1. Sujal Parikh 1,2 ; John Prensner 1,2 ; Jesse Loar 1,2 ; Nate Trayner 1,2 1.MD Candidate, University of Michigan Medical School 2.Universities Allied for Essential Medicines, University of Michigan Chapter The Way Forward: The role of the University of Michigan UAEM chapter in the access to essential medicines movement Introduction M ore than ever, medical students are participating in international health field work during their degree programs 1 (Fig. 1). For these students, working in resource- limited settings with drastic health inequalities can have important effects on their lives and career choices 2. These experiences leave students yearning for a better understanding of the political and social mechanisms which foster and sustain global health inequalities. E ducational opportunities that adequately address global health are challenging for US medical schools, given the existing size of the required curriculum and the diversity of student interest. In the place of curriculum-based learning, many medical schools, including the University of Michigan, sponsor student-led organizations interested in multi-disciplinary issues related to global health. One area of interest that has proven of immediate relevance and concern to medical students is access to medicines in resource-limited countries and the role of universities in this dynamic. U niversities Allied for Essential Medicines (UAEM) is a national student-led organization that since 2005 at the University of Michigan has developed a strategy to educate medical students and faculty as well as students and faculty campus-wide, about two issues of critical importance to global health inequality and how universities themselves can serve as a solution. References 1.Association of American Medical Colleges’ Medical School Graduation Questionnaire All Schools Report, 1978 to 2004. Data for 1993 were not accessible. 2.Ramsey et al. Career Influence of International Health Experience During Medical School. Fam Med 2004;36(6):412-6. 3.The Selection and Use of Essential Medicines. Report of the WHO Expert Committee, 2002, including the 12th Model List of Essential Medicines. WHO Technical Report Series No.914. 4.Equitable Access to Essential Medicines: A Framework for Collective Action. WHO Policy Perspectives in Medicine. March 2004. 5.de Joncheere K. WHO European Regional Office 6.Building a global strategy for policy change in neglected disease research. DNDi submission to the WHO IGWG, November 2006. 7.Trouiller et al. Drug Development for Neglected Diseases: a deficient market and public-health policy failure. The Lancet. Vol 359. June 2002. 8.Pecoul, PLoS Med. 2004 (image modified by Trayner N) 9.Chaifetz et. Al. Closing the access gap for health innovations: an open licensing proposal for universities. Globalization and Health 2007, 3:1 10.UNICEF, Progress for Children. 2007. The Access and Research Gaps The Role of Universities Outreach: Editorials and Talks E ssential medicines are those that are needed to meet the priority health care needs of the population. As such, these drugs should be available: Figure 1. Percentage of Medical School Graduates Participating in an elective International Health- Related Clinical Experience 1 Figure 3 4 Access to Essential Medicines 1. Rational selection 4. Reliable health and supply systems 2. Affordable prices 3. Sustainable financing ACCESS A ccess to essential medicines is impacted multifactorially 5 (Fig. 4). Affordable pricing is just one issue related to access, yet high drug prices are an important hurdle in low- and middle income countries. Drug pricing itself is also a dynamic, multifactorial process (Fig. 2 ) Figure 2 5 Factors affecting access O ne problem facing access to medicines is the lack of new drugs. From 1975 to 2004, 1556 new drugs were approved for market 6. Of those, only 21 were for neglected diseases. And two-thirds showed little to no therapeutic gain over existing treatments 7. T he failure to produce new, effective treatments for neglected diseases is the result of multiple research gaps within the drug development pipeline 8 (Fig. 4). Figure 4 The Drug Development Pipeline and Gaps affecting Neglected Diseases 8 Addressing the Access Gap: M odern universities are centers for scholarship and research devoted to the public good. While universities do not mass-produce drugs, they do license drugs and technologies to pharmaceutical companies and biotechnology firms for production or further development. Figure 5 Schematic diagram of the Equitable Access License mechanism. 9 U niversities are thus in an ideal position to insist that licensing terms for all university- developed products, particularly those that C urrently, one-third of the world’s population lacks access to these essential medicines (Fig. 3). In many African and Asian countries, up to half of people lack adequate access 4. With assured quality information At an affordable price At all times In adequate amounts In appropriate dosage forms 3 address priority health conditions in the poorest nations, support access and include language that requires companies to make these technologies readily available those most in need (Fig. 5). By employing an Equitable Access License for relevant products, universities can exert their important social influence by improving the availability of essential drugs and technologies that they generate 9. Future Plans The University of Michigan: 2007-2008 I n 2007-2008, the University of Michigan (UM) UAEM chapter undertook several large scale projects: 1.Creating a comprehensive survey of UM neglected disease research and licensing practices - the UM “Working Paper” (Fig. 6) 2.Endorsement and recognition by the top governing student body, the Michigan Student Assembly (MSA); 3.Community outreach via published editorial pieces; 4.Development of a maternal health curriculum module. The UM Working Paper I n Feb. 2008, UM UAEM completed a comprehensive Working Paper, describing neglected disease research and technology transfer policies at UM (Fig. 7). The document was presented to the UM Office of Technology Transfer, members of the Office of the Vice President for Research (the UM senior research officer), and the Dean of the UM Medical School. T his effort was well-received by the U-M deans and administrators. However, there is no consensus on the next steps to take. Current efforts to achieve public administrative support for concrete actions in this area are still underway. The UM MSA Resolution F ollowing the Working Paper, UM UAEM approached the Michigan Student Assembly (MSA), the elected body of student representatives. With MSA, UM UAEM passed a resolution urging UM to take concrete steps toward ensuring more access-friendly licensing approaches (Fig. 8). O ther UM UAEM efforts in 2007-2008 focused on engaging the broader UM and Ann Arbor communities in these issues. We held a day-long workshop for UM students on global health issues and published two local editorials, in the Michigan Daily (the major university newspaper) and the Ann Arbor News (the major Ann Arbor city newspaper) (Fig. 9). New Projects: the Maternal Health Curriculum S andeep Kishore and colleagues at the New York City Tri-Institutional program recently developed a modular multi-disciplinary seminar series around malaria. Building on that work, UM UAEM is in the initial stages of planning a multi-disciplinary seminar series on maternal health (Fig. 10). UM UAEM is well-positioned for this project because of strong interest among chapter group members and the strong international health focus of the Obstetrics and Gynecology Department at UM, who will play an advisory role. I n 2008-2009, UM UAEM will focus on: 1.Working with and accessing the upper levels of administration, including the President and Regents, regarding UM policies toward technology licensing; 2.Continuing and expanding faculty outreach to encourage inventor-initiated access language in individual licenses; 3.Developing and piloting a maternal health modular curriculum. ND research Licensing Working Paper Metrics ? Global Access Policy Statement Access Clauses in Licenses Increased neglected diseases research Public reporting of OTT metrics Figure 7 Flowchart describing the process and plans for the UM UAEM working paper UM UAEM Chapter Members Figure 9 Editorials written by UM UAEM members Figure 10 Maternal mortality rates by country. 10 Figure 6 UM UAEM Working Paper Table of Contents W e are now working with the MSA to reach and gain the support of the University President and Board of Regents. Figure 8 UM UAEM-sponsored MSA resolution.