Inter Press Service » Bitter Pill: Obstacles to Affordable Medicine News and Views from the Global South Thu, 25 May 2017 13:17:05 +0000 en-US hourly 1 Hopes of Controlling Sierra Leone’s Ebola Outbreak Remain Grim Thu, 06 Nov 2014 10:12:45 +0000 Lansana Fofana Concern is being raised by civil society and the public about how Sierra Leone’s government is handling the Ebola pandemic. Credit: Marc-André Boisvert/IPS

Concern is being raised by civil society and the public about how Sierra Leone’s government is handling the Ebola pandemic. Credit: Marc-André Boisvert/IPS

By Lansana Fofana
FREETOWN, Nov 6 2014 (IPS)

The fight against the deadly Ebola epidemic ravaging West Africa seems to be hanging in the balance as Sierra Leone’s Minister of Health and Sanitation Dr Abubakar Fofana told IPS that the government is overwhelmed by the outbreak.

“We were not prepared for this Ebola scourge. It took us by surprise and with our weak health system, we can only rely on support given to us by our international partners,” he told IPS.

According to a report published last week by British charity Save the Children, five people are infected every hour here and the situation is worrisome.

The government has, however, downplayed this, claiming the report is hugely exaggerated and that the situation is getting better in some parts of the country.

However, concern is being raised by civil society and the public about how the government is handling the outbreak.

Bernard Conteh, the director of the rights advocacy group Anti-Violence Movement, told IPS: “The authorities should be more pro-active. They should pay health workers, who are the frontline soldiers in this fight, reasonably well and ensure they are supplied adequate Personal Protective Equipments. This is not happening. Even the enforcement of the quarantine of Ebola suspects is not effectively done.”

On just one day, Nov. 2, 61 new cases were reported across the country bringing the nationwide toll to 4,059 people infected by the virus. This surpasses neighbouring Liberia which, until a month ago, was the worst-hit country. Liberia has recorded 2,515 cases while Guinea, where the epidemic first started, has 1,409 recorded cases of Ebola.

Since the outbreak of the epidemic in April, Sierra Leone has lost five medical doctors, more than 60 nurses and auxiliary health workers to Ebola. And the figure keeps going up.

The African Governance Initiative has also painted a grim picture of the outbreak here, saying that it is spreading nine times faster than it did two months ago. Of the 12 districts in the country and the capital Freetown, only Koinadugu in the north was Ebola-free — until recently. It now has at least six confirmed cases. Now, no part of Sierra Leone is unaffected but the virus.

The government has, however, been assisted by the international community. The United Kingdom has sent medical equipment and health workers, and has built test and treatment centres in parts of the capital. China has also sent medical aid, while Cuba has deployed dozens of medics on the ground.

But, there are still many challenges to be addressed. According to the medical charity MSF or Doctors Without Borders, the outbreak is far from over and more help is desperately needed.

“There is a huge gap in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation,” MSF says.

As the fight against the killer epidemic continues to prove difficult with the virus spreading fast, the government in Freetown has just implemented a year-long state of emergency. This comes just two days after an earlier 90-day state of emergency, implemented in July in response to the outbreak, ended.

Attorney-General and Minister of Justice Frank Kargbo told IPS the extension of the emergency period was necessary to help control the spread of the virus.

“No one knows when the Ebola epidemic will end. We believe that within this period and with our hard work, we will be able to contain the disease.”

Many attribute the rapid spread of the Ebola virus to people’s attitudes and, as MSF says, a lack of sufficient community education and mobilisation. Cultural practices and traditional beliefs are also greatly hampering the fight against Ebola.

“Our people still continue to touch, wash and bury their dead. This is an easy way to get infected, even though they have been told repeatedly not to do so,” the chairman of the National Ebola Response Committee, Alfred Palor Conteh, told IPS.

People also refuse to report to hospitals when they fall ill because of the fear of stigmatisation by their families and communities. Many believe that Ebola is fatal and that going to treatment centres will not help. Ebola survivors and discharged patients also face stigmatisation.

