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Note: This document is from the archive of the Africa Policy E-Journal, published by the Africa Policy Information Center (APIC) from 1995 to 2001 and by Africa Action from 2001 to 2003. APIC was merged into Africa Action in 2001. Please note that many outdated links in this archived document may not work.


Africa: Treatment Access Update, 1

Africa: Treatment Access Update, 1
Date distributed (ymd): 010419
Document reposted by APIC

Africa Policy Electronic Distribution List: an information service provided by AFRICA ACTION (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Find more information for action for Africa at http://www.africapolicy.org

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +economy/development+ +health+

SUMMARY CONTENTS:

This posting contains a brief Africa Action commentary by director Salih Booker on the withdrawal of the drug company law suit against South Africa. It also includes two documents from the workshop on drug pricing held on April 8-11, 2001 in Hosbjor, Norway, organized by the World Health Organization, the World Trade Organization, the Norwegian Foreign Ministry, and the Global Health Council. The documents included are a statement by five non-governmental organizations after the workshop and the official press release from the workshop.

Additional background on the Norway workshop can be found at: http://wto.org/english/tratop_e/trips_e/tn_hosbjor_e.htm

An extensive analysis of the current status of drug-pricing by Jamie Love of the Consumer Project on Technology, entitled 'How to Help the Poor, Really (and how not to), prepared for the Norway workshop, can be found at:
http://lists.essential.org/pipermail/pharm-policy/2001-April/000923.html

For documentation on the South African court case, see the web site of the Treatment Action Campaign
(http://www.tac.org.za/archive.htm).

An additional posting today has a press release on next week's OAU summit, an NGO commentary on the proposed UN statement of position on treatment for the UN Special Session, and a brief update on new World Trade Organization discussions on intellectual property rights and drug patents.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

AFRICA ACTION COMMENTARY

April 19, 2001

The decision by multinational drug companies to withdraw their suit against South Africa is a major victory for Africans and people around the world who support Africans' equal rights to health. Coordinated worldwide protests have had a profound impact.

At the same time, this victory does not yet bring treatment to those in need. International agencies as well as African governments are moving to recognize that treatment is necessary and not optional. But meetings in the weeks since the South African case opened on March 5 still reveal pervasive ambivalence about what needs to be done, reluctance to open the doors widely for lowest-cost generic production, and a false dichotomy between treatment and prevention.

The Organization of African Unity hosts a summit on HIV/AIDS and other diseases next week. The United Nations is in the last stages of preparation for the UN Special Assembly Session on HIV/AIDS in June. These meetings will set the tone for governmental and intergovernmental policies over the next year. It is essential that they avoid vague language and clearly affirm the universal right to health, the legitimacy of low-cost generic medications, and the global obligation to fund both treatment and prevention for HIV/AIDS as part of a strategy to prioritize public health as a fundamental human right.

Once the principles are established, the real tests will come in practice. Are the funds quickly appropriated and spent not only for drugs (at the lowest possible cost) but also for infrastructure to address treatment, prevention and the underlying social injustices that are fueling the AIDS pandemic?

Let's celebrate the victory. And let's keep the pressure on.

Salih Booker
Director, Africa Action


Joint Statement of Consumer Project on Technology (CPT), Health Action International (HAI), Medecins sans Frontieres (MSF), Oxfam and Treatment Action Group (TAG) on the WTO/WHO on Differential Pricing & Financing of Essential Drugs

April 11, 2001

Hosbjor, Norway - Representatives of the five non-governmental organizations (NGOs) who participated in the three day WHO / WTO Workshop on Differential Pricing & Financing of Essential Drugs issued the following joint statement on the goals, proceedings, and outcome of the workshop.

The WHO/WTO workshop provided a new forum for health and trade experts to come together to work on eliminating trade barriers to long-term, affordable drug access. However NGOs expressed disappointment about the fact that no real progress was made to bring drug prices for essential drugs in developing countries down.

NGOs present at the meeting stressed that one proven effective way to bring prices down is to increase competition by encouraging generic competition.

In June following an initiative of a group of African countries a special session of the WTO TRIPS Council will be devoted to health. For the first time countries will discuss how the requirements of the TRIPS Agreement can be reconciled with health needs in developing countries. NGOs will work together to ensure that their proposals voiced at this workshop in Norway are addressed at the upcoming WTO TRIPS Council meeting in June 2001 in Geneva. These proposals include a call on the TRIPS Council to extend the deadline for the least developed countries to comply with the TRIPS Agreement and to design mechanisms to ensure R&D for neglected diseases in developing countries.

Comments on the Meeting - Progress & Frustration

A diverse group of stakeholders including rich and poor country governments, multilateral UN agencies, multinational pharmaceutical companies and generic drug companies, and NGO representatives gathered to discuss whether differential pricing of essential drugs could be used as a tool to expand access in developing countries while preserving incentives for future drug development.

