BRIC Health Systems and Big Pharma: Strategic Policy Issues Guilhem Fabre and Victor Rodwin Université Paul Valéry Montpelier 3, Wagner School of Public Service New York University June 5, 2017

Table 1. Age standardized mortality rates by cause (per 100 000 population) in BRIC nations Communicable Disease (2012) Non-communicable disease (2012) Injury (2012) Life expectancy at birth (2013) Brazil 93 514 80 75 China 41 576 50 India 253 682 116 66 Russian Federation 74 790 103 69 France 21 313 35 82 Source: World Health Statistics 2015

Table 2. Burden of disease due to HIV/AIDS in the BRICS countries Number of people (all ages) living with HIV (2015) [range] Prevalence of HIV in adults 15-49 (%) (2015) [range] Number of deaths due to HIV/AIDS (2015) Brazil 830 000 [610 000– 1 100 000] 0.6 [0.4 – 0.8] 15 000 [11 000 – 21 000] China 501 000 (Avert, 2014) 0.037% (avert, 2014) 21 000 deaths (avert, 2014) India 2 100 000 [1 700 000 – 2 600 000] 0.3% (avert, 2015) 68 000 [47 000 – 99 000] Russian Federation [850 000 - 1 500 000] (Avert, 2016) 0.8 – 1 (Avert, 2016) 24 000 (avert, 2014) Sources: Avert.org, WHO Global Health Observatory Data Repository

Table 3. Burden of disease due to Tuberculosis in the BRICS countries Number of deaths due to TB (excl. HIV) (2015) Number of incident tuberculosis cases (2015) Brazil 5 500 [5 200 - 5 900] 84 000 [72 000 – 97 000] China 35 000 [34 000 – 37 000] 918 000 [788 000 – 1 060 000] India 480 000 [380 000 – 590 000] 2 840 000 [1 470 000 – 4 650 000] Russian Federation 15 000 [15 000 – 16 000] 115 000 [98 000 – 132 000]

Cancer Mortality Estimates: BRIC Nations, France and US, 2012 Mortality (per 100 000 people) Brazil 103.72 Russia 122.55 India 64.49 China 122.19 France 107.93 United States 105.78 Source: Cancer Research UK – Worldwide Cancer Mortality Statistics

Table 4. Probability of dying between ages of 30 and 70 from cardiovascular disease, cancer, diabetes, or chronic respiratory (%) in 2015 and 2010 (both sexes) 2015 2010 Brazil 17 19 Russia 29 33 India 23 24 China 18 France 11 12 United States 14 Sources: WHO Global Health Observatory Data Repository

Table 5: Health Expenditures in BRIC Nations

IMS HEALTH. PHARMERGING MARKETS - PICKING A PATHWAY TO SUCCESS

Table 6. Pharmerging and Mature Markets IMS HEALTH. PHARMERGING MARKETS - PICKING A PATHWAY TO SUCCESS

Table 7. Pharmerging Markets, 2008-2017 IMS HEALTH. PHARMERGING MARKETS - PICKING A PATHWAY TO SUCCESS

Table 8. China Leads the way

Watt, N. F. , Gomez, E. J. , & McKee, M. (2013) Watt, N. F., Gomez, E. J., & McKee, M. (2013). Global health in foreign policy—and foreign policy in health? Evidence from the BRICS. Health Policy and Planning, N/A, 1-11. 10.1093/heapol/czt063

Table 9. BRIC Pharmaceutical Market Brazil Russia India China Pharmaceutical Sales (in $ US Billion) (1) 18.38 15.4 17.45 116 Per Capita (in $ US) 88 107 13 8.3 Pharmaceutical Sales as % of Health Care Expenditures (2009) (2) 25% 20% 41% 42.5% (3) % Expenditure on Patented Drugs 47 21 9.3 22 Pharmaceutical net Imports in $ US Billion (2016)(4) 2.4 6.5 11.3 Percent of Total Sales 13% 42% 0% 10% (1) Forecast for 2016 (2) From Watt, Gomez, McKee, Global Health in Foreign Policy - and Foreign Policy in Health th,Health Policy and Planning nning (29),2014 (3) The figure for 2015 -----> is 17% (4)Investorpedia, Daniel Workman, Drugs and Medicines Exports by Country 2017,5/15 www.worldstopexports.com Source: US Department of Commerce. International Trade Administration. 2016 Top Markets Report - Pharmaceuticals www.trade.gov/industry

Brazil EMI, Brazilian Pharmaceutical sector, Dec. 2013

Structure of Russian Pharmaceutical Market Deloitte, Development Trends and Practical Aspects of the Russian Pharmaceutical Industry, 2015

Chitour, Hind-Louiza, Big Pharma in China – the Driving Forces behind Their Success –A qualitative Analysis. Chinese Studies (2)4, 2013.

China Hsaio W., Li M., Zhang S. Universal Health Coverage: The Case of China. 2015 Working Paper, UNRISD