Why can’t medicine be more like Coke?

I don’t mean taste-wise (although it’d probably save parents everywhere a lot of grief if sick toddlers would swallow their meds as happily as they do soda).

And I’m definitely not asking pharmaceutical companies to start adding 40 grams of sugar to every pill.

No, what I’m talking about has less to do with the products themselves and more to do with where they’re sold.

In case you haven’t noticed, Coca Cola is pretty much everywhere.

Case in point: Coke is sold in over 200 countries—that’s 80% of the world if you throw in dependent territories and the like.

Coke is apparently so big and so widespread, 94% of the world recognizes its classic red and white logo.

And then there’s medicine.

According to the World Health Organization, one-third of the developing world consistently lacks access to medicines considered essential to maintaining a healthy population. And we’re not talking super-advanced drugs here, either: WHO’s list of essentials includes basics like Ibuprofen, Insulin and vaccines—the kind of things most folks in the developed world probably take for granted.

The question is: why can’t pharmaceutical companies flood the world with their products the way Coca Cola does? Coke has figured out a way to get their iconic curvy bottle or stout can into the hands of consumers from Seattle to Singapore. How much better would the world be if drug makers could do the same? After all, they make something people actually need to lead healthy lives, unlike soda.

If only it were so simple. Here’s what it boils down to:

1) Coke is made all over the world. Medicine is not.

Coke’s global success starts with its supply chain. The company says its 250 bottling partners and 900 bottling facilities worldwide constitute the largest beverage distribution network on the planet. Mind you, all those local franchises do more than just bottle the sugary stuff: they actually help tailor the product and how it’s sold to meet local demand.

Drug manufacturing is decidedly less widespread. The overwhelming majority of the world’s drug production takes place in the developed world, as evidenced by the fact that developing countries account for just 6% of all medicine exports.

Granted, that stat isn’t much of a surprise: a lot of countries just don’t have the research savvy or technological firepower required to make modern drugs. With any luck, that will change in time. But here’s the problem: at the moment, developing countries only import 17% of the world’s medicine output, meaning that the countries least capable of producing their own drugs can’t even import enough medicine to make up for it. Which brings me to point number 2...

2) Medicine goes where the big money is. Coke doesn’t have to.

I’m not a business expert or anything, but I know this much: at the end of the day, the number one goal of every company ever is to sell enough stuff to recoup the cost of making it (and then some). That’s every bit as true of Coke as it is of Pfizer or any drug maker you can name. And there’s nothing wrong with that.

Where the Cokes and the Pfizers of the world diverge is in how they go about achieving that goal.

Coke is like a lot of companies who peddle their wares internationally, in that its products are cheap enough to make that the company can sell them at a price most of the world can afford. Throw in Coke’s next-level distribution wizardry, and you have yourself a recipe for world domination.

Drug manufacturers are in a different boat. For one thing, their products typically cost hundreds of millions of dollars to research and produce. Coke’s got some overhead, don’t get me wrong, but that is some serious R&D.

Then there’s the fact that all countries’ drug needs are not alike. In much of Africa, for example, medicines to treat tropical diseases like malaria are in high demand. Folks in the US, by comparison, don’t have those illnesses to worry about, but they do face higher rates of stuff like diabetes and heart disease, courtesy of a more privileged (and processed-food-fueled) lifestyle.

The reality is, what kinds of medicine a country needs most has a lot to do with how well off that country is.

Coke, on the other hand, has—through some combination of marketing and the universality of the human palate—managed to make its signature taste transcend culture and socioeconomic status.

Faced with high overhead and non-uniform demand, then, how’s a pharmaceutical company supposed to satisfy its profit motive?

Short answer: by focusing all their efforts on the diseases wealthier countries get—and neglecting those that mostly affect the poor.

As my colleague John points out in a recent piece, there is a well-documented imbalance—often called the “10/90 problem”—affecting how research money for new drugs gets spent.

Malaria’s a clear example of a disease that got the short end of the R&D stick for this exact reason. The mosquito-borne killer has caused hundreds of thousands of deaths over the years, mostly in Africa, despite the fact that it is entirely preventable and curable. Any idea how many of the 1,200 drugs developed between 1971 and 1996 were for malaria?

Three.  Ugh.  

3) Medicine is stupid expensive.

And then there’s the cost of medicine.

You want to know why Coke is so cheap? Beyond the fact that it’s glorified sugar water, if Coke ever tried to jack its prices, a lot of potential customers would just reach for the nearest competitor. Coke may be iconic, but there are about a million other Coke wannabes nipping at its tail.

Medicine doesn’t work that way. When one company discovers a new drug, all of its competitors are expressly forbidden from coming up with their own versions of said drug for decades under the terms of what’s called a patent.

The best argument in support of drug patents is that they incentivize all the costly R&D required to develop new drugs. Otherwise, why not just wait for some other company to crack the code and then imitate them?

There’s a dark side, however. Until their patents expire and competitors flood the market with cheaper alternatives (often called “generics”), companies are essentially free to charge whatever they see fit.

Simply put, patent law is a big reason why so many people in wealthy countries—let alone in poorer ones—struggle with the cost of medicine. If competition were allowed to drive prices down sooner after drug discovery, people in need would have better access to essential medicines. (Of course, that makes it harder for companies to make back those high R&D costs I mentioned earlier which… well, I think you get the point that this is complex).

So what’s the solution here?

As you can imagine, a problem this complex has no quick fix. That’s why organizations like Doctors Without Borders have been pushing for sensible, multipart approaches to the problem for years.

When it comes to incentivizing research for diseases that target the poor, nonprofits and philanthropic organizations play a huge role. The world’s first-ever malaria vaccine could soon debut thanks in no small part to a US $200 million dollar grant from the Bill & Melinda Gates Foundation.

The good news is that governments aren’t totally powerless when it comes to ensuring access to essential meds. In the event of a public health crisis or other special circumstance, countries can trump the patent system and allow the production of cheaper meds by issuing what’s known as a compulsory license.

In many cases, countries can also import cheaper versions of the same meds without the patent-holder’s consent, a strategy known as parallel imports. Why pay $500 a pill for a patented drug when a $15 generic version is already available in India?

At the end of the day, though, it’s still frustrating to think that we as a global society have figured out how to put a sugary drink within reach of almost every human on the planet, but the same isn’t true of life-saving medicines.

How sweet would it be if we could close that gap?