Cross-Country Collaborations to Improve Access to Medicines and Vaccines in the WHO European Region

"[T]he importance of information exchange was highlighted by all collaborations."

Access to safe, effective, high-quality, and affordable essential medicines is one of the major challenges for health systems in achieving universal health coverage, to which countries have committed as part of the 2030 Agenda for Sustainable Development (target 3.8). In response, several government-led, voluntary cross-country collaborations have been established in the World Health Organization (WHO) European Region. This report from the WHO Regional Office for Europe examines 5 such collaborations, detailing their objectives, key characteristics, and outcomes, and identifying facilitating and hindering factors for progress in a collaboration. Based on this analysis, it provides an action plan for countries considering collaborating on pharmaceutical policy.

Of 35 cross-country collaborations identified worldwide, 5 in the Region were selected:

• The Baltic Procurement Initiative (Estonia, Latvia, and Lithuania) performs joint procurement of vaccines, and countries lend medicines to each other when shortages occur.
• The Beneluxa Initiative (Belgium, the Netherlands, Luxembourg, Austria, and Ireland) works on pharmaceutical policy in the areas of horizon scanning, health technology assessment (HTA), pricing and reimbursement (negotiations), and information sharing.
• The Fair and Affordable Pricing, or FAAP (Czechia, Hungary, Poland, and Slovakia) performs joint HTA reports and price negotiations.
• The Nordic Pharmaceutical Forum (Denmark, Norway, Sweden, and Iceland, with Finland as an observer) was initiated from the bottom up to increase purchasing power to perform joint procurement for medicines.
• The Valletta Declaration (10 countries in southern and eastern Europe) is exploring ways to share information among member countries to increase transparency of information on medicine prices.

The report describes the workings of these collaborations and outlines key features. For example, the collaborations surveyed defined governing principles to follow, such as accountability, full trust, solidarity, no conflict with national regulations, and a balance between transparency and confidentiality. The exchange of information through various forms of communication is considered a major asset of the collaborations. In the initial phase, face-to-face meetings appeared to be important, particularly in those cases where collaboration representatives did not know each other. Members of the cross-country collaborations communicate on a regular basis via writing (mainly emails), telephone conferences, and meetings (virtual ones being very common). Overall, external communication, such as press releases or statements on a website and/or social media, is considered very important but also time-intensive.

The research shows that tangible results are only seen after months or years of cooperation. A major challenge for collaborations is to secure the interest and willingness of industry stakeholders to engage and participate - for example, in a joint negotiation – and to respond to a call for tenders. Other challenges include the resources required, different languages of participants, dissimilar organisational and legal frameworks, the reluctance of industry to engage in negotiations with a collaboration, and pressure to produce results.

Nevertheless, all collaborations surveyed were unanimous in perceiving the cooperation to be a success and a move in the right direction. Examples of tangible results include the conclusion of a joint procurement or of negotiations leading to lower medicine prices. Facilitating factors identified include political support, trust within the collaboration, commitment of the technical experts involved, similarities between healthcare systems, and leadership of a dedicated person.

The report concludes with a checklist of prerequisites for successful cross-country collaborations. Looking ahead: "Champions of cross-country collaborations may support further countries to work together....Good practice may serve as a model, and experiences of front-runners in cross-country collaborations can support newcomers who aim to follow the path of 'voluntary' collaboration. For the future, collaboration between cross-country collaborations could be a promising option...to improve access to medicines and to support the implementation of the World Health Assembly resolution on improving medicines price transparency..."