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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Drug Availability
Africa: Drug Availability
Date distributed (ymd): 000705
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains several documents focused on the need for
affordable essential medicines for treatment of HIV/AIDS and other
diseases.
The first document comes from South Africa's Treatment Action
Campaign, the lead organization behind The Global March for
Treatment Access on July 9, the first day of the AIDS Conference in
Durban, South Africa. The march is supported by international
groups such as Doctors without Borders (Medecins sans Frontiers),
South African trade union leaders and others, with the cooperation
of the conference organizers. The other documents are from a June
conference in Nairobi on "Improving Access to Essential Medicines
in East Africa,"
A related posting today includes the latest updates from UNAIDS,
released prior to the Durban AIDS Conference.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
Why we must struggle to provide treatment for people with HIV/AIDS
By Mark Heywood
Full version posted on AF-AIDS
(
http://www.hivnet.ch:8000/africa/af-aids); Text below slightly
condensed
Treatment Action Campaign (Article from Reconstruct, July 2nd 2000)
http://www.tac.org.za)
Contact: TAC: Promise Mthembu, 27-31-304367, msf-tac@mweb.co.za;
AIDS 2000: Karen Bennett, 27-31-3010400, karenb@aids2000.com; OR
Zackie Achmat, 083-467-1152, zackie@pixie.co.za; Fakzile Myeza, 27-
31-3010400, fakazilem@aids2000.com.
On July 9th the first act to break the silence around HIV and AIDS
at the International AIDS Conference will be a global march to
demand access to affordable and effective treatments for people
living with HIV or AIDS. The march will be led by the Archbishop of
Cape Town, trade union leaders and people living with HIV/AIDS.
Marchers will come from over 50 countries and include thousands
from South Africa. The main messages of the march will be: Health
is a human right! Health is essential to dignity! Stop profiteering
from ill health! Make anti-HIV drugs affordable for all people who
need them!
Most of these demands existed long before the emergence of the
Human Immunodeficiency Virus (HIV). Indeed, the right to highest
attainable standard of health is contained in the Universal
Declaration of Human Rights. But the HIV/AIDS epidemic has brought
the terrible effects of the privatization (piratisation?) of
medicine and decades of neglect of public health to the fore.
Millions of lives now depend upon whether the recognition that
health is a human right is turned into an international plan of
action. ...
For most people with HIV two major obstacles currently block the
path to putting in place a plan that can rapidly (but carefully)
expand access to treatments. These are: Pharmaceutical companies
and their shareholders which set the price of essential drugs, and
Governments who decide public policy on providing treatment for
AIDS. Even though frequently at odds with each other they have
become unholy gate-keepers for millions of lives. Tragically their
actions amount to the same message: you have a right to health care
but only if you can buy it! . To this we respond with the words of
Anglo American Director Clem Sunter: we accept that the rich can
buy a better house or car, but there's something unacceptable about
being able to buy extra years of life.
Pharmaceutical companies
There are many non-medical causes of vulnerability to HIV infection
and to AIDS. Poverty is the most pressing. However, once a person
is infected with HIV access to medicine eventually becomes the
bottom line for long-term survival. During the 1990s many
breakthroughs were made in treatment for HIV and AIDS. However,
responsibility for the emergence of a battery of anti-retrovirals
(drugs that slow down the course of HIV infection) does not belong
to drug companies alone. It belong to a range players, including,
activists who put pressure on drug companies and governments to
invest in research; committed scientists; people with HIV who were
prepared to test the drugs. However, tragically the fruits of this
common effort have landed in the hands of only one of the partners,
powerful pharmaceutical companies, who now maliciously use their
ownership of the end-result and their manufacturing capacity
primarily to make huge profits from the drugs -- thereby making
them unaffordable to 90% of people who need them. Faced with
mounting criticism, these companies use arguments about
intellectual property rights and the costs of research and
development. This is a smokescreen. These arguments fall flat
because the companies cannot support them with evidence on a
drug-by-drug basis of the actual costs of research and development,
manufacturing costs, costs of active ingredients etc. ...
Governments
All over the world governments seem to have given up the battle to
make treatments widely available for AIDS -- before the first shots
have even been fired. First world governments can quickly mobilize
massive amounts of money to fight wars in Yugoslavia and Kuwait.
