A third of the world’s population still has no access to essential drugs. In the poorest countries of Africa and Asia this figure rises to half. With the global agreement on intellectual property rights (TRIPS) forcing countries to introduce new patent protection laws over the next decade, this situation could worsen, according to a new report from the London-based Panos Institute.
Developing countries have until 2005 or 2016 to implement TRIPS-compliant legislation on pharmaceuticals. So far many governments have drafted or enacted legislation that seems to prioritise patent rights over public health. Some countries are being pressurised into adopting policies that go further than TRIPS in protecting patents. Patents give big international pharmaceutical firms monopoly over production of new drugs, including, for example, those needed to treat HIV/AIDS.
There is concern they may push up prices, and the TRIPS rules could thus limit poor countries’ freedom to buy cheaper “generic” versions of patented drugs. For example, in January 2001, South African HIV/AIDS treatment activist Zackie Ahmat went to Thailand to buy 5,000 pills of the generic version of an anti-fungal drug patented by the US pharmaceutical giant Pfizer. He paid $0.21 a pill. The price of the patented version in South Africa was $13.
The Panos Report, 'Patents, Pills and Public Health: can TRIPS deliver?' warns that patent legislation is not being debated widely enough in most developing countries, and the process of introducing it needs to be more consultative and transparent. In Uganda, for example, American consultants were brought in to review the country’s patent laws and make proposals for reform. The result was the drafting of laws which, according to local campaigners, are skewed in favour of business interests rather than social or development needs. The principle of extending access to essential drugs in poor countries is widely supported, but the means of doing this is still hotly disputed, says the report.
According to the World Bank, middle-income countries may benefit from increased foreign investment, but if the cost of drugs rises as a result of patent systems spreading throughout the developing world, there is a real danger of restricting access to drugs, such as anti-AIDS drugs, where they are most needed. The World Health Organisation suggests that implementing patent protection where it did not already exist would result in the average price of drugs rising, with projected increases ranging from 12 to 200 percent.
The pharmaceutical industry argues that patent systems promote innovation and investment in research and development. Without patents, new ones would not be developed to tackle diseases such as tuberculosis and HIV/AIDS. They believe the real barriers to making drugs more available are poverty, weak political leadership, lack of trained health personnel and poor health infrastructures.
The report examines alternative approaches and gives examples where differential pricing (where poorer countries pay considerably less for a product than wealthier ones) and compulsory licensing (where a patent is overridden in return for a payment of a royalty) have potential, although they are not free of problems. Two countries highlighted in the report, show how differently patent protection can impact on the nation’s public health: Brazil is seen as a model for other countries of what can be achieved for public health by boosting local production of drugs such as the anti-AIDS drug AZT, lowering prices through competition and negotiating discounts on patented drugs. Between 1996 and 2001 around 358,000 AIDS hospitalisations were prevented, saving around $1.1 billion. On the other hand, Thailand’s capacity to provide essential drugs for its people has been severely limited in the last decade due to relentless pressure from the US to tighten up its patent laws which, they complained, meant the loss of $30 million a year in sales for the American pharmaceutical industry because it referred only to pharmaceutical processes and not products. The US went as far as imposing $165 millions’ worth of sanctions on eight Thai products exported to the US. The US continued to exert pressure until the patent laws were changed and made even more restrictive than the international TRIPS agreement requires.
“This report should be a wake-up call to developing countries to look carefully at how they go about complying with TRIPS legislation and make sure that access to essential drugs is kept as an overriding right for the entire population – not just a wealthy few” says Martin Foreman, author of the Panos report.
* The full report and additional country studies can be downloaded from this website http://www.panos.org.uk/
* The Panos Institute is an independent, non-profit organisation specialising in communication for development. It works to catalyse informed public debate, particularly in developing countries. It has 12 offices in Africa, Asia, Europe and the Caribbean.
1. Editorial
2. Equity in Health
For many African countries the worst of the HIV/AIDS epidemic is still to come, according to a new UN report. "In the absence of massively expanded prevention, treatment and care efforts, the AIDS death toll on the continent is expected to continue rising before peaking around the end of this decade," the UNAIDS/World Health Organisation AIDS Epidemic Update 2002 said.
