14/3/2016

Medicamentalia: A data driven investigation to contextualize global access to medicines

 

By the investigative team at Civio Foundation

Medicamentalia is a field research and data journalism investigation from Civio Foundation, a Spanish not-for-profit organization with the mission of increasing government transparency and accountability through the use of information technologies and data journalism. The project analyzes and compares prices of 14 essential drugs in 61 countries, mostly developing ones, to report on the global access to medicine. Medicamentalia was carried out thanks to a Journalism Grant from the European Journalism Centre (EJC) and the Bill & Melinda Gates Foundation.

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The task of understanding the complex rules and international regulations that affect the prices of medicines was colossal. Before beginning the project, we conducted several interviews and reviewed dozens of papers and reports on the measurement of prices just to know what to investigate and how to investigate it. This research, prior to collecting and analyzing the data, was essential to improve the accuracy and depth of our journalism, and saved us precious time.

For weeks we looked for a common standard through which we could compare, in the most rigorous way possible, the accessibility of treatments in different countries. That’s when we discovered the cornerstone of the project - the Medicine Price Database developed by the not-for-profit Health Action International (HAI). Thanks to an exhaustive and detailed methodology, which we studied thoroughly to understand the complexity of the data, they’ve managed to collect information from dozens of countries worldwide on pricing, access, cost composition, and differences between brand name drugs and generics, for 14 essential medicines with specific compositions. These compositions were diazepam, paracetamol, atenolol, amoxicillin, omeprazole and other.

Collecting the data

The first obstacle to our research, aimed at comparing countries of different regions and income, was that HAI’s pricing data was not available for every year. Although we considered updating all the figures to 2015 (taking into account inflation and currency rate changes), we eventually decided that the comparisons would be inaccurate if we used absolute data. That’s the reason you won’t find prices in our data visualization.

Thus, we decided to use two relative indicators found in HAI’s reports. Firstly, we looked at Median Price Reference (MPR), that is, the ratio of the drug price versus an international reference value set by the not-for-profit organization Management Sciences for Health (MSH). We can compare the price deviation across countries from this reference price, which is updated every year. The second indicator we analyzed was affordability, that is, the work time needed to pay for a full treatment in each country. As specified by HAI’s methodology, in order to avoid more volatile figures in developing countries such as minimum salary, we used the net salary of the lowest-paid public servant. In both cases, we decided to use the price of the cheapest generic and display both private (direct purchases from pharmacy counters or with prescriptions from private insurers) and public data (purchases subsidized partially or fully by public health systems).

With our goals now clear, we downloaded about 70 documents from HAI’s website, and processed them automatically to build a working database. We then filled the gaps, cleaned, restructured and checked all the data, either automatically or manually. From this work, we set our base camp: data from 56 countries for 14 essential drugs.

Having understood the methodology and cleared up some doubts thanks to HAI’s Margaret Ewen, now came the second part: add data for developed countries to carry out the global comparison. To this end, we used official sources and studied the public health systems of the four countries where we were going to publish the results: Italy, Argentina, Spain and and Germany. Now five, after we recently added Belgium thanks to Kristof Clerix. In all these cases, we used data from 2015 and the latest available international reference price, 2013, following the HAI methodology. In the German case, the team at Correctiv! collected the data and we fact-checked it.

The final database included data from both HAI’s reports and our selected five countries - you can download it here. We visualized it (sorting the countries by name or GDP) using Javascript and D3.js, and presented it with a guided tour.

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Reporting from the field

Analyzing the database allowed us to draw some interesting conclusions. The price differences of the 14 drugs analyzed in 61 countries were very pronounced, even when looking at generics, and salaries did not compensate for this variance. As a result, citizens in developing countries would have to work much harder in order to afford the same treatment.

Although we were able to identify some initial insights, we still had to add background information and explain the causes and consequences of these price differences. To this end, we traveled to Ghana to investigate the problem of counterfeit malarial medicines, as well as Brazil, to learn about its compulsory licensing system, introduced in 2007. We wanted to know, years later, if this alternative to patents had worked. Since the 14 drugs are all considered essential by the World Health Organization (WHO) and therefore are available as generics, we also researched the patent system and its alternatives. This research was important, as it examined one of the major debates on access to medicines: is the patent system the best way to compensate for investments in the drug’s development, and, at the same time, ensure access to medicines for everyone? This background information was essential to prove that the costs of creating a new drug are not transparent. We found that although the pharmaceutical industry acknowledges the benefits of some alternative models to intellectual property in very particular cases, the patent system is non-negotiable. We also found out that the 2007 approval of compulsory licensing in Brazil didn’t make drug companies abandon the country, as was augured by certain companies and governments. Quite the opposite, both foreign investment and the number of patents have kept growing since then.

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The output

Medicamentalia puts together a main data-visualization feature that allows users to dive into over 45.000 fields of information on medicine prices and 14.500 fields on affordability. A guided-tour with nine highlights helps the audience familiarize themselves with the data in a clear, direct and understandable way. The reader can self-explore the information, check the methodology and access the raw database. The guided-tour infographic was adapted to be fully embeddable by any news organization, as La Nación (Argentina) did.

In addition, three long-form articles provide background information on the factors that condition access to medicines globally: patents, counterfeits, and existing alternatives, such as the compulsory license. Eleven short videos, four data visualizations, animated graphs and one photo gallery complete this multimedia investigation.

Following up, Medicamentalia is currently investigating the complex issue of vaccine prices. Stay tuned!

Read more about Medicamentalia's methodology here.

Explore the Medicamentalia project further here.

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