces

Frames, Paradigms and Power: Global Health Policy-Making under Neoliberalism

The study of global health governance has developed rapidly over recent years. That literature has identified a range of factors which help explain the “failure” of global health governance, but it has largely neglected the global public policy processes which perpetuate that failure. In this paper we argue that there is such a thing as “global health policy” and set out a new framework for analyzing the processes through which it is made, highlighting the mixture of power and ideas, agency and structure, which impact upon the policy cycle. The framework rests upon four pillars: framing; paradigms; power; and the “deep core” of neoliberalism. Through integrating insights from a range of literatures, in particular from the global health governance and public policy analysis fields, we seek to enrich the conceptual basis of current work on global health governance

Acute kidney injury: electronic alerts in primary care - findings from a large population cohort

Background: Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. Aims: We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. Design: A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI. Method: The study utilised the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service. Results: 28.8% of the 22,723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalisation was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within seven days, 42.5% between seven and ninety days, and 8.4% was not repeated within ninety days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function. Conclusion: The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within seven days should be considered an appropriate response to AKI e-alerts in primary care