The meeting focused on differential pricing, which the NGOs feel can be a crucial tool to help broaden access to affordable medicines in developing countries. But differential pricing mechanisms cannot come with onerous conditions attached, such as forcing poor countries to surrender their rights guaranteed under the TRIPS agreement.

Besides differential pricing, other tools -- such as voluntary licensing, compulsory licensing, and parallel importing - are available to help broaden access to affordable medicines.

After 2 + days of discussion not a single company disclosed plans to actually implement differential pricing for their drugs. Current offers for AIDS drugs are ad hoc, inadequate, and still far below the prices that can be obtained from generic manufacturers. CPT's Jamie Love said, "It's ironic that in a meeting organized to help the poor, the main drug company proposals were to increase intellectual property protection and ask for the elimination of national price controls. At one point, Oxfam actually offered to give the industry a grant, since they were pleading poverty."

The Way Forward -- Global Access to Essential Medicines

The NGOs issued a series of recommendations to enhance research and development (R&D) and to ensure that intellectual property (IP) protection, serves public health needs rather than the reverse. The NGOs stressed that there is no single solution; rather, a mix of mutually supportive strategies will be required to assure dramatically reduced drug prices in developing countries. Policies to achieve this goal should:

  • be sustainable and not be solely based on charity or donations
  • strengthen developing countries' autonomy
  • attract donor funding
  • include all essential medicines and should not be limited to drugs for HIV/AIDS and related conditions only.

Greater Competitiveness Helps Lower Drug Prices

MSF's Ellen 't Hoen made the following proposals at the meeting:

Equity pricing strategies should not depend solely on voluntary offers by the multinational drug firms. Hitherto, most drug companies have preferred low-volume-high price strategies. Equity or differential pricing should be combined with mechanisms to increase competition and encourage sustainable approaches. For example, it should not have a negative effect on the development of a generic industry in the South.

One proven effective way to decrease drugs prices is to increase competitiveness:

  • In Brazil, antiretroviral prices for certain anti-HIV drugs came down by 82% within five years after Brazil initiated local production and provided universal free HIV treatment to Brazilians who needed it.
  • Recent offers from generic producers have sparked a price war for antiretrovirals and have brought the annual price for triple therapy down from $10,000 to $350 in a single year.

The need for competitive markets will require flexibility in implementation and a pro public health interpretation of the TRIPS agreement. The NGOs welcome a special TRIPS Council meeting as proposed by a group of African countries and which will take place in June 2001.

Global procurement strategies and funding should include measures to increase and upgrade generic production in the south.

Voluntary licensing and compulsory licensing can help increase the number of generic producers in the market.

Voluntary licensing agreements have the added advantage that they would effectively deal with the companies' fear that low-priced drugs in developing countries might flow back into high income country markets.

Research & Development

The NGOs called for a new global Convention on research & development, designed to strengthen both public- and private-sector research. At every gathering to discuss access to medicines, the big pharma companies raise the specter that any effort to help the poor will harm R&D. Some claim proposals to lower drug prices in developing countries, including the use of compulsory licensing of patents on essential medicines, may lower their profits. The idea of the Convention is to create new mechanisms to boost global R&D funding in ways consistent with access to medicines and health needs by encouraging research on neglected diseases. Country support for R&D funding could take a variety of forms, including publicly funded R&D, mandatory R&D requirements for companies, or the big pharma solution, which is high levels of patent protection and high prices.

The NGOs will ask the World Health Assembly in May to request the WHO to convene the negotiations by the end of the year.

The NGOs noted with interest the proposal by Jeffrey Sachs of Harvard University, who addressed the workshop by video uplink, for a global infectious disease prevention and treatment fund which would pool resources from rich countries to provide access to low-cost drugs for HIV/AIDS, tuberculosis, and malaria. However, they opposed any effort to link the endowment of such a fund to conditions such as the surrender by developing countries of their rights under TRIPS to utilize compulsory licensing, parallel imports, and other mechanisms to assure sustainable access to low priced, high quality essential medicines.

The NGOs will continue working to support the development of an effective, long-term, sustainable, global strategy and a drug procurement and distribution system to provide affordable drugs for people with HIV/AIDS in developing countries.

For additional information please contact:

CPT - James Love: + 1 202 3613040 (mobile)
HAI - K. Balasubramaniam (Malaysia) - + 603 77261599
MSF - Ellen 't Hoen: + 33 6 22375871 (mobile)
Oxfam - Phil Bloomer: + 44 186 5312251 mobile: + 44 7720259769
TAG - Mark Harrington: + 33 1 43267246


11 April 2001

Joint WTO-WHO-Norwegian Foreign Ministry-Global Health Council press release

http://www.wto.org/english/news_e/pres01_e/pr220_e.htm

Hosbjor, NORWAY - Making life-saving medicines more affordable for poor countries is vital for improving public health. More importantly, it is realistic, experts said in a three-day workshop that ended today (11 April 2001).