However, Health Health and Sanitation Minister Fofana said he was hopeful the situation would be brought under control soon with international help.

Edited by: Nalisha Adams

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East Africa Breaks the Silence on Menstruation to Keep Girls in School Fri, 15 Aug 2014 14:30:18 +0000 Amy Fallon Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 15 2014 (IPS)

When Peninah Mamayi got her period last January, she was scared, confused and embarrassed. But like thousands of other girls in the developing world who experience menarche having no idea what menstruation is, Mamayi, who lives with her sister-in-law in a village in Tororo, eastern Uganda, kept quiet.

“When I went to the toilet I had blood on my knickers,” she told IPS. “I was wondering what was coming out and I was so scared I ran inside the house and stayed there crying.

“I just used rags. I feared telling anybody.”For girls, “pads are as good as schoolbooks” -- Dennis Ntale, 18, a student at co-ed Mengo Senior School in Kampala, Uganda

Not having access to or being able to afford disposable sanitary pads or tampons like millions of their Western counterparts, desperate Ugandan girls will resort to using the local ebikokooma leaves, paper, old clothes and other materials as substitutes or even, as a health minister told a menstrual hygiene management conference this week, sitting in the sand until that time of the month is over.

“We always try to give them something to use at school, just at school,” Lydia Nabazzine, a teacher at Mulago Private Primary School in Kampala, where about 300 out of 500 students are female, told IPS.

“When they go home we don’t know how they go about it, because we cannot afford funding up to home level.”

But the 2012 Study on menstrual management in Uganda, conducted by the Netherlands Development Organisation (SNV) and IRC International Wash and Sanitation Centre in seven Ugandan districts, found that over 50 percent of senior female teachers confirmed there was no provision for menstrual pads for schoolgirls.

When some girls have their period, they may miss up to 20 percent of their total school year due to the humiliation of not having protection, according to separate research from the World Bank. This profoundly affects their academic potential.

“Those days when I was menstruating I could be absent for up to five days a month until menstruation had stopped,” recalled Mayami.

It’s a continent-wide problem. The United Nations Children’s Fund says one in 10 African girls skipped school during menstruation. Some drop out entirely because they lack access to effective sanitary products.

A number of recent initiatives have, however, tried to address this.

On May 28 this year, the world marked the first Menstrual Hygiene Day to help “break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.”

On Aug. 14 – 15, East Africa’s first national menstrual hygiene management conference, which has the theme “breaking the silence on menstruation, keep girls in school,” has been taking place in Uganda’s capital Kampala.

At least 100 schoolteachers, schoolgirls – and boys – NGOs, including Network for Water and Sanitation (NETWAS) Uganda, civil society members and others are taking part in the two-day event. They’re calling on the government to put in place a menstrual hygiene management school policy. They also want the government to provide free sanitary pads to girls in schools, like neighbouring Kenya has done.

Despite keeping silent about the horrors of menstruation for months, Mamayi shared with the conference attendees the solution she found to that time of the month.

The student, now 13, had been walking home from school when some older pupils told her, “madam [the teacher] said menstruation is a normal thing for every girl.”

“So I asked them about it,” she told IPS.

“Now I’m using AFRIPads.”

Invented by the eponymous Uganda-based social business, AFRIPads are washable cloth sanitary towels designed to provide effective and hygienic menstrual protection for up to a year.

One Ugandan, Dr. Moses Kizza Musaazi, a senior lecturer in the Department of Electrical and Computer Engineering at Kampala’s Makerere University, has also invented the environmentally-friendly MakaPads, from papyrus reeds and waste paper. MakaPads are said to be the only trademarked biodegradable sanitary pads made in Africa.

Mamayi said the re-useable pads work out to be 5,500 Ugandan shillings (2.11 dollars) a year, compared to the 30,000 shillings (11.49 dollars) that disposable pads would have set her back.

