Joint Statement by Oxfam, Treatment Action Campaign, Consumer Project on Technology (CPT), Médecins Sans Frontières (MSF) and Health GAP NGOs which are treating people with AIDS and working to improve access to medicines say patents block affordable, easier-to-take medicines from reaching people who need them. This is in sharp contrast to a 17 October communication co-authored by Amir Attaran of the Harvard Center for International Development and Lee Gillespie-White of the International Intellectual Property Institute, "Do Patents for Antiretroviral Drugs Constrain Access to AIDS Treatment in Africa". The publication claims that "patents in Africa have generally not been a factor in either pharmaceutical economics and antiretroviral drug treatment access."
The findings of this paper have been extensively used by industry to back their claim that patents are not an issue. The pharmaceutical company Merck has also funded one of the authors.
The NGOs agree with the "special communication's" claim that many barriers impede access to health care in Africa, and support their call for international financial aid to fund antiretroviral treatment.
However, they believe that the data presented in the paper do not support the conclusions drawn, but actually shed light on the extent of patent barriers to treatment. In African countries, the most practical and sought after combinations include fixed dose medicines (2 drugs in one pill) and affordable non-nucleosides. The most popular combination of AZT/3TC is patented in 37 out of 53 countries and the only affordable non-nucleoside (nevirapine in generic form) is patented in 25 out of 53 countries.
Many of the non-patented drugs listed in the study, including some of the protease inhibitors, are not practical as first-line treatments in resource-poor settings because of side effects (which need to be monitored) and cumbersome dietary requirements. The study data show that patents are concentrated in countries where pharmaceutical markets are the largest. In South Africa, which has 4.7 million people living with HIV/AIDS and represents half of the pharmaceutical market in Africa, 13 out of 15 antiretroviral treatments are patent protected. In fact, half of the people with HIV/AIDS in Africa live in countries with significant patent barriers on antiretroviral drugs.
The authors claim that even if prices of patented ARVs come down, African countries cannot afford them. But since generic triple therapies can now cost as little as US$ 30 a month, significant numbers of individuals and employers can afford the treatment, if it were not for patents. Patented prices are still three times higher than generic prices. This means that for a given amount of international aid, three times as many people can be treated if generic production is allowed.
This misleading "communication" seems to be an attempt to sabotage a process initiated by the developing world, which seeks to ensure that patents will no longer be a barrier for access to medicines. A draft declaration calling for a pro-public health interpretation of TRIPS was put forward by 60 developing countries in the September 2001 TRIPS council session on access to medicines. The declaration, signed by 41 African nations, states that "nothing in the TRIPS agreements shall prevent members from taking measures to protect public health." The declaration, which will be considered at the next WTO ministerial conference, has been opposed by the United States, Switzerland, Japan and Canada.
If nothing changes, beginning in 2006, all WTO Members will be obligated to grant twenty-year minimum patents for medicines. For this reason, it is critical that the false conclusions drawn from the data do not lead people to believe that patents are not an issue in access to life-saving medicines.
1. Editorial
2. Equity in Health
The war on Aids takes a new turn with local filmmakers involving themselves in the largest HIV-awareness television series to date, writes Jann Turner.
Teenaged girls in Swaziland reacted with anger at the five-year ban on their sex lives this week, complaining that their boyfriends "won't wait". The ban was introduced two weeks ago as a measure to curb spread of HIV/AIDS in the kingdom.
More than 80 members of parliament have formed a movement, The Tanzania Parliamentarians Aids Coalition (TAPAC), intended to battle the HIV/AIDS scourge. The movement, formed in the last parliament session, will be launched by President Benjamin Mkapa in Dodoma in November.
UNAIDS' Intercountry Team for Eastern and Southern Africa (UNAIDS ICTESA) and the International Organisation for Migration -Regional Office for Southern Africa (IOM) have signed a Memorandum of Understanding to strengthen collaboration to address the vulnerability of migrant populations, and improve their access to HIV/AIDS prevention and care.
The US government admitted yesterday that it had held discussions with a German drugs company about overriding the patent on its anthrax drug, Cipro, in a move that could throw wide open the
debate about the cost of medicines in poor countries. The administration has also contacted an Indian generic drugs manufacturer to see if it can produce a large supply of the anthrax antibiotic in wake of the growing panic about bioterrorism in the US.
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3. Human Resources
According to a report in the UN's IRIN (Integrated Regional Information Network) humanitarian information unit, Capital Alliance, an insurance company, has produced South Africa's first insurance product that allows employers to take out insurance against the risk of their employees contracting HIV/AIDS.
African truck drivers have long been implicated in the spread of HIV. They stop at towns along major routes to eat, sleep, sell goods and have sex. Intermediaries are often involved in negotiations between drivers and commercial sex workers (CSWs). Could these middlemen contribute to HIV prevention efforts?
