Bill Clinton on Global Public Health

Former United States President Bill Clinton offered closing remarks at the UN Economic and Social Council (ECOSOC) event (February 23, 2009) that was convened as a special Preparatory meeting for the 2009 High-level Segment on the theme of Philanthropy and Global Public Health. The meeting discussed and explored collaborative opportunities in advancing progress in maternal and girls’ health and neglected tropical diseases.

In his speech at the UN, former President Bill Clinton stated that:

“My experience has been that almost no one in the world will die this year because of the cost of lack of availability of AIDS medicine, but many people will die of AIDS this year because of the absence of effective health care systems in rural areas of the poorest countries.

We cannot solve the problems of the 21st century, we cannot meet the Millenium Development Goals, without the involvement of governments, corporations in their business mode – the private sector – and civil society.

Other experts shared their views on the current status of global public health as well as recommendations for future progress.  Some of the key elements which emerged from the discussion were the fundamental importance of building out elemental health care networks; the need for continued — and greater — collaboration; the need to identify and share best practices in health delivery and philanthropic efforts.

“The economic crisis is putting at risk the unprecedented rise in public and private funding we have witnessed in recent years,” said Secretary-General Ban Ki-moon.

Mr. Ban challenged participants “to think radically about how we can take our efforts to the next level and forge a truly powerful global partnership for global health.”

Tanzania pays price for cheap knockoffs

National Public Radio’s Marketplace – a public radio program in the U.S. - recently reported on the prevalence — and danger — of countefeit products in Africa.  The prices are cheap, but the long term economic and public health costs can be high.  The following is an excerpt from the transcript:

Listen to the full report

Tanzania has an international reputation as a dumping ground for fake merchandise, most of it made in China. As much as 20 percent of goods in the country are cheap look-a-likes. And what’s happening here tells a bigger story — of counterfeiters making a quick buck off the world’s poor. And the difficulty in the developing world to shut them down.

But this isn’t just about cheaper prices for consumers. Local businesses can’t compete. One industry group says counterfeit goods translate into the loss of 140,000 local jobs.

And there are serious public health concerns. A recent crackdown found all sorts of counterfeit pharmaceuticals in Tanzania’s markets, including AIDS medications and anti-malarial drugs. These worthless pills that are made to look exactly like the real thing in order to fool pharmacists and unwitting consumers.

In Dar es Salaam, one pharmacist who gives only his first name, Ramal, tells me on tape that he’s confident in the quality of his medicines.

Ramal: And I have to trust my suppliers. Suppliers who have passed through the proper channels, those are the people that we deal with.

But when Ramal is sure I’ve stopped recording, he tells me something else. He says he knows 10 percent of the drugs in his pharmacy are probably fake. But that he’s not about to shut down 90 percent of his business because of it.

Most counterfeit goods come into the country through sea ports, like this one in Dar es Salaam. They’re usually shipped alongside legitimate products, which makes them harder to identify. A new law gives authorities more power to search private businesses and destroy fake merchandise. It also makes it easier to slap big fines on offenders.

Not letting the facts get in the way of a weak argument

Ensuring that patients around the world have access to safe and affordable medicines – be they brand name or generic – is an issue worthy of thoughtful global discussion and action.  But that discussion should be honest and forthright and not driven by half-truths and misrepresentation of the facts.

Recently, officials in the Netherlands exercised diligence in safeguarding the integrity of the medicines supply chain within their own country by delaying a shipment of generic drugs until it could be determined if these drugs were legally entering the Netherlands market or whether they were being trans-shipped to another country.

The feigned outrage of Brazilian officials and anti-intellectual property rights activists over this reasonable action by the Netherlands demonstrates the extent to which anti-IP activist will go to manipulate  facts in the absence of sound arguments to support their own biased views.

Here are the facts:

In December of 2008, a small load of generic drugs were shipped from India to Brazil, via the Netherlands.  The drugs are not patented in Brazil or India, however they are patented in the Netherlands.  Therefore, Dutch customs authorities detained the drugs in order to determine if they were destined for the Netherlands .  They did so in conformity with the law.  Once authorities ascertained that the drugs were not destined for the European market, the authorities released the drugs to the original owner (India’s Dr. Reddy Laboratories), again in accordance with the law.

