Warren Kaplan

Warren Kaplan
Boston University | BU

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81
Publications
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Publications

Publications (81)
Preprint
Background During the past two years, the COVID-19 pandemic has cost millions of lives around the globe, caused major morbidity and provoked widespread economic and social disruption. In response, governments have enacted policies to mitigate the impacts of the pandemic. This research focuses on policies aimed at increasing access to essential heal...
Article
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In 2021, the United Nations Committee on Development Policy adopted a resolution that Bangladesh would graduate from least developed country (LDC) status after a period of 5 years. This means that in 2026 Bangladesh would have to forego its exemption to intellectual property (IP) provisions of the World Trade Organization (WTO). Bangladesh has take...
Article
Over the past four decades Bangladesh has built enough domestic productive capacity in the pharmaceuticals and related industries to generate manufacturing capacity and employment to provide access to medicines in the country and to become a modest exporter of medicines as well. This paper traces the role played by government policy in fostering Ba...
Technical Report
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This report investigates the relationship between the policy interventions made by governments to deal with the health and economic challenges posed by COVID and the obligations they have assumed under international trade and investment rules. It focuses on a sample group of six large countries – the United States, Germany, France, China, South Afr...
Article
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Background: Universal access to essential medicines and routine diagnostics is required to combat the growing burden of cardiovascular disease (CVD) and diabetes. Evaluating health systems and various access dimensions availability, affordability, accessibility, acceptability, and quality is crucial yet rarely performed, especially in low- and mid...
Article
This study assesses the associations between primary sources of insurance coverage and out-of-pocket outpatient and inpatient medical expenses among Chinese older adults. The 2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (n = 6,924) were analyzed. Sources of coverage for survey participants were recorded as the: New Coope...
Article
This paper develops new indicators that measure the strength of intellectual property rights (IPR) provisions in Chile’s free trade agreements (FTAs). We use these new indicators to examine the extent to which FTAs with strong IPR provisions impact the volume, unit value and overall value of imported biologic medicines into Chile. We find that FTAs...
Article
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Background: We present a systematic review describing ex-ante and ex-post evaluations of the impacts of intellectual property provisions in trade treaties on access to medicine in low and middle income countries. These evaluations focused on multilateral and bilateral trade agreements. We ascertained which IP provisions impacting access to medicin...
Article
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Background Affordability is a key barrier to access to medicines. Generic medicines policies can address this barrier and promote access. Successful uptake of generic medicines depends, in part, on ensuring that these products are interchangeable with reference products. Typically, bioequivalence certification is established in order to demonstrate...
Article
Education and income have been considered two primary determinants to affect individuals’ health outcomes. China initiated a large comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothes...
Article
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Aim To describe the global insulin market. Methods Market intelligence data, United Nations Commodity Trade Statistics for insulin trade, the International Medical Product Price Guide for prices of human insulin and additional web searches were used as data sources. These sources were combined to gain further insight into possible links among mark...
Article
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Introduction Chile implemented a generic substitution policy in 2014 to improve access to medicines. This study aims to measure if the generic substitution policy had an effect on the sales volume and prices of referent and the branded generic products with demonstrated bioequivalence (BEQ) in the private pharmaceutical market. Methods The volume...
Article
National Health Insurance (NHI) was implemented in Taiwan in 1995, and has significantly increased coverage to 99% of the population. The implementation of NHI has had large impacts on health disparities. Despite that, the NHI faces multiple challenges, including the condition of “coverage without access” among the Taiwanese aboriginal population,...
Article
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New innovation ecosystems are emerging that challenge the complex intellectual property and regulatory landscape surrounding drug development in the United States (US). A prime example is an initiative known as the Open Insulin Project. The goal of the project is to sidestep patents and enable generic manufacturers to produce cheaper insulin. Howev...
Article
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Background Nepal is facing an increasing burden of diabetes and relies almost entirely on insulin imported through India. Methods We employed a modified version of the WHO/Health Action International standard survey to assess insulin availability and prices, along with qualitative interviews with insulin retailers (pharmacists) and wholesalers in...
Article
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Background: Nepal was struck by devastating earthquakes in April-May 2015, followed by the India-Nepal border blockade later that year. Methods: We used the United Nations Commodity Trade Statistics (UN Comtrade) database to analyse exports of various health commodities from India to Nepal from January 2011-September 2016. We used time-series re...
Article
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Background Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on t...
Article
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Background To assess the effect of policies supporting local medicine production to improve access to medicines. Methods We adapted the WHO/HAI instruments measuring medicines availability and prices to differentiate local from imported products, then pilot tested in Ethiopia and Tanzania. In each outlet, prices were recorded for all products in st...
Article
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Objective: India's majority of patients—including those living with diabetes—seek healthcare in the private sector through out-of-pocket (OOP) payments. We studied access to insulin in the private-sector market of Delhi state, India. Methods: A modified World Health Organization/Health Action International (WHO/HAI) standard survey to assess insul...