Africa's twin epidemics of HIV/AIDS and famine must be fought together because they are intertwined, Alex de Waal, director of Justice Africa and an adviser to the U.N. Economic Commission for Africa, writes in a New York Times op-ed. HIV/AIDS is crippling African nations' ability to resist famine because the disease is killing young people who make up the majority of farmers and other laborers, de Waal says. Meanwhile, famine and malnutrition destroy health, making people more susceptible to disease, more likely to quickly progress from HIV to AIDS and less likely to respond well to existing treatments, de Waal states, adding that the epidemics have disrupted social structures and made it more difficult for affected populations to recover.
AIDS-related illnesses are now the leading cause of death among South African women ages 15 to 39, accounting for nearly 10% of deaths among South African women, according to new figures released by Statistics South Africa, SABCNews.com reports. In addition, the proportion of South African deaths due to AIDS-related causes almost doubled from 4.6% in 1997 to 8.7% in 2001.
The United Nations held a two-day conference in Johannesburg, South Africa, in November to discuss the relationship between Africa's severe food shortages and the HIV/AIDS pandemic, Xinhua News Agency reports. More than 50 people, including U.N. delegates and representatives from local and international non-governmental agencies, were scheduled to meet at the conference.
AIDS threatens our very raison d'etre; our ability to live and our instinct to create life. Little wonder, therefore, that HIV and AIDS are so feared. As the articles in this IRIN World AIDS Day web special(http://www.irinnews.org/webspecials/aids/) illustrates, fear is at the heart of much of the stigma and discrimination that surrounds HIV and AIDS: fear of death, fear of the unknown, fear of rejection, and, as Eric Nachibanga, an HIV-positive Zambian points out, "fear of helplessness".
HIV/AIDS education and prevention campaigns often ignore prisoners but a project in Malawi is reaching out to educate them about the disease and treat those with sexually transmitted infections (STIs). Malawi prisons are considered fertile grounds for transmission of HIV/AIDS and yet little has been done to prevent the spread of the virus or treat patients already infected, Walker Jiyani, programme director for the Health in Prisons (HIP) project, told PlusNews.
People living with HIV/AIDS (PWAs) in Mozambique are learning how to live longer and more productive lives under a new programme currently being rolled out in the country. The Vida Positiva/Positive Living programme is a "social education" project targeting those infected and affected by the disease, national coordinator for Vida Positiva, Nyeleti Mondlane, told PlusNews.
Medecins Sans Frontieres (MSF) plans to launch a five-year pilot programme in collaboration with the Mozambican government to provide free antiretrovirals (ARVs) to a selected group of HIV-positive people in the northern province of Tete and in the capital, Maputo. The programme, to be introduced before the end of December, would begin with 350 people in Maputo and 350 in Tete during the first year, and gradually increase to 1,500 people by the end of the second year. The MSF programme follows an announcement last month that an Indian manufacturing company, approved by the UN's World Health Organisation, would begin supplying Mozambican pharmacies with cheap generic ARVs.
Rich nations have done little to help fight HIV-AIDS, the United Nations's top adviser on AIDS in Africa says. Stephen Lewis, the UN Secretary General's Special Envoy for HIV-AIDS in Africa, said the rich nations were "not serious" when it came to contributions towards the Global Fund to Fight AIDS, TB and Malaria.
The nongovernmental organisation Medecins Sans Frontieres has criticized Swiss drug maker Roche Holding for not "liv[ing] up to its promise" to reduce the price of its antiretroviral drugs for developing nations, the Wall Street Journal reports. The organisation said that of the five major drug makers that have announced plans to cut their prices of antiretroviral drugs in developing nations, Roche is the "lone holdout" in failing to follow through.
Pages
3. Human Resources
South African law protects the rights of employees living with HIV/AIDS on paper, but the reality is that discrimination and denial still prevails in the workplace in a country which has one of the highest HIV/AIDS rates in the world. "We have the best legal frameworks around but this hasn't changed mindsets. People still get dismissed because of their HIV status. I handle HIV/AIDS discrimination cases almost every day," Jennifer Joni, an attorney for the AIDS Law Project told IRIN.