But their expressions of concern about AIDS in Africa are backed up
with trivial amounts of money. Bombs are easier to manufacture and
distribute than drugs even if they cost more. On the other hand
high drug costs, poor health infrastructure and competing demands
for scare public health resources trip off the tongues of Africa's
Health Ministers as convenient excuses for consigning millions of
people to premature illness and death. Sad to say, South Africa' s
experience offers a case in point. Earlier this month the Minister
of Health, Dr Manto Tshabalala Msimang, launched South Africa's
latest five-year AIDS plan. The plan promises to improve access to
treatment for people with HIV and AIDS. However, this aspiration
still lacks content, vision or a plan. ...
The Minister of Health has courageously lambasted the
pharmaceutical companies for profiteering from AIDS. Together with
her SADC counter-parts she has threatened to use legal measures
such as compulsory licensing to reduce the price of essential
drugs. But, on the other hand, she has refused to countenance the
use of anti-retroviral drugs by people who depend on the public
health service, saying that even if the drugs were affordable,
South Africa's fragile and weak health infrastructure would not
permit their use. This may be true but it can be changed. These
mixed messages dash the hopes of people with HIV. But they also
have other serious negative consequences. The national HIV
prevention strategy aims to encourage more people to volunteer for
HIV counseling and testing. But, put crudely, why go to the doctor,
if you are told in advance that the medicine cupboard will be bare?
...
But above all, it amounts to a dereliction of the government's
constitutional responsibility to promote equality and take
legislative and other measures to improve access to health care .
In this respect, the response to AIDS is curiously at odds with the
approach adopted by the government to dealing with other social
problems. For example, the government has not refused to start
building houses until it can house everyone. It has not refused to
renovate schools until it can renovate every school. In the same
fashion, a plan to provide treatment for illnesses caused by HIV,
could not possibly provide essential drugs to everyone immediately.
But it could quantify and identify needs; it could use the AIDS
crisis as a lever for demanding international funding to more
rapidly improve basic health infrastructure; it could spend less on
defence and more on health; it could insist that AIDS related
opportunistic infections are consistently treated, whilst finances
and facilities are put in place to begin providing more effective
treatments; it could provide drugs that prevent mother-to-child HIV
transmission.
These are the issues that the Global March will aim to bring to the
fore. No supporter of the Treatment Action Campaign believes that
they are easy to resolve. But they will not go away.
Mark Heywood, E-mail 125ma3he@solon.law.wits.ac.za
Treatment Action Campaign
Medecins Sans Frontieres / Health Action International
PRESS RELEASE
NEW STUDY SHOWS EAST AFRICANS PAY MORE THAN EUROPEANS FOR
LIFE-SAVING DRUGS
For information on the international campaign for access to
essential medicines, see the following web sites of MSF
(http://www.accessmed-msf.org) and HAI
(http://www.haiweb.org/news/news.html),
Regional leaders call for action
Nairobi, June 16, 2000 - The international movement to increase
access to life-saving medicines gained momentum today, as
government and civil representatives from Kenya, Uganda, Tanzania,
Ethiopia, and 17 other countries met to devise a regional strategy
at a conference in Nairobi. The conference, "Improving Access to
Essential Medicines in East Africa - Patents and Prices in a
Global Economy," was organized by Medecins Sans Frontieres/Doctors
Without Borders (MSF) and Health Action International (HAI)
"The data presented today confirm our suspicion that Kenyan drug
prices are not only equal to, but actually higher than European
prices," said Kirsten Myhr of Health Action International, who
presented a pricing study at the conference.* "The figures show
that the entire region is suffering from reverse equity - the poor
are paying more than the rich."
Among the many examples cited in the new study is that of the
potent antibiotic, ciprofloxacin, which was found to be twice as
expensive in Uganda as in Norway. Similarly, an earlier study
comparing retail prices of drugs showed the same disturbing
pattern: ten out of 13 commonly used drugs are more expensive in
Tanzania than in Canada. The huge disparity in average income
between the two countries also means that a Tanzanian would have
to work 215 days to buy these 13 drugs, while a Canadian would
only have to work 8 days.