“Now when I go somewhere [when I have my period] I sit and am comfortable,” said Mamayi. “I’m not bothered by anything. I don’t worry whether I’ve got anything on my skirt. I don’t miss school.”

She added: “I’m going to tell my friends that menstruation is a normal thing in girls.

“I want my friend also to be free, to tell their parents to buy for them pads. Let them not fear.”

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Courtesy: Amy Fallon

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Credit: Amy Fallon/IPS

Breaking the culture of silence around menstruation is the aim of a new book, Understanding and Managing Menstruation, launched by Uganda’s Ministry of Education and Sports at the conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys.

Maggie Kasiko, a gender technical advisor at the Ministry of Education and Sports, told IPS that the government hoped the book would reach as many students, teachers and parents across the country as possible.

“Not many girls have the opportunities to have their mothers and aunties around, so they start their menstruation without knowing,” she said, adding many parents and relatives were busy trying to earn a living for their families.

Dennis Ntale, 18, a senior five student at co-ed Mengo Senior School in Kampala, said he didn’t know what menstruation was when he encountered a fellow student with her period in class earlier this year, and tried to comfort her. It was only sometime later when he relayed the incident to his male friends and they told him she was “undergoing her MP [menstrual period].”

“They’re [teachers] not teaching this to the boys in schools,” Ntale told IPS.

“I believe boys should be informed about this because there are many of them out there who have no idea about this.”

He said for girls, “pads are as good as schoolbooks”.

“If you don’t have that pad she won’t be able to do a thing,” Ntale said. “[We should] make sure she has what will keep her in school.”

Kasiko said the Ministry of Education and Sports was continuing to ensure schools had separate facilities for boys and girls, with the girls having washrooms and changing rooms where they could bathe and change, had access to clean water, extra pads and Panadol.

But she said she didn’t see the government providing free pads to girls “in the short-term or the long-term”.

“Starting to distribute sanitary towels to each and every girl, every month, is quite a cost for the ministry when you look at all the other areas that the ministry needs to take care of,” she said.

“That, our guidelines for Universal Primary Education (UPE) is very clear, is a role of parents. It’s sanitary wear. Just like you buy a panty for your child, you should be responsible for buying a sanitary towel for your child.

Kasiko added: “But we’ll support the parents and work together with the parents to give them knowledge to ensure the environment is clean and girls stay in school.”

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

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Using Ethiopia’s Healthcare Gaps to Do Good and Make a Profit Thu, 03 Apr 2014 07:45:46 +0000 James Jeffrey Ethiopians waiting inside a hospital in Addis Ababa on the weekend. The capital has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

Ethiopians waiting inside a hospital in Addis Ababa on the weekend. The capital has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

By James Jeffrey
ADDIS ABABA, Apr 3 2014 (IPS)

For a while now, Magnetic Resonance Imaging or MRI scanners have typically been a luxury that both government and private hospitals in Ethiopia have struggled to afford to purchase for in-house use.

Addis Ababa, the Ethiopian capital with an ever-growing population of around 3.8 million, currently has only four stationary MRI scanners that provide services to 30 government and private hospitals, according to Zelalem Molla, a surgeon based in Addis Ababa.

Outside of the capital, only two MRI scanners exist. But the six scanners — in this Horn of Africa nation of some 92 million people — are old fashioned and far behind the technological curve in the West.

“It would be wrong to claim that the mobile MRI scanner would save lives,” says Zelalem, whose lunchtime chat with American entrepreneur Peter Burns III about the paucity of scanners sparked a business idea.“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the side-lines.” -- Alayar Kangarlu, MRI research centre, Columbia University

But, Zelalem notes, more MRI scanners — which use strong magnetic fields and radio waves to generate images of the inside of the body that can be analysed on computers — would crucially allow more doctors to diagnose illnesses far earlier when they are operable and potentially curable.

“Often it is not possible for doctors to diagnose illnesses such as tumours until they physically appear at a stage when the chances of saving a patient are slim — or it is too late,” Zelalem tells IPS.

