An international treaty is a promising tool for improving the coherence, fairness, efficiency, and sustainability of the global health research and development system according to international experts writing in this week's PLoS Medicine.

Suerie Moon from the Harvard Global Health Institute, Jorge Bermudez from Fundação Oswaldo Cruz, Rio de Janeiro, and Ellen 't Hoen from the University of Amsterdam argue that such a treatyan R&D treatyshould be based on the understanding that a politically and financially sustainable system for generating health research will require both fair contributions from all, and fair benefit sharing for all.

The authors argue: "Medical innovation and access to the fruits of scientific progress are no longer policy concerns restricted to the national level or to wealthy countries alone." They continue: "In an era of health interdependence, effective tools for global governance are required to generate medical R&D as a global public good that can deliver benefits for all."

According to the authors, the current system for the research and development (R&D) of new medicines does not adequately meet the needs of the majority of the world's population, 80% of whom live in developing countries. For example, there is no global system of rules to ensure that new medicines are affordable to the majority of people who need them, and funding for R&D into the diseases that predominantly affect developing countries remains precarious, with contributions falling last year in the wake of the economic crisis.

This situation has prompted extensive international debate and proposals for reform but despite the emergence of many new approaches to generating R&D that meets the needs of poorer populations, the authors believe that such efforts remain ad hoc, fragmented, and insufficient.

The authors argue: "An R&D treaty could complement and build on existing initiatives by addressing four areas that remain particularly weak: affordability, sustainable financing, efficiency, and equitable governance."

They continue: "An international agreement is likely to be required to establish robust, sustainable, predictable, and sufficient financial flows for R&D."

The authors make the case for treaty rules which could structure financial rewards for innovation so that they are commensurate with a medicine's health benefit. They say: "A system in which all countries contributed finances and knowledge could form the basis of more equitable governance arrangements in which affected populations have a stronger voice in decision-making."

They conclude: "Leaders of governments, civil society, industry, and academia should seize this unprecedented opportunity to move forward."

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More information: Moon S, Bermudez J, 't Hoen E (2012) Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? PLoS Med 9(5): e1001218. Journal information: PLoS Medicine Moon S, Bermudez J, 't Hoen E (2012) Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System?9(5): e1001218. doi:10.1371/journal.pmed.1001218