Peter S. Heller and Christian Keller, 2001 Washington: International Monetary Fund IMF Working Paper No. 01/35
The high unemployment rates seen in many of the transition economies make it difficult for households to improve their living standards and escape from poverty, while existing labor market regimes at times appear to be obstacles to job creation. Labor laws must be examined to see whether they strike the right balance between protecting workers' rights, on the one hand, and allowing for sufficient labor market flexibility, on the other. Overly restrictive employment protection legislation might have to be liberalized, minimum wage practices reevaluated, and flexible fixed-term contracts permitted in order to increase labor market flexibility and make labor codes more appropriate for prevailing labor market conditions. The transition countries' often extensive menus of active labor market policies must be continually reassessed with respect to their cost and effectiveness.
4. Public-Private Mix
The perception that governments cannot efficiently provide water and sanitation (WSS) services has led to greatly increased private sector participation (PSP). Are regulatory regimes ensuring that service providers do not exploit their customers? Can PSPs save water and make it safer? Are the poor getting basic services?
Universal access to contraceptives is a key goal of sexual and reproductive health programmes. But what is the best way to supply them? Donated or subsidised contraceptive supplies raise questions of sustainability whereas there are concerns that market-based distribution has negative impacts on equity and access.
User fees are an increasingly common component of public health financing. The intention is to provide patients with a cheaper but high quality alternative to private healthcare. But does it work? What is the impact on the poorest households? Do poor people still use public health services when they have to pay fees?
5. Resource allocation and health financing
Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.
Chris Simms, Mike Rowson and Siobhan Peattie (Save the Children UK and Medact), 34pp
This report, informed by consultations with 50 donor representatives involved in health reform in Africa, welcomes the global initiative to tackle HIV/AIDS, TB and malaria. The report warns that lessons learned over the past 30 years should be heeded before huge sums are committed.
6. Governance and participation in health
Africa Action will fight for the following goals:
1. unconditional cancellation of Africa’s illegitimate foreign debt, 2. equal access to drugs and treatment, 3. an end to IMF/ World Bank colonialism, 4. an end to discrimination on the basis of race, gender, and HIV status, and 5. promotion of a public discourse on reparations (the need for the West to invest in Africa’s health care as an obligation— not charity). For a wide range of campaign resources, visit the Africa Action website.
Every day 37,000 people die from preventable diseases such as HIV/AIDS, malaria, and tuberculosis.* Most of these deaths are in the developing world where many life-saving drugs are unaffordable because they are patented under rules set by the World Trade Organisation (WTO). There is now a strong movement of governments, charities, churches, activist groups and health bodies urging the WTO to change these rules to allow countries the right to make vital medicines more cheaply. However a few rich WTO members - particularly the United States - are blocking these moves, and pressurising developing countries to apply even more restrictive rules at national level. Oxfam, Third World Network and Health Gap Coalition are part of a global alliance which is urging WTO members, in particular the US, to demonstrate their commitment to put people's health before the profits of powerful drugs companies. Will you help us change the WTO rules? Add your name to our petition which we will present to the WTO at its forthcoming summit.
The book is a review of the June 1999 democratic elections in South Africa and has extensive chapters on the role of civil society and voter education and election monitoring of the elections as well as a 25 page chapter on the role of the media in the election process.
7. Monitoring equity and research policy
Stone, D; Maxwell, S.; Keating, M. Produced by: Bridging Research and Policy: workshop and research project (2001)
This paper reviews some of the existing literature in various disciplines exploring the relationship beteen research and policy, and draws out the implications for both researchers and policy-makers.
Young, J.Produced by: Bridging Research and Policy: workshop and research project (2001)
This proposal describes a participatory 4-month process to develop a bridging programme to improve linkages between development research and policy. The process will continue the discussions started at the Global Development Network conference in Tokyo (December 2000), and continued at the workshop on Bridging Research and Policy in Warwick (July 2001), to develop a programme including a number of fundable proposals for specific activities with wide ownership.
The Office of Behavioral and Social Sciences Research (OBSSR) of the National Institutes of Health (NIH) has released a report, August 2001, that proposes a research agenda for the NIH related to the social and cultural dimensions of health. The focus of the report is on the development of health-related research in the social sciences. The report, "Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health," is based on recommendations made by participants in an OBSSR-sponsored conference held on June 27-28, 2000. The report reflects the belief that the continuing development and advancement of social sciences research are critical to the "future success of studies integrating all levels of analysis, from the molecular to the community or nation".
8. Useful Resources
This new journal will publish papers that make an original contribution to understanding the social dimensions of HIV/AIDS in African contexts. AJAR should be of interest to researchers in sociology, demography, epidemiology, psychology, anthropology, media, cultural studies, nursing, health promotion, social work, and economics.