However, actual figures about the number of people directly affected here by the lack of MRI scanners do not exist.

In the past, some Ethiopians have needed to travel to other African countries such as Kenya and South Africa, or to Europe to have scans. This even included Haile Gebrselassie, Ethiopia’s track runner, who used to go to Munich, Germany for scans to help diagnose running injuries.

Ethiopia technically has free healthcare for all, which is provided by government-run hospitals. The reality, however, is that “there are not enough hospitals and most suffer from inadequate staffing, budgets and machinery,” Zelalem says. Private hospitals exist but as an option affordable to very few Ethiopians.

And the cost of an MRI scan proffered privately is a frightening figure for most Ethiopians, many of whom earn between 500 to 1,000 birr (28 to 56 dollars) a month.

The scale of demand at government-run hospitals for free MRI scans means patients can be left with the choice of having to wait and risking their health, or raising funds to pay for a scan at a private hospital or institution.

Such gaps in Ethiopia’s healthcare are areas of concern to the government and many NGOs as three of the eight United Nations Millennium Development Goals (MDGs) for 2015 are healthcare focused, concentrating on reducing child mortality, improving maternal health as well as combatting HIV/AIDS, malaria and other diseases.

But people like Burns are taking advantage of these gaps to do good while making a profit at the same time.

“This project represents the highest form of achievement edified by the mantra: ‘Doing well by doing good,’” Burns, who is based in Addis Ababa as a self-styled “ExPatrepreneur”, tells IPS.

Burns describes the project to provide the country with scanners as a for-profit enterprise with a charitable component.

“We will be offering a total of 25 percent of our scans for free to those that are unable to afford it,” Burns says.

So far, Burns says he will only bring one mobile MRI scanner to Addis Ababa and will sell its services on a pay-per-scan basis.

Ethiopia’s capital, Addis Ababa, has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

Ethiopia’s capital, Addis Ababa, has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

Also, there is a plan for a portion of profits to fund a not-for-profit venture called Doctors Within Borders, which aims to provide financial incentives to encourage Ethiopian doctors to remain within Ethiopia, as well as work in remote rural areas.

A previous private MRI scanner service in Addis Ababa set a precedent for profitability, Zelalem says. The business conducted about 30 scans a day — an MRI scan typically costs from about 115 to 150 dollars to conduct and process the images — totalling annual revenue of more than one million dollars. However, this scanner is fixed and patients are transported to it from various hospitals across the city.

“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the sidelines,” Alayar Kangarlu, who leads the physics and engineering group at the MRI research centre at Columbia University in New York, tells IPS. At the same time this creates an opening for private business, he notes.

And generating a healthy bottom line can have a beneficial role in healthcare provision, some say.

“NGO-based humanitarian healthcare usually struggles with sustainability and operates from grant to grant,” a worker within the health sector in Ethiopia, who wished to remain anonymous due to current work commitments, tells IPS.

Private enterprise, on the other hand, he notes, can achieve long-term sustainability thanks to profit generation. And it is usually more flexible, and more efficient due to greater accountability, than NGOs typically hampered by rigid fiscal rules on profit. Private enterprise can also free up capacity within public- or NGO-provided healthcare.

Admittedly profit generation within healthcare can turn sour and escalate wildly, he notes, as witnessed in the U.S., but Ethiopia’s healthcare system remains light years away from encountering such problems.

Burns remains confident that he can improve MRI scanner availability in Addis Ababa.

And if that is achieved, then the same business model could be applied to other major Ethiopia cities around the country — and go some way towards helping achieve the MDGs related to healthcare.

“Much can be accomplished through the small combined efforts of the many, and it is each of our responsibility to contribute,” Burns says. “This is one small step to serving just one of the many needs of a population in a place like Ethiopia.”