Article
It has been over 20 years since Taiwan's implementation of its National Health Insurance (NHI) program. Under this program, the health insurance coverage rate has reached approximately 99% of the population. Despite guaranteeing the residents of Taiwan equal access regardless of socioeconomic status and background, critical problems and controversi...
Article
We greatly appreciate the positive comments regarding our article1 in the letter from Antignac et al. We agree that there is a dearth of published information about the quality of noncommunicable disease medicines including cardiovascular. In 2011, contamination of a cardiovascular medicine in Lahore, Pakistan, caused nearly 200 deaths among up to...
Article
Full-text available
Objective India's majority of patients—including those living with diabetes—seek healthcare in the private sector through out-of-pocket (OOP) payments. We studied access to insulin in the private-sector market of Delhi state, India. Methods A modified World Health Organization/Health Action International (WHO/HAI) standard survey to assess insulin...
Article
Full-text available
Background Lack of access to insulin and poor health outcomes are issues for both low and high income countries. This has been accompanied by a shift from relatively inexpensive human insulin to its more expensive analogs, marketed by three to four main global players. Nonetheless, patent-based market exclusivities are beginning to expire there fo...
Article
Cardiovascular diseases (CVD) represent the highest burden of disease globally. Medicines are a critical intervention used to prevent and treat CVD. This review describes access to medication for CVD from a health system perspective and strategies that have been used to promote access, including providing medicines at lower cost, improving medicati...
Article
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As part of the 2030 Agenda for Sustainable Development, WHO Member States have set a target of reducing premature mortality from non-communicable diseases (NCDs) by a third. The authors of the 2016 World Health Day Report1 recommend that Member States strengthen their capacity to collect, analyse, and use NCD data. Unfortunately, many low-income an...
Technical Report
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Background: India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private...
Technical Report
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This review seeks to help policy-makers prioritise pro-generic medicine policy actions through: • providing an introduction to policies that can be used to address enhancing uptake of generic medicines; • reviewing existing literature on generic medicines policies with an emphasis on low- and middle-income countries, particularly as the literatu...
Article
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Background Not all new drug products are truly new. Some are the result of marginal innovation and incremental patenting of existing products, but in such a way that confers no major therapeutic improvement. This phenomenon, pejoratively known as “evergreening”, can allow manufacturers to preserve market exclusivity, but without significantly bette...
Data
Raw patent and product information data file. (XLSX)
Article
1 discuss the issue of patents and other marketing exclusivities covering insulin, providing some interesting information about the situation in the USA. This information, however, has global ramifi cations. For example, the authors note that most insulin products available in 2014 were protected by formulation or pen-device patents, which was a su...
Poster
Full-text available
Insulin is an essential medicine needed for people living with type 1 diabetes and some people living with type 2 diabetes. Access to insulin is particularly poor in low and middle income countries due to low availability and unaffordable prices. In high income countries, such as the US, patients without health insurance or who have high co-payment...
Poster
Full-text available
Limited access to insulin is a major concern in some African countries that have a growing burden of diabetes. Due to the general absence of insulin manufacturing capacity in Africa, these countries rely on the global trading system to obtain insulin. We conducted this analysis to estimate if the insulin being imported into African countries is ali...
Article
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Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-speci...
Article
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Promoting generic medicines to increase access to essential medicines is relevant to achieve the Millennium Development Goal (MDGs) and post 2015 goals. There are several barriers to encouraging wider use of generic medicines in health systems, e.g. the widely-held perception that low price equals low quality and misalignment of provider and consum...
Article
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This observational study investigates the private sector, retail pharmaceutical market of 19 low and middle income countries (LMICs) in Latin America, Asia and the Middle East/South Africa analyzing the relationships between volume market share of generic and originator medicines over a time series from 2001 to 2011. Over 5000 individual pharmaceut...
Article
Review the literature on the impact of policies designed to enhance uptake of generic medicines in low and middle income countries (LMICs). We searched for publications related to generic medicines policies (January 2000-March 2010) and did a bibliometric, descriptive analysis of the dataset in addition to an analysis of studies evaluating the impa...
Article
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Public sector price analyses of antiretroviral (ARV) medicines can provide relevant information to detect ARV procurement procedures that do not obtain competitive market prices. Price benchmarks provide a useful tool for programme managers and policy makers to support such planning and policy measures. The aim of the study was to develop regional...
Article
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The objective of this study was to assess the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products. Our preliminary hypothesis is that studies showing a robust relationship between local production and access to medical product...
Article
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Pharmaceutical markets in low resource settings are imperfect. Suppliers provide information on ‘suggested’ medicine prices, but actual purchase prices vary substantially across purchasers and these prices paid are typically unavailable. Public procurement databases now, however, provide timely market intelligence on prices for antiretroviral (ARV)...
Article
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Background to the debate: Pharmaceutical and medical device manufacturers argue that the current patent system is crucial for stimulating research and development (R&D), leading to new products that improve medical care. The financial return on their investments that is afforded by patent protection, they claim, is an incentive toward innovation a...
Article
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To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment. We estimated the impact of global strategies to reduce ARV prices using data on 7253 procuremen...
