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Ugandan HIV Drugs Outpriced by Imports

KAMPALA, Dec 20 2013 (IPS) - The Ugandan government is struggling to live up to its promises to protect the local production of antiretrovirals and anti-malarials from competition from abroad.

Following a 2008 agreement with Indian generic drug maker Cipla Limited, a Ugandan company, Quality Chemicals Limited (QCIL), began manufacturing antiretrovirals (ARVs) and artemesinin-based combination therapies (ACTs) in 2009.

But locally manufactured drugs are proving more expensive than generic ARVs produced in India, China and Pakistan, and even by big pharmaceutical firms in the West.

According to the Uganda Pharmaceutical Manufacturers Association, in 2010 Uganda’s pharmaceutical market was worth an estimated 276 million dollars; 90 percent of these medicines were imported.

Paul Asiimwe, a Ugandan lawyer knowledgeable about intellectual property laws and access to medicines, says QCIL and other pharmaceutical manufacturers in Uganda have not been given enough protection from foreign generic manufacturers eager to cash in on the multi-million-dollar Ugandan pharmaceutical market.

But he concedes the government has limited room to influence this. “The problem is that the government does not actually purchase most of these drugs, since they are largely paid for by donors and the Global Fund for AIDS, Tuberculosis and Malaria, which has insisted that all procurement should be competitively tendered out,” Asiimwe explained.

Denis Kibira, the medicines advisor with the Coalition for Health Promotion and Social Development (HEPS-Uganda), said prices for locally produced ARVs in Uganda will remain high until government and its partners such as the World Health Organisation [WHO] address what he referred to as “niggling concerns”.

“Prices of locally-produced medicines will only come down if costs of production are reduced through availability of affordable financing for the sector, improved road infrastructure as well as local production of active pharmaceutical ingredients,” Kibira said, adding that local  manufacturers still incur high costs for raw materials whose prices fluctuate widely depending on demand from other countries.

Emmanuel Katongole, QCIL’s chief executive officer, recently asked the government to intervene to help his firm strengthen local sourcing of raw materials.

“It is becoming too costly to import raw materials from India,” explained Katongole.

He added that the cultivation of Artemisia in parts of Uganda has not helped to lower the cost of producing anti-malarial medicine as raw Artemisia from Uganda was yet to be approved by the WHO.

Dr Gilbert Ohairwe, a board member of the Pharmaceutical Society of Uganda, explained that in addition to competition from manufacturers in India, China and Pakistan, the local pharmaceutical industry has had to contend with cheap drugs reaching Uganda via voluntary pooled procurement.

The Global Fund relies on pooled procurement, which secures medicines in bulk at preferential prices from the world’s leading drug companies, as an effective way to solve challenges of both prices and quality control.

But Ohairwe said with Big Pharma capturing the lion’s share of the nearly 20 billion dollars spent by the Global Fund on drugs for 144 countries in 2010, local producers are disadvantaged.

Advocates for better access to ARVs and other medicines suggest that Uganda should take better advantage of exemptions for Least Developed Countries under World Trade Organisation regulations – which were recently extended to 2021 – to acquire technology to produce high-quality, inexpensive medication.

Moses Mulumba, the executive director of the Centre for Human Rights and Development (CEHURD), which advocates for local generic manufacturing, said, “We can’t rely on importation of medicines forever. This is why I think that we need to deal with the challenges that make our ARVs more expensive.

“The time is now, when we have the policy space under the TRIPS (Trade-Related Aspects of Intellectual Property Rights) agreement, as recently extended. It will be more challenging to deal with these concerns when the policy space is finally closed.”

Sarah Opendi, the country’s national minister for health, agreed that the local pharmaceutical sector is facing challenges. “But nobody can say we have not supported Quality Chemicals Limited to reach where it is now. It is definitely in our interest to have more medicine manufactured here,” she said.

Dr Gordon Sematiko, director of the National Drug Authority, revealed that the NDA was formulating a new national pharmaceutical strategy in co-operation with the Ministry of Health.

The new policy, according to Sematiko, will put measures in place to reduce dependence on imported medicines.

“It is hoped that the plan will improve their manufacturing practices and thus enhance their competitiveness on the domestic market,” he said.

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