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South Africa Battles Drug-Resistant TB Wed, 12 Mar 2014 10:04:55 +0000 Brendon Bosworth South Africa is battling to reduce its cases of multidrug-resistant TB (MDR-TB) with the success rate for those on treatment at about 40 percent. Miriam Mannak/IPS

South Africa is battling to reduce its cases of multidrug-resistant TB (MDR-TB) with the success rate for those on treatment at about 40 percent. Miriam Mannak/IPS

By Brendon Bosworth
CAPE TOWN, Mar 12 2014 (IPS)

Despite an increase in diagnosis times, South Africa is facing a growing drug-resistant tuberculosis (TB) burden as nationally there remains a large gap between the number of patients diagnosed with multidrug-resistant TB (MDR-TB) and those who start treatment.

Between 2007 and 2012, recorded cases of MDR-TB, which is resistant to at least two of the primary drugs used to combat standard TB, almost doubled.

South Africa has improved its ability to test for drug-resistant TB by introducing GeneXpert, a rapid testing machine that can diagnose TB in sputum samples in less than two hours.“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it.” -- Gilles van Cutsem, Médecins Sans Frontières (MSF)

But in 2012, just 42 percent of patients diagnosed with MDR-TB began treatment, according to government figures. The success rate for those on treatment is about 40 percent.

“If we don’t do something about it now, MDR-TB is going to become XDR-TB [extensively drug-resistant TB],” Dr. Jennifer Hughes, a drug-resistant TB doctor with Médecins Sans Frontières (MSF), told IPS. XDR-TB is a strain of TB resistant to at least four of the main TB drugs.

“If we don’t start focusing on how we treat XDR-TB properly as well, we’re just going to drive further and further resistance as we go.”

Treatment Gap

Most of South Africa’s provinces have increased their treatment capacity for MDR-TB patients after the government introduced a 2011 framework for decentralising MDR-TB care. This allows patients to start treatment at sites closer to their homes instead of the country’s few specialised TB hospitals, where a typical stay is six months.

But provision of treatment at primary healthcare level needs to increase, Dr. Norbert Ndjeke, director of the Department of Health’s DR-TB, TB and HIV division, told IPS.

“[Decentralisation] is not moving at the speed we want it to,” admitted Ndjeke. There is no special budget for decentralisation and provincial governments choose how to prioritise their spending, he said.

The number of sites MDR-TB patients can start treatment in the Western Cape, Gauteng, Eastern Cape, and the Free State provinces has quadrupled due to decentralisation. The number of sites in the Western Cape, for instance, went from four to 17, while Gauteng now has five treatment sites instead of one.

Limpopo Province has not added new facilities, while North West and the Northern Cape provinces have doubled available treatment initiation sites, going from one to two, and two to four, respectively.

When properly implemented, decentralisation can cut the treatment gap.

In Khayelitsha, a large semi-informal township on the fringes of Cape Town, a combination of quicker testing and decentralisation has led to the time between diagnosis and treatment for drug-resistant TB dropping from 73 days to just seven days between 2007 and 2013, according to data by MSF. Ninety-one percent of patients diagnosed with MDR-TB in Khayelitsha in 2013 began treatment.

Ndjeke noted that provisional national data for 2013 indicates that 10,095 MDR-TB patients began treatment. Figures are not yet available for the number of patients diagnosed during that period, but in the first nine months of the year 7,271 patients were diagnosed with MDR-TB, possibly indicating a shrinking gap between treatment and diagnosis.

Accurate recording and reporting of patient numbers and outcomes remains a challenge, and the government is working to improve its systems, he said.

Large Burden

South Africa has the world’s third-largest TB burden, after India and China, according to the World Health Organisation. It also reports the world’s most cases of XDR-TB, a virulent form of the disease that is resistant to at least four of the main TB drugs and has a treatment success rate of less than 20 percent. An estimated one percent of the population of about 51 million develops TB every year.

“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it,” said Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho, at a media briefing.

Doctors are concerned about the rise in transmission of drug-resistant TB.

When drug-resistant TB started emerging it was mainly due to patients not being able to complete their full course of treatment for standard TB, said MSF’s Hughes. But now most drug-resistant TB transmission happens through people breathing it in from others, she said.

