Archive for October, 2006

October 13, 2006

AIDS & Trade in Thailand

Posted by Mead Over in HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases

Should Thailand sign a bilateral Free Trade Agreement with the U.S.? That would be a tempting idea to any Thai who works for a firm selling to the U.S. market. And Thai consumers would value the reduction in the prices of U.S. imports to Thailand. But there would be at least one important drawback for Thailand of signing an FTA: the government commitment to treat all people with AIDS might cost Thailand as much as $3.2 billion more over the next 20 years, according to a recent World Bank analysis. The possible effects of the FTA on Thailand’s AIDS program will be the focus of discussion at a CGD event next Monday.

Along with Brazil and Botswana, Thailand has been at the forefront of developing countries in making AIDS treatment freely available to all who need it. By authorizing their own pharmaceutical firm to produce a generic version of patented AIDS drugs, Thailand has been able to afford to put almost all of its estimated 80,000 patients on so-called “first-line” therapy. Unfortunately, all patients on AIDS treatment will eventually develop resistance and require second-line drugs when the first-line drugs stop working. This is where the proposed FTA with the U.S. will raise difficulties. Even if the U.S. grants Thailand the right to continue producing generic first-line drugs, any effort by Thailand to expand production of generics to include the second-line drugs might be disallowed by a treaty that bans compulsory licensing.

So what should Thailand do? The benefits of the FTA to Thailand must be weighed against all the costs, including the potential additional $3.2 billion in the cost of second-line AIDS treatment. Since Thailand exports about $17 billion to the U.S. each year under the current trade arrangement, even a 2% or 3% increase in these exports from an FTA would be worth more than enough to offset the $3.2 billion in extra AIDS drug expenditures. But once having made the decision to accept the FTA, the Thai would then have to face the decision of whether to spend the extra money on AIDS treatment, rather than other important government programs, with interest group politics ultimately determining the outcome. So it would be easier for Thai AIDS patients and for the Thai health ministry if the FTA included an exception for AIDS drugs — or were never signed at all.

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October 13, 2006

Iraq Body Count: Don’t Ask, Don’t Tell

Posted by Ruth Levine in Global Fund

At the intersection of global health and politics is the most recent estimate of excess deaths among Iraq’s population, published in the Lancet, by researchers from the Johns Hopkins School of Public Health. The estimate of about 650,000 deaths, with an uncertainty range of roughly 300,000 to 900,000, has been summarily dismissed by government officials who cite far lower mortality estimates from sources that depend on limited counts (Baghdad-only) and/or ad hoc methods of measurement (toting up casualties in media reports). The new figures have also been derided in parts of the blogosphere, with outraged commentaries based in part on the proposition that public health is a bastion of left wing ideologues. However, as highlighted by the Chicago Tribune’s Judith Graham, one the few journalists who took the estimates seriously enough to talk to a range of experts in survey methodology and statistics, this may well be the best estimate out there; few if any other estimates are based on any scientific method whatsoever.

The U.S. Administration, despite its elaborate efforts to quantify the benefits of state-building (.pdf), has made no serious attempts to scientifically estimate the direct and indirect civilian casualties in this war. And the Congress appears to be more interested in budgeting for a $20 million celebration of the war than in devoting a few dollars to get a decent estimate of the losses.

Discourse in public health, particularly when it’s about the health of the public in countries other than our own, is often a numbers game. “What counts is what gets counted” when real-world, highly contentious policy questions are answered by invoking body counts. The number of deaths and/or illnesses from particular causes or in certain countries is used to justify priorities in resource allocation. Just watch the advocacy for AIDS, TB and malaria to see this in action.

It is right that facts should inform how much money we spend and how we spend it. And when information is so important for policy making, we have to place priority on getting the numbers as close to right as possible, so they become tools for good decisions not instruments of advocacy. Investments must be made to develop and apply methods that are widely vetted, and to collect and analyze data in way that is beyond the influence of a particular political perspective.