In particular, 'differential pricing' - companies charging different prices in different markets according to purchasing power - is a feasible means of achieving this, provided certain conditions are met.

That was a widely held view among a diverse group of 80 experts from 21 countries and a wide range of professional backgrounds, participating in a workshop organized jointly by the World Health Organization, World Trade Organization, Norwegian Foreign Ministry and Global Health Council, a broad-based US organization in the healthcare field.

The workshop examined in detail ways to reduce pharmaceutical prices in low-income countries and how to increase financing so that the world's poorest people can obtain necessary medicines and healthcare. HIV/AIDS, malaria and tuberculosis featured prominently, but a wide range of other diseases that affect poor people were also discussed.

WHO Director-General Gro Harlem Brundtland said the meeting had been constructive and helpful.

'It is clear that the price of medicines does matter - especially for people in poor countries,' she said.

'We heard from the experts that much lower prices can be achieved for the poorest countries. Equally important is strengthening health systems, and, for the poorest countries, securing additional international financing,' Dr Brundtland said.

Participants attended as experts in their own right. They came from: developed and developing country governments; international research-based companies; generic pharmaceutical companies from Asia, Africa and Latin America; non-governmental organizations; consumer and treatment groups; universities; and international organizations.

'Although participants clearly approached the issues from different points of view, there was broad recognition that differential pricing could play an important role in ensuring access to existing drugs at affordable prices, particularly in the poorest countries, while the patent system would be allowed to continue to play its role in providing incentives for research and development into new drugs,' said Adrian Otten, director of the WTO's Intellectual Property Division.

Two of the organizers, the WHO and WTO, will each report on the outcome to forthcoming meetings in their organizations to be held in the next few months. In May, the WHO holds its World Health Assembly, and in June the WTO's Council on Trade-Related Aspects of Intellectual Property Rights (TRIPS) will hold a special discussion on intellectual property and access to drugs.

All participants will be able draw on the ideas and experiences exchanged in the workshop, for use in their own work, together or separately.

Differential pricing has already been achieved for commodities such as vaccines, contraceptives and condoms through a combination of high-volume purchasing, reliable and adequate financing, advocacy, corporate responsibility and market forces.

The challenge is to find ways to expand this to life-saving medicines. The participants accepted that there is no single formula to achieve this. A wide mix of options is needed, they said.

'Intellectual property rights stimulate development of new medicines, but must be implemented in an impartial way that safeguards public health. We also need to ensure that there are additional incentives for the development of the drugs needed to address the health problems of people in poor countries,' Dr Brundtland said.

Among the ideas emerging from the meeting were:

Differential prices

Differential pricing would allow companies that make patented drugs to recover most of the costs of research and development in richer markets and at the same time to sell or license production at lower prices in lower-income countries. Advocates said this could be a win-win solution if consumers in richer countries do not face higher prices as a result.

Critical to the success of this would be methods of preventing lower priced drugs from finding their way into rich country markets. A number of speakers were also concerned that lower prices in development countries should not be used as reference points for price controls in industrialized countries.

Options for appropriate strategies suggested in the workshop included: creating the right conditions so that the market determines differential pricing; discounts negotiated bilaterally between companies and purchasers (which could include bulk purchasing on behalf of many customers); licences agreed voluntarily between patent owners and generic manufacturers; and global procurement and distribution systems.

Competition and generic drugs

Several speakers also felt that generic drug manufacturers play an important role in bringing competition to pharmaceutical markets and improving production efficiency, which would reduce prices further.

Intellectual property and TRIPS safeguards

Participants acknowledged that intellectual property protection is an important incentive for research and development into new drugs. Some said there are also other ways to encourage research and development.

At the same time, countries need to be able to make use of the public health safeguards built into the TRIPS Agreement - including compulsory licensing (governments allowing others to produce a patented invention without the patent owner's permission) and 'parallel' imports (i.e. imports of products supplied by the patent owner or a licensee at a lower price in another country).

Financing

When drug prices fall - and many low priced essential drugs are already available - there is still no guarantee that poor communities can afford them. This is particularly true for HIV/AIDS drugs. Even with costs coming down to $500 per patient per year, this is well beyond the reach of the many countries whose total health expenditure is less than $10 to $20 per year. In these cases, significant amounts of external financing is needed.

Many of the participants also said financing for drugs should not be considered in isolation. They called for massive increases in finance to develop effective healthcare systems in general, including training, education and delivery, as well as for buying the drugs.


This material is being reposted for wider distribution by Africa Action (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Africa Action's information services provide 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.

URL for this file: http://www.africafocus.org/docs01/acc0104a.php