Article
OBJECTIVE: To estimate the impact of global strategies, such as pooled procurement arrangements, third-party price negotiation and differential pricing, on reducing the price of antiretrovirals (ARVs), which currently hinders universal access to HIV/AIDS treatment. METHODS: We estimated the impact of global strategies to reduce ARV prices using dat...
Article
Editor—The recent World Health Organization-Health Action International, Europe report on disparities in price, availability, and affordability of medicines for chronic diseases is important work.1 This entire subject matter as it relates to medicines for chronic diseases deserves wider appreciation and understanding. It should not be allowed to b...
Article
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The ongoing policy debate about the value of communications technology in promoting development objectives is diverse. Some view computer/web/phone communications technology as insufficient to solve development problems while others view communications technology as assisting all sections of the population. This paper looks at evidence to support o...
Data
Gross Domestic Product per capita (US $) and Mobile Phone Subscriptions per capita for selected countries. Data obtained directly from Reference [62]. U.S. dollar figures obtained by applying average annual exchange rates from the International Monetary Fund (IMF) to the national currency for that year. Where such rates were unavailable, a World Ba...
Article
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Fees charged by drug regulatory authorities (DRAs) may be used as a policy instrument to speed up regulatory approval, to encourage retention of quality staff and to stimulate introduction of generics versus new chemical entities. Often, the cost recovery function of these registration fees is not related to the true cost of the pharmaceutical regu...
Technical Report
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The purpose of this paper is to review the reasons for problems in achieving reliable access to Child Health medicines and to provide guidance for senior program managers and their technical advisers in the dealings with drug supply and Essential Drug program managers. The paper will supply specific recommendations as to what can be done by Child H...
Article
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As a part of the NASA's Amazon Boundary Layer Experiment 2A mission, the cycle of atmospheric CO2 over the Amazon Basin was examined using measured vertical profiles of CO2 concentrations in the canopy and aloft, and direct measurements of CO2 emissions from soils. The results provide a detailed picture of daily exchanges of air between the tropica...
Article
Rates for emission of NO and deposition of O3 were measured at a tropical forest site in Reserve Adolfo Ducke, near Manaus, Brazil. Two independent techniques were used to determine the NO flux: (1) a soil enclosure method and (2) a method based on simultaneous observations of NO and O3 vertical profiles at night, when NO is irreversibly removed by...
Article
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Undisturbed oxisols in a central Amazon tropical forest were fertilized with ammonium, nitrate, or phosphate. Enhanced emissions of N2O were observed for all treatments with 1 day of fertilization, with the response NO3->>NH4+>>PO43-. Approximately 0.5% of applied NO3- was converted to N2O within 2 weeks after application, with less than 0.1% of th...
Article
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Emissions of nitrous oxide, methane, and carbon dioxide were measured at diverse locations in tropical forests of Brazil, Ecuador, and Puerto Rico using a static open chamber technique. Mean fluxes to the atmosphere were 1.7 x 10 to the 10th, -0.7 x 10 to the 10th, and 1.5 x 10 to the 14th molecules/sq cm per s for N2O, CH4, and CO2, respectively....
Article
Reviews the reductive pathways for microbial production of N2O, oxidative pathways for N2O production, microbial sinks for N2O in aquatic systems, and N2O in marine systems, rivers and lakes. -P.J.Jarvis
Article
The transformations of inorganic nitrogenous nutrients that can lead to the frequently observed high levels of nitrite in the Chesapeake Bay and York River were investigated by a combination of ¹⁵N tracer techniques and assays of the concentrations of chemical constituents (NHâ/sup +/, NOâ⁻, NOâ⁻, Oâ, NâO, and CHâ). The distributions of NâO,...
Article
Soils in an Amazonian rainforest are observed to release N2O at a rate larger than the global mean by about a factor of 20. Emissions from a New England hardwood forest are approximately 30 times smaller then Brazilian values. Atmospheric methane is consumed by soils in both systems. Tropical forests would provide a major source of atmospheric N2O...
Article
The cycle of nitrogen in the Cariaco Trench was studied using stable isotope techniques with vertical profiles of nutrients, oxygen, and N2O. The rate of nitrification was found to be zero order with respect to the concentration of NH4+ at levels above 0.1 μM. The associated half-saturation constant is about 0.15 μM, much lower than in laboratory c...
Article
Extensive measurements were carried out during the summers of 1977 and 1978 to define concentrations of inorganic nitrogen, O2 and N2O in the Potomac River. The chemistry of the river varied significantly between 1977 and 1978, with nitrification rates slower near the city of Washington D.C. by more than a factor of 10 in 1978. The nitrification ra...
Article
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Pure cultures of the marine ammonium-oxidizing bacterium Nitrosomonas sp. were grown in the laboratory at oxygen partial pressures between 0.005 and 0.2 atm (0.18 to 7 mg/liter). Low oxygen conditions induced a marked decrease in the rate for production of NO(2), from 3.6 x 10 to 0.5 x 10 mmol of NO(2) per cell per day. In contrast, evolution of N(...