Global health. The current scenario and future perspectives

272 continued negotiating the treaty now known as TPP-11 with some measures “suspended” but not eliminated. Michelle Bachelet, President of Chile signed it in 2018 and only parliamentary ratification is pending. The process has been ongoing since then. Regional initiatives for health collaboration on access to medicines Medicines are considered an essential social good and main therapeutic support to maintain health. As for their availability, they pose a great challenge for the region. Therefore various strategies or technical collaboration initiatives have been implemented between countries to access quality medicines at fair prices. Emblematic cases of collaboration, cooperation, negotiations and joint purchases include Oras Conhu’ s 37 initiative and Mercosur’s initiative where Health Ministers, supported by the Pan American Health Organization (PAHO), using Strategic Fun d 38 , have gained access to medicines at much lower prices than market prices to provide healthcare coverage for their populations. In 2003, Oras Conhu accompanied by the PAHO managed a negotiation process and joint purchases of antiretroviral drugs and reagents in the Andean Subregion for HIV treatment. This was successful initiative during its first two versions as it achieved discounts up to 93% on prices for first-line triple therapy regimens. However, the pharmaceutical industry holding the monopoly over treatments and patents did not participate in the third negotiation and thus stalled progress; nevertheless, it remains an example of successful organization for access to medicines. In 2015, during meetings of technical experts on medicines in Mercosur, the possibility of negotiations and joint purchases among member countries and associated states began to take shape again with support from Unasur 39 and the PAHO. In the negotiation led by Brazil, HIV and Hepatitis C drugs were included. Companies with registrations for these products were invited but some decided not to participate while others did not modify their prices as they held patents and considered that, since there were no alternatives to their drugs, countries were obliged to pay what they 37 Andean Health Organizations (Oras) of the Hipólito Unanue Agreement (Conhu). Organization website: https://www.orasconhu.org/. 38 The Strategic Fund PAHO is a regional supply fund for which pharmaceutical production companies apply at very low prices. Available at: https://www.paho.org/es/fondo-estrategico-ops. 39 Union of South American Nations, a South American integration organization, created in 2011. In 2018, because of changes in the political trends of governments in the region, Chile and other countries withdrew. Available at: https://parlamentomercosur.org/innovaportal/v/4503/1/parlasur/unasur.html.