New Drugs Offer Hope 

One of the main challenges for treating drug-resistant TB is that the available drugs come with side effects including nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course.

“The drugs are horrendous – it’s a terrible regime but it’s the best they’ve got,” Hughes told IPS. On average, patients need to take between 12 and 15 tablets daily for two years, she explained.

South Africa is running a clinical access programme for up to 200 XDR-TB – and pre-XDR-TB patients with limited treatment options for a new drug called Bedaquiline, the first drug designed specifically to treat TB in over 50 years.

One of the features of the drug, which is taken along with other drugs, is that patients get better a lot quicker, said Dr. Francesca Conradie, clinical advisor to Sizwe Hospital, a MDR-TB hospital in Gauteng.

“It’s the first in a pipeline of maybe four or five drugs that will revolutionise the way we treat MDR-TB,” said Conradie.

Based on the outcomes of this initial programme, South Africa’s Medicines Control Council will decide whether or not to register Bedaquiline for use for more patients.

A new regime of drugs for drug-resistant TB patients could be ready by 2022 based on the outcomes of existing trials, said van Cutsem.

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A Matter of Life and Death Sun, 09 Mar 2014 16:08:55 +0000 Martin Khor

Martin Khor, executive director of the South Centre, warns that negotiations on the Trans Pacific Partnership Agreement are a matter of life and death.

By Martin Khor
GENEVA, Mar 9 2014 (IPS)

If you or some family members or friends suffer from cancer, hepatitis, AIDS, asthma or other serious ailments, it’s worth your while to follow the negotiations on the Trans Pacific Partnership Agreement and other similar bilateral trade agreements.

It’s really a matter of life and death. For the TPPA can cut off the potential supply of cheaper generic medicines that can save lives, especially when the original branded products are priced so sky-high that very few can afford them.

Recently, a cancer specialist in New Zealand (one of the TPPA counties) warned that the TPPA would prolong the high cost of treating breast cancer because of new rules to protect biotechnology-based cancer drugs from competition from generics. And this will affect the lives of cancer patients.

Some cancer medicines can cost a patient over 100,000 dollars for a year’s treatment. But generic versions could be produced for a fraction, making it possible for patients to hope for a cure and a reprieve from death.

In India, local companies are leading the fight to make medicines more affordable to thousands of patients suffering from breast, kidney, liver and

gastrointestinal cancer and chronic leukemia.

For example, an Indian company produced a generic drug for kidney and liver cancer 30 times cheaper than the branded product (140 dollars versus 4,580 dollars for a month’s treatment) after it was given a compulsory license.

India has a law that disallows patents for a newer form of drugs or known substances unless it improves the medicine’s efficacy or effectiveness. Under the World Trade Organisation (WTO) rules, countries are free to set their own standards for novelty, or whether a product is novel enough to be eligible for a patent.

Also, in many countries, the patent law allows for companies to obtain compulsory licenses to import or make generic versions of original medicines. Governments grant such licenses if the branded products are too expensive and the original companies do not offer attractive terms for a voluntary license to other firms.

Multinational companies have strongly opposed compulsory licenses or the Indian-type laws that allow for patents only for genuine innovations.

This is where the TPPA comes in. Mainly at the insistence of the United States, countries are being asked to accept standards of intellectual property, that go beyond the rules of the WTO’s.

Especially noteworthy is the U.S. insistence that the TPPA countries agree to give a type of intellectual property known as “data exclusivity” for five years to companies producing original medicines.

This is extended to eight or 12 years for “biologics”, or medicines made with biotechnology. Many of the new medicines for treating cancers are biologics.

This will cause immense problems for patients waiting for cheaper medicines because “data exclusivity” prevents generic companies from relying on the safety and clinical trial data of the original company to get safety clearance for their generic products.

Thus, even if a generic company can prove that its medicine is bio-equivalent to the original medicine that has already passed the safety standard required by the health regulatory authorities, it will not be allowed to sell its medicine unless it comes up with its own safety and clinical trial data.

