Access barriers to medicines and health: Op-Ed

Canadian MP Keith Martin recently wrote an interesting Op-Ed for the Edmonton Journal on the challenges of providing access to medicines and health for the world’s poorest.  He notes that lack of infrastructure, access to trained health workers, potable water and sanitation are the real barriers to access to medicines and care — not patents.

98.6 per cent of ‘essential medicines’ are generic or are not patented in developing countries, but for those living on $2 a day even generic drugs are too expensive (when available).

Tinkering with patent laws won’t get medicine to world’s poorest

The debate around enabling the world’s poorest people to acquire life-saving medications is coming to a head. This week, Parliament votes on a bill that will modify Canada’s Access to Medications Regime (CAMR). If the bill becomes law, it will enable Canadian generic manufacturers to produce and sell medications that are currently under patent protection to developing countries. On the surface this makes sense. But are patents really the obstacle proponents of the bill claim to enabling the poor to access drugs for AIDS and other diseases?

Every year, the World Health Organization (WHO) convenes an independent panel of experts, chosen equally from developing and developed countries, to draw up a list of essential medicines. Currently, 319 drugs are on this list.

Of these, 98.6 per cent are generic or are not patented in developing countries. Thus, the life-saving medications the poor needs are already off patent. Generic manufacturers can make them today if they wish. Therefore, patents are not the problem.

WHO report on NTDs highlights ongoing commitment of pharmaceutical industry

An interesting article on neglected tropical diseases — and a recent report from the WHO — sourced from World Health Advocacy.

First WHO report on NTDs highlights ongoing commitment of innovative drug companies

The World Health Organization today released their first report on neglected tropical diseases – diseases that affect mainly poor people and cost billions of dollars in lost productivity annually.

“Good medicines are available for many of these diseases, and research continues to document their safety and efficacy when administered individually or in combination,” said Dr Margaret Chan, WHO Director-General. “Generous drug donations by pharmaceutical companies have helped relieve some of the financial barriers and allowed programmes to scale up coverage.”

Leading research-based pharmaceutical companies have already provided high-quality medicines free of charge for hundreds of millions of poor people suffering from such diseases, mainly in remote areas of Latin America, Asia and Africa, according to the WHO.  In coordination with the launch of this report, additional long-term industry commitments to combating neglected tropical diseases were announced today, including:

• Novartis renewed its commitment to donate an unlimited supply of multidrug therapy and loose clofazimine for leprosy and its complications.
• GlaxoSmithKline announced a new five-year commitment to expand their donation of albendazole through WHO, in addition to their current donation for lymphatic filariasis to treat school-age children for soil transmitted helminthiases in Africa. The commitment includes 400 million doses per year for this purpose.
• Sanofi-aventis has agreed to renew its support for the WHO programme to eliminate sleeping sickness, and its support for Buruli ulcer, Chagas disease and leishmaniasis for the next five years.

This continued support will ensure that necessary resources will be available also to move forward in combating leishmaniasis, Buruli ulcer and Chagas disease. In addition:

• Bayer has started discussions with WHO on how to evolve their current commitment to fight sleeping sickness and Chagas disease.
• EISAI has committed to work towards the global elimination of lymphatic filariasis by providing diethylcarbamazine (DEC) and
• Johnson&Johnson has recently also announced expanding its donation of mebendazole to supply up to 200 million treatments per year for treatment of intestinal worms in children

Despite these commitments from innovative drug makers, Dr. Chan added, “Production of medicines used to treat NTDs must be made more attractive to companies that manufacture generic pharmaceuticals.” It is important to note that many of these products are off- patent, but generic companies have not invested in their production.

“Neglected tropical diseases blight the lives of a billion people worldwide and threaten the health of millions more,” said Dr. Chan in the report.

The WHO report provides an overview of 17 neglected tropical diseases and provides details on their prevalence, distribution, economic and social impact as well as prevention and control strategies. Examples of these diseases include:

• Lymphatic filariasis – a mosquito-borne disease that causes intestinal worms and disfigures limbs and genital parts, costing an estimated $1.3 billion a year in lost productivity in Africa and South East Asia.
• Dengue fever – about 1 million confirmed cases of dengue are reported annually to WHO. The aggregated annual economic cost of dengue was estimated to be at least US$ 587 million. Preliminary adjustment for underreporting could raise this total to US$ 1 800 million
• Trachoma – in 57 countries where trachoma is endemic millions of people have irreversible visual impairment and blindness caused by the disease, and more than 40 million people are in need of treatment. The economic cost of trachoma in terms of lost productivity is estimated at US$ 2.9 billion annually.
• Chagas disease continues to persist in the Region of the Americas, but the estimated number of infected people has fallen from approximately 20 million in 1981 to around 10 million in 2009. A recent study in Colombia estimated an average expected annual cost per patient with chronic Chagas disease of US$ 1028. On average, the estimated lifetime cost of treating a patient with chronic Chagas disease in Colombia is US$ 11 619.

