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New Delhi: Unitaid promotes access to treatment for patients of HIV/AIDS, malaria and tuberculosis, mainly in low-income countries. One of its main funding sources has been the introduction of a levy on air tickets in some countries that endorsed the initiative. Denis Broun, executive director of Unitaid, met officials in the civil aviation ministry last week to push the concept at a time when Indian airline companies are struggling with years of accumulated losses and debt. He spoke about the concept, and other issues, in an interview. Edited excerpts:

How practical is taxing air tickets given the current challenges facing the Indian aviation sector?

I met officials in the civil aviation ministry and they were a little surprised that I was suggesting (the) tax at a time when the airlines are suffering so much.

Healthcare services: Broun says India has a unique health sector without public-private partnerships which are specific to the region. Photo: HT

We now have evidence that levying air tax has no effect on air traffic. Unitaid has two simple strategies to fund medicines—by purchasing them at wholesale, subsidized rates and by funding the purchases in a sustainable manner through an airline ticket solidarity levy.

Majority of our funds are raised through contribution levied on air tickets. This is already applied in 11 countries and I hope that India will become a member-state as well. We have not submitted a final proposal to the civil aviation ministry as yet, but the idea is to tax 20 per passenger for a domestic flight and $1 per international economy ticket and $10 per international business class ticket. India has benefited from Unitaid supply of drugs and should these taxes be levied, it will be invested back in the Indian economy.

What are the effects of Unitaid’s innovative financing strategies, like the financial transaction tax (FTT) on national financial markets?

From France’s experience, we have enough evidence to show that there are no significant negative impacts on the market. We want our member-nations to impose a general financial transaction tax to raise new resources since traditional donor countries are having problems with (their) budget.

In case of countries already implementing FTT, our challenge is to ensure that proceeds go to health of the poorest nations for development and not on reducing debt burdens of rich countries.

Financial sector has, for long, most benefited from globalization and it definitely contributes the least to universal equity.... While we leave it to the member-countries to determine the rates and fields to be taxed, the purpose of FTT is to generate funds for development at an international level and for the benefit of a common development policy. Secondly, having a development fund will contribute towards establishing financial stability internationally.

One of the strategies to improve access to medicines, being debated globally, is a binding global health convention with all governments sharing the costs of research and development (R&D), delinking patents from profits and getting innovators to share formulations with generic manufacturers to produce affordable medicines. How much consensus is there within the scientific community on these recommendations?

We want to separate monopoly and innovation because there are better ways to reward innovation without making new technology prohibitively expensive like voluntary licences.

In my opinion, it is a welcome change that questions like these (of sharing resources to make R&D cheaper) are being raised in public discourse.

There are several mechanisms to make monopoly redundant without causing financial losses to the innovators. In America, there is already a debate about publishing research on the Internet instead of journals with expensive fees.

I would say we are moving in the right direction but it is going to be a uphill task.

What is India’s biggest public health challenge currently—financing health schemes, access to medicine, human resources shortages and/or the quality of governance?

India has a unique health sector without public-private partnerships which are specific to the region. The private sector provides majority of care while patients incur huge out-of-pocket expenses to buy healthcare.

There is, no doubt, an urgent need for a unified system with unified pricing and standardization of quality of care provided. The private sector needs to be looked at more favourably instead of seeing them as someone who benefits from public money.

The issue here is of governance. If private sector is providing care, the government should look at the best possible way to make it accessible to everyone at an acceptable cost.

The concept of health insurance and health assurance are not incompatible. The National Rural Health Mission (NRHM) is a great example of reducing healthcare expenses. The government has reaffirmed belief in primary care by providing a basic safety net to everyone.

Having said that, the cases of corruption within NRHM are not surprising as they occur wherever so much money is involved. That is a question of governance and public integrity.


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