This goes against the current practice of generic medicines and safety standards. But the U.S. is insisting on this in the TPPA.

Few generic companies have the funds or technical ability to do their own clinical trials, and thus generic medicines could well be prevented from being used in TPPA countries for five to 12 years – even if the medicines are not patented.

That is the most significant aspect of the TPPA, and this is why so many groups of patients, health organisations and independent medical experts have been outraged and outspoken in their opposition to the agreement.

According to Jamie Love of Knowledge Ecology International, an expert on drugs and patents, the average cost of eight biologic cancer drugs registered with the U.S. drug authorities in 2011-2013 is 128,000 dollars (for a year’s treatment), with the most expensive being over 390,000 dollars. At such prices, hardly anyone in developing countries can afford these medicines.

In mid-February, eight prominent organisations including Medicins Sans Frontieres, Oxfam, Public Citizen, Health Gap and Knowledge Ecology International, issued a strong statement on their deep concern about the public health implications that the TPPA’s measures will have for millions of patients in need of access to affordable medicines around the whole Asia-Pacific region.

Said the groups: “The negotiations must take into account the health needs of all patients living in TPPA countries, and the U.S. must halt its efforts to limit countries’ freedom and flexibilities, otherwise the TPPA will jeopardize many, if not millions, of lives.”

Developments in India, which is not a TPPA country, show the patient-friendly policies that can emerge when public health concerns are given priority.

For instance, an Indian company is producing a generic version of the drug Gleevac, which is used to treat a chronic form of leukemia as well as gastrointestinal cancer, bringing the cost of treatment down from 70,000 dollars a year (in the U.S.) to 2,500 dollars a year in India.

This was possible because the Indian government denied the original company a patent on Gleevac because it was not judged to be novel enough, and an objection to that decision was rejected by the Indian Supreme Court.

Countries that join the TPPA will find it very difficult or impossible to undertake policies and practices similar to India’s, should the U.S. proposals in the intellectual property chapter be accepted.

Moreover, countries that don’t produce the generic drugs have the option to import them from India and other generics-producing countries. But if the TPPA imposes data exclusivity rules of the type desired by the U.S., it would be difficult to import and sell them.

Some countries are opposed to some of the U.S. proposals. The views and positions that defend public health must prevail, for after all, it is a matter of life and death.

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Saving Cameroonians from Ill Health Thu, 23 Jan 2014 13:51:23 +0000 Monde Kingsley Nfor The Cameroon government says that the uncontrolled number of health clinics and training institutions are responsible for the death and worsening medical conditions of many here. Credit: Monde Kingsley Nfor/IPS

The Cameroon government says that the uncontrolled number of health clinics and training institutions are responsible for the death and worsening medical conditions of many here. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Jan 23 2014 (IPS)

The Cameroonian government has begun a crackdown on illegal medical facilities and plans to shut down more than 524 medical training centres and 600 private clinics operating unlawfully in this Central African nation. 

“We are starting activities to bring order to the medical sector that has gone out of control. Most of [the illegal medical institutions] lack the training, appropriate staff, equipment and infrastructure to operate either as a medical training institution or a clinic,” Biwole Sida, the national health inspector in the Ministry of Public Health, told IPS.

“The uncontrolled number of clinics and training institutions are responsible for the death and worsening medical conditions of many innocent Cameroonians,” Sida added.

In the student residential area of Bonamusadi, in Cameroon’s capital, Yaounde, IPS visited one such clinic that is open 24 hours a day and which provides a wide array of medical services, including prenatal and paediatric care.

But a patient who was rushed to this private clinic with burn wounds was turned away and taken to the nearby government hospital, Yaounde Central Hospital, as the clinic has stopped admitting emergency patients.

“We now operate only by appointment since the government announced [it was] closing down clinics,” Helen Evinga, the clinic attendant, told IPS.

Francois Penda, a medical officer at the emergency unit of the Yaounde Central Hospital, who attended to the burn patient transferred there by the private clinic, explained that it would not be a bad thing if the illegal clinics were shut down.