“The involvement of the pharmaceutical industry in NTDs, and subsequent donations made to support their control, have increased access to high-quality medicines free of charge for hundreds of millions of poor people,” according to the report. “The increasing willingness and commitment of local and global communities of partners to work with endemic countries have brought resources, innovation, expertise and advocacy to efforts to overcome NTDs. Intersectoral collaboration, involving education, nutrition and agriculture, has reinforced NTD control.”

The “D” Word – Economist blog

From the Economist’s Babbage blog…

LIFESAVER

FOR those in rich countries, diarrhoea is a nuisance. For those in the poor, though, it is a killer. About 1.3m children a year die from the dehydration it causes, and even those who survive may have their development stunted by the loss of nutrients it entails. One of the main causes of diarrhoea is rotavirus, so the development, four years ago, of a vaccine against this virus might have been thought good news for the poor world. It was not, though, because the trials were carried out only in rich countries and aid agencies were unwilling to subsidise the distribution in the poor world of a vaccine whose efficacy was unproven there.

That has just changed with the publication in the Lancet of clinical trials that tested the efficacy of rotavirus vaccine in Bangladesh, Ghana, Kenya, Mali and Vietnam. These trials, organised by Merck (the vaccine’s manufacturer) and the Programme for Appropriate Technology in Health (a medical charity based in Seattle), showed that although the new vaccine is not as efficacious in the poor world as it is in the rich, it is good enough to make a difference. In the wake of these studies another medical charity, the GAVI Alliance, has agreed to subsidise the vaccine. That will allow countries in Asia and sub-Saharan Africa to purchase the product at 10-30 cents a dose, compared with a market price of around $10. According to the trials’ organisers, injecting the vaccine into the immunisation programmes of the world’s poorest countries could save 2m children’s lives over the next decade.

WHO report: more than 5 million in developing countries receiving HIV treatment

Today, the World Health Organization (WHO) issued a press release praising a dramatic increase in access to HIV treatment in developing countries, while advising earlier adoption of treatment to reduce mortality.

According to the WHO, an estimated 5.2 million people in low and middle-income countries were receiving life-saving HIV treatment at the end of 2009 — an increase of 1.2 million from 2008.  To further build on this push to fight HIV/AIDS, the WHO recommended that HIV+ patients begin treatment sooner, as that could reduce related mortality by an estimated 20%.  Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

19 JULY 2010 | GENEVA | VIENNA — An estimated 5.2 million people in low and middle-income countries were receiving life-saving HIV treatment at the end of 2009, according to the latest update from WHO.

WHO estimates that 1.2 million people started treatment in 2009, bringing the total number of people receiving treatment to 5.2 million, compared to 4 million at the end of 2008.

“This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development,” says Dr Hiroki Nakatani, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases.

At the XVIII International AIDS Conference, WHO is calling for earlier treatment for people with HIV. The objective is to begin HIV treatment before they become ill because of weakened immunity.

“Starting treatment earlier gives us an opportunity to enable people living with HIV to stay healthier and live longer,” says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.

Estimates developed through epidemiological modeling suggest that HIV-related mortality can be reduced by 20% between 2010 and 2015 if these guidelines for early treatment are broadly implemented.

Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.

The strength of a person’s immune system is measured by CD4 cells. A healthy person has a CD4 count of 1000 – 1500 cells/mm3. WHO previously recommended starting HIV treatment when a person’s CD4 count drops below 200 cells/mm3 but now advises starting HIV treatment at 350 cells/mm3 or below.

“In addition to saving lives, earlier treatment also has prevention benefits,” Dr Hirnschall says. “Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners.”

WHO’s treatment guidelines expand the number of people recommended for HIV treatment from an estimated 10 million to an estimated 15 million. The cost needed for HIV treatment in 2010 will be about US$ 9 billion, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“The investments we make today can not only save millions of lives but millions of dollars tomorrow,” said Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS. “People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier.

Since 2003 – which marked the launch of the historic “3 by 5” initiative to provide access to HIV treatment to 3 million people living in low- and middle-income countries by the end of 2005 – the number of people receiving HIV treatment has increased 12-fold.

At AIDS 2010, WHO is releasing the 2010 guidelines on Antiretroviral treatment of HIV infection in adults and adolescents – public health approach.

UN Report: Efforts to boost maternal and child health falling short

From the UN Daily News:

An annual assessment report released today by the United Nations shows that while significant declines have been recorded by many countries in reducing maternal and child mortality, greater progress must be made to meet the global targets contained in the Millennium Development Goals (MDGs).

According to the MDG Report 2010, launched by Secretary-General Ban Ki-moon in New York, the number of deaths among children under the age of five has dropped from 12.6 million in 1990 to an estimated 8.8 million in 2008.

The greatest advances were made in Northern Africa, Eastern Asia, Western Asia, Latin America and the Caribbean, and the countries of the Confederation of Independent States (CIS).  But most striking is the progress that has been made in some of the world’s poorest countries. Bangladesh, Bolivia, Eritrea, Laos, Malawi, Mongolia and Nepal have all reduced their under-five mortality rates by 4.5 per cent annually or more.

“Despite these achievements, and the fact that most child deaths are preventable or treatable, many countries still have unacceptably high levels of child mortality and have made little or no progress in recent years,” stated the report.  The highest rates of child mortality continue to be found in sub-Saharan Africa, which accounted for half of the 8.8 million deaths in children under five worldwide in 2008.