4. Public-Private Mix
Public-private partnerships are increasingly popular initiatives in international health. The Global Alliance for Vaccines and Immunisation (GAVI) was launched in January 2000 with a donation of US$ 750 million from the Bill and Melinda Gates Foundation. An assessment of its work by researchers at the London School of Hygiene and Tropical Medicine reveals important lessons for similar initiatives, including the new Global Fund to Fight AIDS, Tuberculosis and Malaria.
Often some government and donor officials have denied that Malawi will privatise nearly every lifeline. But progress indicates that the government intends to privatise institutions providing food security in Malawi, water, electricity and more. This will translate into the livelihood of the people being at the mercy of 'forces of the market'. This privatisation behaviour has been opposed by civil society, says this briefing from the Malawi Economic Justice Network.
5. Resource allocation and health financing
HIV/AIDS is an enormous development crisis and debt repayment represents a remarkable obstacle to the fight against it. HIV/AIDS claims more than one million lives each year in heavily indebted countries. Half of the countries receiving debt relief under the Enhanced Heavily Indebted Countries Initiative are still spending 15 per cent or more of government revenue on debt repayment. This paper, produced by Oxfam, highlights that repayments to creditors by these countries are diverting resources needed to find a solution to this terrible pandemic. Debt repayment is taking precedence over human needs. In order to convert debt transfers into public investments in health, a radical reform of the Enhanced Heavily Indebted Poor Countries (HIPC) Initiative is required so that these countries can spend more on public health than on debt and so that debt relief can be seen as a strategy for creating more resources.
A country's policy on healthcare financing can help or hinder access to services by poor people. How can different approaches to resource allocation enable poor people to access essential health services? A report from the UK Department for International Development's Health Systems Resource Centre presents lessons from Cambodia, South Africa and Uganda. In many low-income countries resources are allocated through a mixture of political negotiation and incremental budgeting based on established patterns. This can result in resources going disproportionately to more vocal and visible urban populations, perpetuating pre-existing inequity. Allocation based on need would be a significant break with tradition. The report concludes that a needs-based approach is not necessarily pro-poor. The definition of equity must be consistent with any existing pro-poor health policy. Reallocation of resources takes time and should be incorporated into medium-term expenditure plans. Using a formula is objective and transparent and preferable to more subjective alternatives.
The measles vaccine is safe and highly effective, so why is this disease still the leading cause of death among African children? The governments of seven countries in southern Africa have implemented targeted measles elimination campaigns over the past five years with help from the World Health Organisation (WHO). How successful have they been? This study shows that the WHO-recommended strategies for measles elimination are feasible and effective in the region, even in very low-income countries and those with high HIV prevalence. The report points out that lasting reduction in measles disease and deaths in southern Africa will require: Sustained national commitment; Continued high levels of routine and follow-up campaign vaccination coverage; Complete and timely surveillance of all suspected cases with laboratory confirmation; Careful community investigation of confirmed measles cases to assess the extent of secondary spread.
This report warns that if urgent and strategic action is not taken to close the gaps in funding, research and global immunisation coverage, the world will see the re-introduction of old diseases and the emergence of new infections. The report was launched in Dakar, Senegal, at the 2nd Partners' Meeting of the Global Alliance for Vaccines and Immunisation (GAVI). Jointly produced by the World Health Organisation (WHO), UNICEF and the World Bank, the report highlights remarkable achievements in immunisation over the last decade and outlines the challenges for the future.
The countries worst hit by the worldwide TB epidemic, including South Africa and Zimbabwe, urgently need extra help if they are to meet ambitious global targets set for the year 2005, the World Health Organisation (WHO) says. Experts working with WHO estimate that the total cost for TB control worldwide is $1.2 billion every year. Three-quarters of that total is already covered by countries, donors and other sources. The remaining $300 million each year is urgently needed if the targets are to be met by 2005. WHO's World Health Assembly has set global targets of detecting 70% of TB patients and successfully curing 85% of these patients by 2005. "This is a race against time," said Dr. J.W. Lee, director of WHO's STOP TB Department in Geneva. "Poor control practices in many countries and the TB/HIV coepidemic mean that urgent action needs to be taken to control TB." "This funding gap is clearly identified and affordable," he added. "If we are to meet these targets, we must act now."