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October 13, 2006

LA Times on the vaccine market

Posted by in HIV/AIDS and other Infectious Diseases, Intellectual Property Rights, Pharmaceuticals & Health Products

This morning’s Los Angeles Times ran an editorial on the state of the vaccine industry in light of Pfizer’s acquisition of PowderMed:

Two years ago, the closure of one British vaccine plant wreaked havoc on the world’s ability to respond to the flu. The investments by Pfizer and others show how market forces, in concert with the nonprofit and public sectors, can work in the public interest

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October 12, 2006

Pascal Lamy addresses IFPMA in support of compulsory licenses

Posted by in HIV/AIDS & Infectious Diseases, News

WTO Director-General Pascal Lamy gave the keynote address at the 23rd Annual Meeting of the International Federation of Pharmaceutical Manufactures and Associations (IFPMA) yesterday. While focusing primarily on the “stalled” Doha negotiations, he acknowledged many of the efforts that pharmaceutical companies are doing to increase access to medicine and subtly promoted the use of compulsory licenses for developing countries:

I would like to thank you and your governments for the continuous efforts to increase and improve access to cheap medicines, including the recent proposal by Switzerland and the United States to expand the membership of those Members willing to bring import tariff duties to zero on medicines. This type of measures can reduce the cost of healthcare through the substantial elimination or reduction of tariffs and specific non-tariff barriers affecting the trade in medicines. In fact, the Uruguay Round zero duty initiative for pharmaceutical and medicine products has been the most successful sectoral initiative: its coverage has increased and so has its membership. Together with the new WTO provision on access to medicine allowing for compulsory licenses by poor countries that do not have any manufacturing facilities, these initiatives can make an important difference in saving people’s life or in ensuring that more people can afford minimum medical treatment. And providing the evidence that trade can work to improve health conditions which we know is essential to economic and social development.

I have always believed deeply in the need to offer more protection to weaker victims of globalization; and as diseases cross frontiers — in fact we now speak of the “sovereignty of disease” over that of States — our globalized world response must always remain ultimately focussed on human beings. And this is one of the reason why I have personally invested so much in the debate on access to medicines. And thanks to all of you, I hope we’ve made it possible now.

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October 11, 2006

New HIV/AIDS Buffer Stock Service for Africa

Posted by Ruth Levine in HIV/AIDS & Infectious Diseases, Vaccines

Here’s an idea that’s easy to like: Set up a warehouse in Johannesburg stocked with AIDS drugs that can be shipped on an emergency basis to virtually any country in Africa when treatment program runs out of supplies. That’s what the non-profit Dutch group, IDA Solutions, has just received a license to do — and they can do so without having to deal with the registration and patent restrictions that would be in effect for drugs intended for use in South Africa, so they can bring in relatively low cost generics.

This is indeed a good, short-term solution to deal with problems in the global supply chain for drugs. But far more is needed to respond to the challenge of getting life-saving and life-extending products to those who need them. With the large amounts of new money aimed at purchasing health products — from the Global Fund to UNITAID to PEPFAR and more — the conversation has to shift from one about getting more money to one about using that money as effectively as possible, given a realistic assessment of health system weaknesses that will take long-term support and political will to address.

Programs run out of drugs because the capacity to forecast demand, manage inventory and conduct procurement activities is extremely limited in many countries — and because donor funding can be erratic and difficult to access in a timely manner. These are problems that need to be diagnosed well, and then systematically solved by thinking beyond the AIDS programs alone, and identifying ways in which both donor funding and public health programs can be oriented to provide a reliable supply of many different kinds of health products, from vaccines to anti-malarials to bednets.

Finding a way to provide drugs when stock-outs occur is a good first step. Now we need to prevent those stock-outs in the first place.

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October 11, 2006

Novartis reduces the price of anti-malarials below costs

Posted by in HIV/AIDS & Infectious Diseases, Intellectual Property Rights, Pharmaceuticals & Health Products

Amid talk of a global subsidy for anti-malarials (proposed by the Institute of Medicine and under consideration by UNITAID), Novartis recently announced that it would reduce the price of its artemisinin combination therapy, Coartem, from $1.57 to just under $1 by subsidizing its production by more than $10 million per year in order to increase access within developing countries. While this sounds like good news — and it is, in the very near term — it should strike fear into the global health community when a pharmaceutical CEO decides to provide products “below our costs,” especially coming on the heels of Sanofi-Aventis‘ tragic decision to trash 10 million doses of their own surplus ACTs.

I hope that this move is a strategic financial decision by Novartis to “prime the pump” by boosting demand and scaling up the supply chain for Coartem now in anticipation of a future global ACT subsidy; otherwise, it bears out the already deep-seated belief by pharmaceutical companies that the market for anti-malarials and other products for developing countries is not profitable enough to merit investment in R&D, and will deter them from doing so. But the sunny, charitable rhetoric of the press release was belied by CEO Daniel Vasella’s blunt statements to the Wall Street Journal and Financial Times (subscriptions required):

“We have no model which would [meet] the need for new drugs in a sustainable way…You can’t expect for-profit organisation to do this on a large scale. If you want to establish a system where companies systematically invest in this kind of area, you need a different system.”