Global Health Policy
Posts in: Drug Resistance
December 28, 2009
A Public Health Time Bomb
Posted by Rachel Nugent in Drug Resistance, Global Health, Health Product Innovation and Access, Pharmaceuticals & Health Products Tags: Drug Resistance
Emma Back and Alix Beith, consultants to the CGD Drug Resistance Working Group, contributed to this post.
There’s a lot of attention being paid to the counterfeit drug trade at the moment. Former President of France, Jacques Chirac, recently chaired a meeting with West African leaders to discuss how to crack down on counterfeiting. Meanwhile, the Wellcome Trust and the American Pharmaceutical Group held an Opinion Formers’ conference on counterfeit medicines (presentations here); the International Federation of Pharmaceutical Manufacturers and Associations produced a brief on the issue; and Roger Bate has continued to draw attention to counterfeits and other drug quality issues in developing countries, including through his book Making a Killing. And this is all on top of the WHO-hosted IMPACT initiative on counterfeits, which started in 2006.
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April 16, 2009
Double Bonus: Novartis Antimalarial Coartem Receives Both FDA Approval and First Priority Review Voucher in History
Posted by Scott Kniaz in Drug Resistance Tags: Drugs, Incentives/Financing, Malaria
Exactly one week ago, the FDA gave the nod to Novartis’ antimalarial drug Coartem, simultaneously granting it the first Priority Review Voucher (PRV) in FDA history. As reported in this blog several times before, the PRV program was enacted by an amendment to FDA law in September of 2007. The amendment gives FDA the authority to award a PRV to the sponsor (company/entity) of a newly-approved neglected disease product application. The fully-tradable voucher can then be used to obtain a priority (6 month) review for another product application of its choosing†. More…
April 13, 2009
China-Gates Foundation Program to Tackle TB
Posted by Rachel Nugent in Drug Resistance, Gates Foundation Tags: Drug Resistance, Gates Foundation, Health Systems, TB
The Gates Foundation and the Government of China recently announced a partnership to fight TB in China that is so multi-dimensional (a scaled-up diagonal health program) and so audacious (more so than the malaria eradication target proclaimed by the Gates’ two years ago) that it just might work! The Gates Foundation is putting $33 million on the table, and the Chinese are promising to change the way they deal with TB as part of their $130 billion health care initiative. More…
August 18, 2008
Le Raison de Résistance: Substandard TB Drugs Found in South Africa
Posted by cgdadmin in Drug Resistance, HIV/AIDS and other Infectious Diseases, News
The 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.
August 11, 2008
New Round in Tug of War on Nurse Migrants
Posted by Rachel Nugent in Drug Resistance, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, News
Somewhere in the cross-oceanic battle over where doctors and nurses are allowed to work, I saw a rather pathetic cartoon: a bunch of little paper dolls with stethoscopes and nurses caps being suspended along a rope traversing half the globe – they were each hanging from their own little noose. Behind this story, real people are indeed victims, and the world is treating them like two-dimensional dolls.
In spite of what is now an abundance of reports, calls to action, inquiries, and task forces on the subject of human resources in health, we seem to be no closer to solving the fundamental problem: how to match supply and demand of health workers? Just last week, I was at a Gates Foundation conference on malaria vector control and the question was put to the entire group: how to meet human resource needs in health? No-one had a ready answer, including, I hasten to add, moi-meme.
My colleague, Michael Clemens, is passionate about this topic. He has posted frequently and eloquently on this blog and CGD’s Views from the Center about it. His bottom line:
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May 12, 2008
Prevention Failure Redux: Unexpected Tradeoffs in HIV Testing, Prevention and Treatment
Posted by Mead Over in Drug Resistance, HIV/AIDS & Infectious Diseases, HIV/AIDS and other Infectious Diseases, Malaria, Pharmaceuticals & Health Products
Last Monday, CGD posted my working paper entitled, “Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS Treatment Spending and What to Do About It.” In response, I’ve received a number of e-mail comments on various aspects of the paper. A wonder of cyberspace is that I heard from far flung correspondents within hours after the working paper was posted. But the modern technology hasn’t overcome the age-old problem of people interpreting an author differently than he intended. This is a chance to continue the conversation and invite others in.
One person characterizes the paper as saying that donors should “improve our efforts in prevention, and avoid ART financing.” Another person feels that the title of the paper places treatment and prevention too much in competition and might lead to slower increases, if not reductions, in AIDS treatment funding. Both seem to feel that the paper exaggerates the trade-off between treatment and prevention – to the disadvantage of treatment.
In fact, I do not argue for the avoidance of ART financing, only for a clear recognition that it entails a permanent, lifetime commitment to the individual patients who receive treatment. I hope that my article helps to assure that donors who start patients on AIDS treatment in 2008 and 2009 never subsequently drop their patients for lack of budget or political will. I also urge that an increasing share of US funding for these patients be routed through multilateral institutions like the Global Fund or the development banks, in order to dilute what is otherwise an extreme form of dependency of patients and their home countries on a single donor country, namely the U.S.
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March 17, 2008
Tearing Down the Barriers: Increasing Access in Emerging Pharmaceutical Markets
Posted by in Drug Resistance, HIV/AIDS & Infectious Diseases, Tuberculosis
Yesterday, the Financial Times reported GlaxoSmithKline’s exciting new strategy to expand markets and increase access to medicines in low- and middle-income countries. Through an internal policy known as “tearing down the barriers,” the company has established differential pricing schemes within and between India, South Africa and other developing countries, in hopes of shifting to a new low price, high volume business model. While similar initiatives have existed for AIDS antiretrovirals (in part through the work of the Clinton Foundation), the GSK strategy notably moves beyond the “Big Three” infectious diseases to tackle the growing challenge of diabetes and other noncommunicable diseases with a dual market among the rich and poor.
Although variants on this idea have been around for quite some time (for example, see related papers by Jenny Lanjouw or Patricia Danzon), GSK is the first company to implement such a policy openly and systematically across a broad range of products. But they almost certainly won’t be the last. Tiered pricing and the “middle markets” were prominent themes throughout last week’s Partnering for Global Health Forum, where biotechnology leaders came together with pharmaceutical manufacturers and global health funders to identify opportunities for collaboration in this new environment. Several biotech companies are seeking opportunities in emerging markets and are seeking novel business approaches that would serve the full spectrum of needs and abilities to pay in those countries. Here, too, the conversation frequently turned towards ways to price products to better serve the poor without eroding prices in their major markets. (Keep tabs on the Kaiser Family Foundation’s HealthCast, which should be broadcasting many of the sessions soon.)
Here at CGD, we hope to continue the dialogue over the next several months under the auspices of our new Global Health Frontiers project. It will be interesting to see whether the low-price high-volume approach taken by GSK can be sustainably extended to other companies and product areas, and whether there are other business models (such as joint ventures, in-country manufacturing, or voluntary licensing) that could profitably serve both those who can afford to pay a lot alongside those who can only afford to pay a little. It seems that some forward looking companies are willing to step into the new frontiers. This is a delicate time when the public health community can be either be supportive of these early efforts or send companies scurrying for less risky opportunities.
