|
Independent research & practical ideas for global prosperity
|
|
|
|
Independent research & practical ideas for global prosperity
|
|
Posts:August 18, 2008Le Raison de Résistance: Substandard TB Drugs Found in South AfricaBy cgdadminThe Times of South Africa recently reported the recall of two TB drugs, manufactured by Pharmascript, after the national health department found them to be substandard. Initial tests at the local WHO laboratory found they did not contain the needed amount of active ingredients, as claimed on the label, and concluded that they “would most likely not have effectively treated ‘thousands’ of TB patients.” The author, Yazeed Kamaldien, seems to find solace in the fact that “these drugs are used only to treat primary TB, however, and not other cases, such as multi-resistant TB.” He appears to completely misunderstand a primary cause of MDR-TB (multi-drug resistant TB) and drug resistance in general. While he is correct to breathe a sigh of relief that this discovery will, hopefully, not cause any MDR-TB cases to become the virtually untreatable XDR-TB (extremely-drug resistant TB), episodes such as this undoubtedly increase the risk of resistance among uncomplicated, primary TB patients. As MDR-TB can cost up to 300 times as much (in time, money and human resources) to treat as primary TB, these errors can put incredible strain on an already weak health system. Comment »January 28, 2008Agriculture & ACTs: New USAID Working PaperBy cgdadminThe market for artemisinin-based combination therapies (ACTs) for malaria is notoriously complicated, and has received a great deal of recent attention as the subject of the proposed Affordable Medicines Facility-malaria. But in order to truly understand the complexities involved – and the potential impact of donor interventions – the global health community would do well to consider the entire value chain for ACTs and the implications for the agricultural market as well. Over the past several years, an entire industry has emerged to supply the active biological ingredient, Artemisia annua, but has received relatively little attention from the malariologists, who have typically focused further downstream. USAID agricultural economist Dana Dalrymple has been following this topic closely and has summarized his findings and observations in an ongoing working paper, “Agriculture, Artemisia, ACTs and Malaria Control in Africa: The Interplay of Tradition, Science and Public Policy.” I highly recommend a thorough read of the most recent draft, which paints a truly comprehensive picture of the critical linkages between agricultural and medical market dynamics. As this is still a work in progress, Dr. Dalrymple warmly invites comments and suggestions from the broader global health community. Feedback should be sent to ddalrymple@usaid.gov. Please consult Dr. Dalrymple before quoting, citing or reproducing any part of the paper. Comment »January 15, 2008User Fees for Health Goods and Services: Con & ProBy cgdadminOn Wednesday we at CGD had the pleasure of hosting Jessica Cohen for a presentation of her Brookings Working Paper authored jointly with Pascaline Dupas and entitled Free Distribution vs. Cost-Sharing: Evidence from a Malaria-Prevention Field Experiment in Kenya. This paper gives us the opportunity to continue the interesting dialogue on the role of user fees in the delivery of services to the poor that kicked off here last July with a blog on a paper by Nava Ashraf, James Berry, and Jesse Shapiro of the MIT Poverty Lab. That blog accumulated comments through the end of the year, some of which supported the selective use of user fees and some of which argued for their abolition. Jessica’s clear slide presentation, which she kindly allowed us to post, lays out the elements of their experiment (also see the useful blog on Wednesday’s presentation by Abigail Keene-Babcock of the World Resources Institute). Supporters of the abolition of user fees will draw comfort from Cohen & Dupas’ finding that demand curves slope down – poor expectant mothers are more likely to accept an offered mosquito net if the price is 10 Ksh rather than 40. Whether the mothers are more likely to accept the net at a price of zero than at a price of 10 KSh is less clear since one of the authors’ estimates says “no” (Table 2, column 6 of their working paper) while another estimate says “yes” (Table 3, column 4). The authors dismiss the Table 2 estimate as due to faulty data, but I would like to see a more thorough attempt at reconciliation of the two estimates. Comment »January 17, 2007Budget Cuts & Lost