The Netherlands’ authorities did not destroy the drugs.  They did not seize the drugs, nor did they return them to India. 

This event (or non-event) took place at a time when the WHO was convening a meeting to define the term “counterfeit medicines”.

The government of Brazil and anti-IP activists used this meeting to sustain their ongoing attacks on intellectual property rules.  In the absence of any better arguments, they chose to exaggerate this incident out of all proportion to imply that the drug shipment investigated by the Netherlands had been deemed to be “counterfeit” under definitions adopted by the WHO.

Citing the detainment of this shipment of drugs from India, anti-intellectual property blogs denounced the pharmaceutical industry, the Netherlands, the WHO, the TRIPS agreement, and the definition of counterfeit drugs.  Brazilian officials brought the matter to official attention at the recent Executive Board of the World Health Organization.  Officials are even quoted saying that the move is a setback for the internationally guaranteed principle of universal access to medicine, and that this event will set a bad precedent for public health by creating yet another barrier to the delivery of quality, affordable generic drugs to developing countries.

This case has nothing to do with counterfeiting or universal access to safe and affordable medicines and everything to do with furthering a political goal.

Dutch officials got the facts before they took action.  But anti-IP activists refused to let the facts get in the way of their arguments.

Innovation in Drug Access

A recent article in Global Health Magazine (Big pharma bets on emerging economies) focuses on the increasing use of tiered pricing by pharmaceutical companies to remain competitive in the global economy. 

“Such nuanced approaches to drug pricing that more closely reflect the ability to pay represent an attractive new trade-off for pharmaceutical companies: they provide greater sales to please their shareholders, while improving access to medicines for patients on lower incomes in the developing world.”

Interestingly, the article also notes that while some generic companies and NGOs continue to fight against patents, arguing that competition is the only way to bring down drugs to affordable levels, a report from the United Nations (released just ahead of a special session on the Millennium Development Goals in September) highlighted that one of the biggest gaps in access to medicines did not relate to patented medicines at all, but rather generic drugs with often very high prices.

The following is the beginning of the article.  The full text is available on the Global Health Magazine site.

On the shelves of pharmacies across India, a new form of competition is taking hold. Patients long neglected by multinational drug groups are beginning to gain access to a wider variety of innovative medicines at more affordable prices.

In the past, even when newer drugs were physically available, they were typically charged at Western prices, too costly for most to buy. Now Merck is offering its diabetes drug Januvia at a fifth of the U.S. price, and GlaxoSmithKline (GSK) is charging different prices even within India to reach more of the population.

Such nuanced approaches to drug pricing that more closely reflect the ability to pay represent an attractive new trade-off for pharmaceutical companies: they provide greater sales to please their shareholders, while improving access to medicines for patients on lower incomes in the developing world.

“The pharma industry has realized that the vanilla solutions that were effective in the past now require significant differentiation,” says Todd Evans, director of the health-care advisory group at PricewaterhouseCoopers, the accountancy and advisory firm. “Pricing is going to be highly varied.”

Gates Foundation boosts fight against neglected tropical diseases

The Global Network for Neglected Tropical Diseases recently announced that it has received $34 million through a grant from the Bill & Melinda Gates Foundation to the Sabin Vaccine Institute to step up the global effort to prevent and treat neglected tropical diseases (NTDs). These debilitating and sometimes deadly diseases affect 1.4 billion people worldwide who live on less than $1.25 a day.

The new campaign will build on recent successes in the global fight against NTDs. In 2007 alone, 546 million people around the world were treated to prevent transmission of elephantiasis. River blindness has been nearly eliminated as a public health problem in 10 West African countries, to the benefit of some 60 million people.

Large-scale drug donation programs have fueled many of the recent successes. The World Health Assembly has called for global attention and governments have begun to expand their commitments, and the World Health Organization is creating a Global Plan to Combat NTDs. Together, a cross-sector network of NTD-affected communities, national ministries of health, public-private partnerships, and international organizations has formed and is poised to expand treatment coverage.