Another telling example is fluconazole, a treatment for
AIDS-related meningitis. In Thailand, where generic competition
has lowered prices, fluconazole costs only USD$0.30. However,
this same drug costs USD$18.00 in Kenya, where it is patent
protected. Dr Christopher Ouma, AIDS project coordinator for
Medecins Sans Frontieres (MSF) in Kenya said: "I am tired of not
being able to treat patients because the medicines are too
expensive. Africans should not be dying because of inability to
pay when effective medicines can be available at affordable
prices. This is already the case in countries such as Thailand,
India, and Brazil."
The causes of high prices of medicines in East Africa include
strong patent protection, high tariffs, taxes, and a lack of
generic competition. The issues of high taxes and tariffs and the
stimulation of generic competition need to be addressed directly
by national governments. Much of the discussion amongst conference
delegates focused on strategies to enact legal safeguards to
remedy abuses by drug companies. Within existing international
trade rules, such safeguards include parallel importing (the right
to shop around for the best prices of branded products) and
compulsory licensing (granting limited production rights to
generic producers).
"Within existing international trade regulations, Kenyans have the
power to ensure that medicines are affordable and accessible,"
said Professor Carlos Correa, an intellectual property expert.
"But, these essential legal safeguards have still not been built
into the Kenyan Industrial Property Bill." This bill is designed
to bring Kenya into compliance with WTO rules and will be
considered by parliament in the coming weeks.
Dr. Amukowa Anangwe, Kenyan Minister for Medical Services,
underlined the need to balance public health needs with private
profit: "It is essential to ensure that the right to issue
compulsory licenses and to allow parallel importing are included
in our national legislation," he said.
Another report presented at the meeting, 'Patent protection and
medicines in Kenya and Uganda,'* calls on governments to ensure
these safeguards and to include the Ministry of Health and health
professionals when negotiating and adopting trade agreements.
* 'Pharmaceutical Pricing: law of the jungle' by Kirsten Myhr,
for Health Action International - June 2000.
* 'Patent protection of medicines in Kenya and Uganda' by Pascale
Boulet, for Medecins Sans Frontieres, June 2000.
Opening speech by Minister for Medical Services, Hon. Dr Amukowa
Anangwe, EGH, MP (excerpts)
Mr Chairman, disease knows no frontiers. It is destroying
individuals, their families, our countries' economies and
ultimately Africa's ability to fight poverty and progress. Despite
the development of new treatments our people are dying from curable
and treatable diseases. People are dying from curable and treatable
diseases.
In the poorest areas of East Africa, up to half of the population
is without access to basic essential medicines to treat life
threatening and chronic diseases.
Africa is facing a daunting human and medical crisis. Every year,
Malaria, Tuberculosis, and HIV kill approximately 5 million people.
We are gathered here to focus on one element of this crisis How
to save lives by improving access to essential medicines. It is
indeed very encouraging to see people from so many countries coming
together to help improve the health of our peoples.
To begin to address the challenge of improving access we first need
'commitment' from all those involved with access to drugs;
governments in both, poor and wealthy countries, international
organisations, the pharmaceutical industry and civil society. We
are counting on this conference to help to build this commitment as
well as to develop new strategies.
Ladies and Gentlemen, we are at the fore-front of the battle
against infectious and 'killer' diseases. The United Nations
estimates that HIV/AIDS affects 24 million people in Africa out of
34 million worldwide. Some 2.2 million people died of AIDS in 1999.
Life expectancy in most affected areas has declined by almost 20%
and more than half of those affected are young people aged between
16 and 24 years of age.
Ladies and Gentlemen, it is a basic human right to be healthy.
Access to essential drugs plays a critical role in fulfilling this
right. This is a priority for Kenya's National Drugs Policy which
aims to ensure that safe and effective drugs reach all segments of
the population at affordable prices. At the same time we
acknowledge that there is a need to facilitate rational use of
drugs, through sound prescribing, dispensing and use of medicines.
Quality assurance of drugs is another challenge. It is for this
reason the National Quality Control Laboratory was established in
1996 to ensure quality control. Kenya has a dynamic local
pharmaceutical industry with the potential to produce quality
generic drugs. This creates interesting opportunities and we aim to
encourage self sufficiency through local manufacturing of drugs for
domestic use and for export. In the last five years we have made
significant progress, but we still have a long way to go to improve
access to medicines.