6. Governance and participation in health
"As supporters of women's rights worldwide, we are deeply disturbed by the statement made by a US delegate at the recent Preparatory Meeting for the forthcoming Fifth Asian and Pacific Population Conference that will take place 11-17 December 2002 in Bangkok. The US has threatened to withdraw from the Cairo Programme of Action of 1994 unless the words reproductive health services and reproductive rights are taken out or changed. This is a shocking development which is a threat to women's rights and women's health world wide. We demand that the Cairo Program of Action that has been endorsed by 179 nations be upheld. Reproductive health services and reproductive rights are essential human rights. Reproductive rights and reproductive health services are integral to the Cairo Program of Action. If the US breaks their commitment to the United Nations and to the world community, there will be disastrous consequences for women in all parts of the world who are in need of safe and effective contraceptive and abortion information and services. The position that the Bush administration has taken sets back the efforts of women's organisations by several decades and needs to be resisted. We urge you to make your own statement of protest and send it to the US administration, to the UN and to sign our petition on line at: http://www.PetitionOnline.com/USantiWO/petition.html."
"As supporters of women's rights worldwide, we are deeply disturbed by the statement made by a US delegate at the recent Preparatory Meeting for the forthcoming Fifth Asian and Pacific Population Conference that will take place 11-17 December 2002 in Bangkok. The US has threatened to withdraw from the Cairo Programme of Action of 1994 unless the words 'reproductive health services' and 'reproductive rights' are taken out or changed. This is a shocking development which is a threat to women's rights and women's health world wide. We demand that the Cairo Program of Action that has been endorsed by 179 nations be upheld. Reproductive health services and reproductive rights are essential human rights. Reproductive rights and reproductive health services are integral to the Cairo Program of Action. If the US breaks their commitment to the United Nations and to the world community, there will be disastrous consequences for women in all parts of the world who are in need of safe and effective contraceptive and abortion information and services. The position that the Bush administration has taken sets back the efforts of women's organisations by several decades and needs to be resisted. We urge you to make your own statement of protest and send it to the US administration, to the UN and to sign our petition on line at: http://www.PetitionOnline.com/USantiWO/petition.html."
7. Monitoring equity and research policy
Every year about 24 million African women become pregnant in areas where the risk of malaria is high. They are more likely than other adults to become infected and this increases the risk of poor pregnancy outcome. Results of a study, funded by the UK Medical Research Council and conducted in The Gambia, emphasise the need for improved management of pregnancy and labour. Since the first study 20 years ago, several trials have produced recommendations on strategies to tackle maternal malaria. This serious public health problem may persist due to a lack of collaboration between scientists and policy-makers or because existing policy is not fully implemented. The researchers suggest that policy-makers should: Implement effective malaria control strategies for pregnant women, including the use of insecticide-treated bednets, and drugs to prevent and treat malaria; Ensure that control measures start as early as possible in pregnancy; Strengthen their working links with researchers and; Conduct community-level research to guide programmes, and monitor and evaluate success.
Of the US$73 billion spent globally every year on health research only about 10% is actually allocated for research into 90% of the world’s health problems. This is what is known as the 10/90 gap. This third landmark report of the Global Forum for Health Research underlines the crucial role that health and health research funding plays in breaking the cycle of poverty.The report covers progress towards narrowing this gap over the past two years and outlines plans for the coming years. The report stresses that prioritisation of health research spending at the global and national levels is a necessity if research funds are to have the greatest impact possible on the level of world health. However, it also notes that setting priorities in terms of individual diseases is not enough and that cross-cutting influences such as the capacity of a country to deliver health services, the necessity to look at gender differences, behaviour and lifestyles harmful to health, and environmental problems like indoor air pollution must also be considered.