TrustBy cgdadminIn spite of the endless analysis and hovering media attention during the new Congress’s “100 hours,” one of the first major budget decisions has somehow gone largely unnoticed: the Democrats decided to nix the Republican’s 2007 budget request and continue funding programs at FY06 levels. As Desmond Tutu wrote in Monday’s Washington Post, the effects of this decision could be tragic for many Africans infected or affected by HIV/AIDS: Staying at 2006 funding levels would result in a loss of up to $700 million for the 15 PEPFAR focus countries. As a result, 280,000 fewer people will be put on AIDS treatment. That is 280,000 lives needlessly lost. At a recent event at the Global Health Council, the US Global AIDS Coordinator, Ambassador Mark Dybul, sounded a similar warning about lost AIDS funding, noting that the greatest cost of funding cuts might not be the lives lost, but rather the broken trust between US government officials and the recipient country governments. From the time the President’s Emergency Plan for AIDS Relief was first announced, it was modeled on the concept that AIDS funding would increase significantly for five subsequent years. Governments, NGOs and contractors working on AIDS within the focus countries were asked to plan accordingly and to make time-consuming preparations to ensure that the money arriving could be used effectively. But now four years into PEPFAR funding, governments and other implementers are suddenly being told that there may be no funding increases after all. Dealing with the fallout from this sudden change of course could be extremely difficult; as Ambassador Dybul says: We have heard from governments that if we don’t meet our ‘07 commitment, they don’t see any reason to believe we’ll ever have a commitment for them. They certainly aren’t going to trust anything we say about 2009 when the Emergency Plan ends. The chilling effect long term for scale up is almost beyond comprehension in our view because of that delay. Comment »January 11, 2007Outwitting & Outwaiting ARV ResistanceBy cgdadminIn the best health news of the year (so far!), a new New England Journal of Medicine study has found that delaying the start of a nevirapine-based antiretroviral therapy by six months can prevent the development of drug resistance in HIV-positive women who took single-dose nevirapine during labor to prevent mother-to-child transmission of the virus. (See the Harvard and NIH press releases and coverage in the NY Times and Boston Globe for more details.) This exciting finding makes for a nice complement to the malaria ACT subsidy proposal and research on the re-emerging effectiveness of chloroquine as part of a new resistance dialogue focusing on policy recommendations to make existing drugs last longer and not just blindly relying on our ability to develop new ones. Comment »December 4, 2006GAVI Commits to Funding for Pneumococcal & Rotavirus VaccinesBy cgdadminAt its latest meeting, the GAVI Alliance board committed $200 million to support the introduction of new vaccines against rotavirus and pneumococcal disease in developing countries; the Washington Post subsequently ran an editorial in support of the decision. Comment »November 1, 2006WHO Virtual Hearing on IP & Innovation in HealthBy cgdadminAt the last World Health Assembly in May 2006, the WHO member states passed a resolution establishing an intergovernmental working group to “develop a global strategy and plan of action including to provide a framework to enhance research and development into diseases that disproportionately affect developing countries,” which will meet for the first time December 4-8 under the leadership of Dr. Howard Zucker, the Assistant Director-General for Health Technology and Pharmaceuticals at WHO, and supported by a dedicated secretariat (see the WHO press release for more details). This effort builds on the recommendations laid out in the report of the Commission on Intellectual Property Rights, Innovation and Public Health, which Owen has previously discussed here and here. In advance of the upcoming Working Group meeting, WHO has now launched a virtual public hearing to solicit feedback from individuals, civil society groups, government institutions, academic and research institutions, the private sector and other interested parties on the proposed plan and related issues for consideration. Submissions will be accepted through November 15. Comment » |
|
|
CENTER FOR GLOBAL DEVELOPMENT
1800 Massachusetts Avenue NW, Third Floor
Washington DC 20036
Tel 202.416.4000 | Fax 202.416.4050
|
|
|
Print
Share