During the 53rd, World Health Assembly, which was held last month
in Geneva, Switzerland, Dr. Gro Harlem Brundtland, the WHO
director-general, expressed concern over inaccessibility of
important drugs to millions of people who need them most: 'they
might as well be on another planet'.
The Kenyan government agrees with Dr. Brundtland. We are living in
an era, which is marked by the most spectacular scientific
innovations benefiting people's health. In this era, it is
unacceptable that millions of people are denied access to
medicines, which could save their lives. It is time to take action,
to balance public health and private and commercial interests.
Medicines should not be regarded as any other product. We should
ensure that public health is made a priority when translating
international trade treaties into national law.
At this year's World Health Assembly, the African Ministers of
Health issued a statement on access to HIV/AIDS drugs. We welcomed
the recent UN and private industry proposal to lower the prices of
anti-retroviral medicines for people living with AIDS. But, the
ministers also called for an approach, which will ensure that any
such reductions will enable people to have access to drugs on a
sustainable basis.
Mr. Chairman, Ladies and Gentlemen, the World Trade Organisation
agreement on trade-related aspects of intellectual property rights
the so called TRIPS agreement is the most important
international agreement on patents, copyrights and trademarks.
However, TRIPS increases patent protection and patents can push the
prices of new medicines up. As the patent-holder has a monopoly, he
can ask whatever price he wants. The rich can afford, the poor
cannot.
People with AIDS related meningitis in Kenya, for instance, are
dying because the price of the only effective treatment is beyond
their means. Patent protection keeps the price high treatment for
one day costs 18 US dollars in Kenya, compared to 0.30 US cents per
day in Thailand. In Thailand, the medicine is not patent protected,
and is produced locally.
For the average Kenyan earning 300 US dollars per year, US 18
dollars per day treatment is absolutely out of reach.
Patents reward years of research and development. They are at the
same time supposed to benefit the public. The TRIPS agreement helps
create a balance by providing for exceptions to exclusive rights
to protect public health. It is important that governments make use
of these exceptions, by including them in their national laws.
A first exception is compulsory licensing which enables governments
to issue licenses to national producers without the permission of
the patent-holder. This can lead to a seventy-five per cent drop in
prices.
Secondly - Parallel importing allows buyers to go in search of the
cheapest supplier of patented medicines. So that if for example,
the foreign company that holds the patent is charging less in South
Africa than Kenya, we could buy the same drug at the lower price
from South Africa.
In principle, patents are supposed to encourage research and
development. But in the global drug industry there is a bias toward
diseases in rich countries such as the lifestyle disease of being
overweight. Research is expanding to help people lose weight, but
the diseases that are killing our people are forgotten.
Take the example of malaria, which claimed more than one million
lives last year worldwide. Although malaria accounts for 3% of
illness in the world, only 0.1 % of the world's research funds were
devoted to it.
Malaria is a major public health concern in Kenya. Every day, 72
children under the age of five die of the disease. And malaria is
increasingly resistant to existing drugs. However, because of the
lack of research, new treatments are extremely sparse. There is
evidently, too little profit to be gained from the 300 million poor
people who have fallen victim to this disease.
Now, lets look at the big picture in terms of TRIPS. All members of
the WTO are obligated to adapt their national laws to the TRIPS
Agreement. Developing countries like Kenya had until January 2000.
Least developed countries like Uganda and Tanzania have until
20006. If countries do not become TRIPS compliant by those
deadlines, they could face trade sanctions.
Kenya applied for an extension to the January 1, 2000 deadline for
TRIPS implementation, but this was refused. Last May, the revised
Kenyan Industrial Property Bill, 2000, regulating intellectual
property rights in Kenya, has been published. The Bill, will soon
go to parliament to be discussed and adopted. This will make Kenya
the first country in East Africa to become TRIPS compliant.
As the process begins, the Ministry is committed to balance patent
protections with public health needs, to ensure access to
medicines. For this reason, it is essential to ensure that the
right to issue compulsory licenses, and to allow parallel importing
are included into our national legislation. We hope that our
legislation may then inspire other legislators in the region. ...
This material is being reposted for wider distribution by the
Africa Policy Information Center (APIC). APIC provides
accessible information and analysis in order to promote U.S.
and international policies toward Africa that advance economic,
political and social justice and the full spectrum of human
rights.
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