8. Useful Resources
The annual AIDS epidemic update reports on the latest developments in the global HIV/AIDS epidemic. With maps and regional summaries, the 2002 edition provides the most recent estimates of the epidemic's scope and human toll, explores new trends in the epidemic's evolution, and features a special section examining the links between HIV/ AIDS and humanitarian crises.
More than 120 individuals from many countries and diverse backgrounds joined this discussion list. The debate covered a broad range of topics, focusing particularly on: HIV treatment as a priority relative to other health and development issues; Strategies for delivering treatment in resource-poor settings; The role and operation of the new Global Fund to Fight AIDS, TB and Malaria; Stigma as a barrier to access. The discussion provided a unique opportunity for a variety of stakeholders to share their views and contribute to this important and topical debate. Hard copies of the report will be available soon. To request a copy, email Tom Barker: tomb@ids.ac.uk
This Operations Research Handbook shows how to use operations research (OR) to design programmes that effectively combat HIV/AIDS. Written for programme administrators and researchers, the handbook draws on real-life lessons derived from projects implemented throughout the developing world.
Engendering International Health presents the work of leading researchers on gender equity in international health. Growing economic inequalities reinforce social injustices, stall health gains, and deny good health to many. In particular, deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated and accessible evidence to downgrade the importance of gender perspectives in health.
JHPIEGO TrainerNews© is a free monthly e-mail newsletter with current reproductive health training news, contraceptive briefs, training tips, announcements about reproductive health and training-related programs and activities, and profiles on Internet and CD-ROM resources of interest to reproductive health trainers. The information is targeted to professionals working in low-resource settings.
The purposes of this bibliography are to present an overview of the published literature on equity in health and to summarize key articles relevant to the mission of the International Society for Equity in Health (ISEqH). The intent is to show the directions being taken in health equity research including theories, methods, and interventions to understand the genesis of inequities and their remediation. Therefore, the bibliography includes articles from the health equity literature that focus on mechanisms by which inequities in health arise and approaches to reducing them where and when they exist.
Earlier this year, 'HIF-net at WHO' subscribers contributed ideas and perspectives around the theme of 'Local creation and adaptation of health information'. This took the form of a vibrant discussion on 'HIF-net at WHO'. Along with other material, the content of this discussion is helping to inform the G8 DOTS Force, a high-level international body 'addressing the global digital divide'. In addition, 'HIF-net at WHO' subscribers and others worldwide contributed more than 30 detailed case stories on health information, which were collated by INASP. These are now available in full at the URL provided.
Source is a unique resource centre, designed to meet the information needs of those working in health, disability and development worldwide. Source is an innovative collaboration between an academic institution, the Centre for International Child Health (at the Institute of Child Health, UCL), and two international NGOs, Healthlink Worldwide (formerly AHRTAG) and Handicap International UK. Source is aimed at health workers, researchers, rehabilitation workers, non-governmental and governmental organisations and disabled peoples' organisations worldwide and has a unique collection of over 20,000 health and disability related information resources.
The Commission on Macroeconomics and Health (CMH) has created an electronic newsletter to provide up-to-date information about national efforts to increase investment in health and improve the effectiveness of health expenditure. The MacroHealth Newsletter will feature Macroeconomics and Health Support Secretariat news, new findings on health investment and economic growth, country CMH launches and progress in implementing national work in macroeconomics and health.
9. Jobs and Announcements
The Global Development Network (GDN) are looking for case studies on the topic of bridging research and policy on development issues. The Bridging Research and Policy project aims to collect 50 case studies of research-policy linkage during 2002. Thirty case study proposals have now been approved, but more are urgently needed if the target of 50 cases by the end of the year is to be met. The cases can focus on a specific project, a policy process or the work of an institution.
The Research Triangle Institute (RTI) is looking for a HIV/AIDS Policy/Advocacy Specialist for a 4-year USAID project focusing on behaviour change to reduce HIV prevalence and reduce number of partners in Malawi to begin in January 2003.
The Margaret Sanger Centre International South Africa is currently recruiting a Resident Technical Advisor (RTA) for placement in Namibia. This position will work closely with our office and that of our parent organization, the Margaret Sanger Centre International of Planned Parenthood, New York City, USA.