Concerns about medicines-or lack of medicines-can be traced back for centuries. The discovery of "wonder drugs" about the time of World War II, however, was a milestone in pharmaceutical management. The dramatic effectiveness of some new pharmaceuticals and the intensive marketing of many others combined to catalyze widespread use of modern medicines. A rapidly growing and profitable industry, together with an enthusiastic but largely uninformed public and an often inadequately regulated marketplace, resulted in excesses of promotion and consumption, along with substantial levels of expenditure that necessitated new policy measures.
Despite the advent of wonder drugs, however, it had become clear by the 1970s that the least-advantaged nations were not even meeting the basic needs of their people for essential lifesaving and health-promoting medicines. Through the 1970s and 1980s, governments and international organizations such as the World Health Organization (WHO) began to redress this imbalance, with support from nongovernmental organizations (NGOs), largely through the promotion of essential medicines programs.
In the 1990s and 2000s, the devastation caused by the HIV/AIDS pandemic specifically helped draw attention to the plight of people living in resource-limited areas-especially sub-Saharan Africa-and the increased interest in health care and funding for treatment in developing countries spawned a number of significant global initiatives to address inequities and increase access to health care and essential medicines in the most-affected countries. As the world responds with dramatically increased financial assistance to provide affordable medicines for HIV/AIDS, tuberculosis (TB), and malaria, there has been growing recognition that the effectiveness of these multimillion-dollar initiatives is limited by the capacity of health care and pharmaceutical supply systems at the national and local levels. Constraints to improving access to medicines include inadequate infrastructure in facilities and a lack of trained staff and equipment for those facilities.
Although differences have always existed between the way pharmaceutical policies have developed in industrialized countries, on the one hand, and developing countries, on the other, many elements of pharmaceutical policy are applicable everywhere. The increasingly globalized economy is driving more uniform approaches to pharmaceutical policy, especially as the many parties engaged in the pharmaceutical arena work together in global programs for the benefit of all.