The publication pointed out that child deaths are not falling quickly enough to reach Goal 4, namely a two-thirds reduction in childhood mortality rates between 1990 and 2015, and millions of children continue to die each year at a tragically young age.

First agreed at the UN Millennium Summit in September 2000, the eight MDGs set worldwide objectives for reducing extreme poverty and hunger, improving health and education, empowering women and ensuring environmental sustainability by 2015.

Access to biotechnology in the developing world: a new policy statement from BIO

BIO, the world’s largest biotechnology organization, announced a new policy on options for increasing access to medicines in the developing world earlier this week.

BIO’s President stated that their “members recognize the significant unmet health needs that are prevalent in the developing world.  While many of our hundreds of members are taking , or have taken, individual steps to address this challenge, they recognize that more can and should be done.”

Download the full policy statement to read more.

GAVI improves access to vaccines – could save close to 1 million lives by 2015

Drugmakers Pfizer and GlaxoSmithKline signed a landmark 10-year deal on Tuesday to supply 60 million doses a year of cut-price pneumococcal vaccines to developing nations (Reuters).   The deal, brokered by the Geneva-based Global Alliance for Vaccines and Immunization (GAVI), is the first under a new scheme called an Advance Market Commitment (AMC) which guarantees a market for vaccines supplied to poor nations but sets a maximum price drugmakers can expect to receive.

GAVI estimates that the introduction of new vaccines against pneumococcal disease — which causes serious illnesses such as pneumonia and meningitis — could save around 900,000 lives by 2015 and up to seven million lives by 2030. GAVI said it plans to introduce pneumococcal vaccines in 47 countries by 2015.

This AMC deal could pave the way for future deals on recently introduced vaccines against rotavirus, which causes severe diarrhea, and an experimental treatment against malaria, which combined kill millions in poor countries each year.

The AMC scheme was devised to try to encourage drug companies to make and supply medicines and vaccines to boost health in poorer countries, which are generally unable to afford the treatments.  Both Pfizer and Glaxo expressed interest in future AMC deals, saying they are committed to tiered pricing structures to ensure their drugs can get to the people who need them most.

$4.3 billion needed to fund vaccines for world’s poor

$4.3 billion is needed if the GAVI Alliance is to meet its goal of supplying life-saving immunizations to millions of children in poor countries by 2015.  In 2000, world leaders from 189 countries signed up to the Millennium Development Goals to reduce child mortality by two-thirds by 2015.

GAVI, which is supported by the World Health Organization, the World Bank, UNICEF, the Bill & Melinda Gates Foundation and vaccine makers, says it has 40 percent of the $7 billion it needs between now and 2015 to help meet that goal.

“With $7 billion, (GAVI) will be able to fully roll out pentavalent vaccine and introduce new vaccines against pneumococcal disease and rotavirus diarrhea in over 40 countries,” it said in a statement. “These last two vaccines alone can save one million children by 2015.”

The scale of GAVI’s buying and distribution power allows it to secure much lower prices for vaccines, which are then supplied to poor nations at a fraction of their cost.

Read more

Gene map may help boost production of malaria treatments

The first genetic map of a medicinal herb used in the best malaria treatments is being published to help scientists develop the species into a high-yielding crop and battle the killer mosquito-borne disease (Reuters).

Artemisinin, derived from the sweet wormwood, or Artemisia annua plant, is the best drug available against malaria, especially when used in artemisinin combination therapy (ACT) medicines made by firms such as Novartis AG and Sanofi-Aventis.

Around 40 percent of the world’s population is at risk of malaria, a potentially deadly disease transmitted via mosquito bites. It kills more than 1 million people worldwide each year and children account for about 90 percent of the deaths in the worst affected areas of sub-Saharan Africa and parts of Asia.

Around 6,500 hectares of land – mostly in China, Vietnam, Africa and India — was devoted to sweet wormwood crops in 2009, producing 30 metric tonnes of artemisinin a year — enough for around 60 million treatments.

Low artemisinin yields in the usual growing areas in Africa and Asia have made production expensive and planting areas have shrunk, raising fears of shortages and contributing to a slow roll-out of ACT treatments across the world.

UN Report: 40% global increase in access to HIV treatment within the last year

Over 4 million people are now receiving treatment for HIV, marking a nearly 40 per cent jump from the previous year according to a new United Nations report.

The new study – produced jointly by the UN World Health Organization (WHO), the UN Children’s Fund (UNICEF) and the Joint UN Programme on HIV/AIDS (UNAIDS) – said that the 4 million figure at the end of 2008 represents a 10-fold increase over five years.

Despite the “tremendous progress” in responding to HIV/AIDS, “we need to do more,” said WHO Director-General Margaret Chan.

“Prevention services fail to reach many in need,” she added. “Governments and international partners must accelerate their efforts to achieve universal access to treatment.”

Nearly half of the 9.5 million people in low- and middle-income countries needed antiretroviral therapy are now receiving, with the fastest progress being seen in sub-Saharan Africa, where two-thirds of all HIV infections occur.