Program for Appropriate Technology in Health (PATH) has just published the Basic Delivery Kit Guide, a step-by-step manual for developing delivery kit programs. Designed for program managers who wish to develop a basic delivery kit as part of their integrated maternal and child health programs, this resource provides comprehensive and practical information on the design, development, distribution, and promotion of single-use, disposable delivery kits.
Bulletin 2, September 2001
Welcome to Consultancy Unit Update! The update aims to provide an insight into the range and scope of services available to clients, and to enable general readers to follow the progress of the consultancy unit, in accordance with Healthlink’s drive toward greater transparency. This month’s update focuses on the effective development of resource centres; and the need for monitoring and evaluation. In STAFF PROFILE we talk to Victoria Richardson (Information Systems Officer), and Christine Kalume (IP&M Team Leader) about the launch of SOURCE and their role in Healthlink Worldwide.
Today's young women are the healthiest and most educated to date, but they still face obstacles to achieving their full potential. This four-page fact sheet discusses the sexual and reproductive health of young women and the steps that countries can take to meet young women's needs for reproductive health information and services.
Document code: PRBIWOKIT01. To obtain, put document code in the body of an e-mail.
How do you measure the value of a specific reproductive health (RH) programme? What indicates the value of NGO interventions in the field of RH? What is the difference between monitoring and evaluating? These and many more questions are answered in the eleventh EC/UNFPA Initiative for Reproductive Health in Asia (RHI) Fact Sheet on Monitoring and Evaluation in a sexual and reproductive health (SRH) context, written by Megan Douthwaite and Ronald Horstman of the London School of Hygiene and Tropical Medicine (LSHTM) and the Netherlands Interdisciplinary Demographic Institute (NIDI), respectively.
Sub-Saharan Africa has one of the world's youngest populations. At the beginning of the 21st century, about one out of every four people in sub-Saharan Africa is 10 to 19 years old. This is the largest group of young people ever in the region. To what extent are young people in the region prepared for adulthood? This chartbook examines factors that are important to a healthy transition, including education and exposure to information, sexual experience and marriage, HIV/AIDS, childbearing, contraception, and maternal health. Document code: PRBIYSSAENG
To obtain, put document code in the body of an e-mail.
9. Jobs and Announcements
Equinet Grants/Awards: Paper On Poverty- Equity And Health In Southern Africa. Closing date for applications: November 1 2001
The Regional Network for Equity in Health in Southern Africa (EQUINET) has played a role over the past three years in highlighting issues of equity in health in southern Africa. It does so by networking professionals, civil society and policy makers to promote policies for equity in health, undertaking research, initiating conferences, workshops, and discussions through the internet, and providing inputs at the SADC forums. Noting the already significant work taking place on poverty, poverty reduction strategy papers and the links to health, and equally the strength of policy commitment to equity in health, and noting work already done by EQUINET in this area (which will be provided), EQUINET seeks to commission a paper to inform policy and research work on poverty, equity and health in southern Africa. Time frame: Six months, with an expected work time of three months.
The Bill & Melinda Gates Foundation has issued a call for nominations for the Gates Award for Global Health. The award comes with a $1 million honorarium and is presented annually to an organization that has made an extraordinary contribution to the improvement of health around the world. Deadline: December 5, 2001
GICO - Gruppo Internazionale di Consulenza is an international engineering company that operates in rural and urban development sectors, both in Italy and Eastern Europe, the Middle East, Africa, Latin America and Asia. The Company offers services, consultancy and technical assistance to international organisations such as the European Union, The World Bank, FAO and UNIDO, as well as to government administrations and to private sector investors. For a long-term project of Public Health Support in Africa, we are looking for candidates in the following areas: economist; manager and administrator; public health medic; communication and IT specialists. Deadline for submission of candidatures: 29th November 2001 / Duration of the assignment: 1 to 2 years, Starting date: to be confirmed.
(Feb 22 2002 - 12 week course). Start Date: February 22, 2002 Location: Durban
The purpose of this Honours/MA module is to acquaint students with broad approaches to communicating for health promotion, focusing specifically on the role of entertainment education. The module can also be taken on its own for certificate rather than degree purposes.
Date: December 6-8, Venue: Cape Town, S.Africa
The Health Systems Research Unit at the Medical Research Council, South Africa's pleased to announce a three-day training course: "Randomised Controlled Trials" 6-8 Dec, 2001. Randomised controlled trials are the most reliable way to evaluate the effects of an intervention, be it a drug, a new technology, a new way of training health care providers or organising health care. Over 10 000 RCT's are published in the scientific medical literature every year, and they have become an important aspect of the advance of knowledge. The course is designed for people, who may not have yet conducted an RCT, or who wish to deepen their knowledge. The course is open to all. There is no cost for the training course itself for participants from developing countries. The course fee for developed country participants, or employees of agencies able to sponsor such training will be R5000.