“Most patients come to the hospital on the verge of death after they wasted time in small private clinics, which are not even equipped technically and professionally to handle emergency cases,” he told IPS.

“A [burn] accident like this is so complicated and requires very delicate and sophisticated medical resources. Any unprepared attempt [to treat the wound] will complicate the patient’s chances of recovery,” Penda said.

Costs of Public Health Care Prohibitive

However, some private clinic operators claim they are providing a much-needed service as the cost of medical care in government hospitals and clinics is prohibitive.

“There is a great need for the services of private clinics in Cameroon. The government structures fell short to satisfy all classes of patients, and are usually saturated with patients, making it difficult for them to receive fair treatment,” Maxwel Fonyu, a laboratory technician and owner of small clinic in Yaounde, told IPS.

He argued that millions of people living in urban slums depend on the affordable medical assistance provided by these private clinics.

“In my clinic, for example, instead of demanding 10 dollars for a malaria test like in big hospitals, I only charge them one dollar to conduct malaria tests, and prescribe and sell medicines that are affordable and vital for their treatment,” Fonyu said.

Illegal Clinics Government’s Fault

Bidjogo Atangana, secretary-general of Cameroon’s National Medical Council, told IPS that the existence of the illegal and ill-equipped clinics was partially because of the government’s liberalisation of the sector some two decades ago.

“In the 1990s people were authorised to open health clinics as a Common Initiative Group (CIG) [a non-profit], which is one of the easiest means to acquire a licence for such ventures,” Atangana said.

Today the National Medical Council wants all medical centres that have been operating as CIGs to close down and obtain proper qualifications and medical licences, which many do not have.

“Nobody will hence own such a structure without authority from the Cameroon National Medical Council, and the training offered in some health institutions must also be checked,” Atangana said.

But according to Etienne Tsou from the health science faculty at Cameroon’s Catholic University, there is a need to regulate more than just the clinics, as most training institutions operate illicitly.

“I don’t see how a medical professional can be trained on the job and not have a formal education. Most retired nurses and doctors think they are qualified to open their own centres and train others when they don’t have what it takes,” he told IPS.

“The sector may lack qualified professionals, but putting the lives of innocent citizens in the hands of charlatans will lead to a bigger public health problem. There are, however, many Cameroonians with good graduate diplomas but their services are exported to countries that pay higher [salaries].”

Lack of Trained Staff

According to the Ministry of Health, about 5,000 Cameroonian medical doctors are currently plying their trade abroad.

Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, said that out of 4,200 medical doctors residing in Cameroon, only about half are practicing as medical doctors.

Of the other half, about 1,000 are on secondment to the Ministry of Health where they perform mostly administrative tasks. The remaining 1,100 are either with the Faculty of Medicine and Biomedical Sciences at the University of Yaoundé I, with NGOs or the private sector.

More than 500 medical doctors and 5,000 nurses graduate annually in Cameroon.

But Ekoe explained that the limited number of practicing medical doctors in the country makes the World Health Organisation doctor-patient ratio of one doctor per 10,000 inhabitants unrealistic in Cameroon – a country of about 21 million people.

“The real ratio is closer to one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Provinces, the ratio is closer to one doctor per 50,000 inhabitants,” Ekoe said.

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The Missing Faces of Ethiopia’s Poor Wed, 22 Jan 2014 11:23:11 +0000 Nick Ashdown Yenenesh Yigsaw (right) recovers from her latest reconstructive surgery with other Noma patients at a recuperation centre outside of Addis Ababa, Ethiopia’s capital. Credit: Nick Ashdown/IPS

Yenenesh Yigsaw (right) recovers from her latest reconstructive surgery with other Noma patients at a recuperation centre outside of Addis Ababa, Ethiopia’s capital. Credit: Nick Ashdown/IPS

By Nick Ashdown
ADDIS ABABA, Jan 22 2014 (IPS)

It’s hard to tell if Gelegay Tsegaye is smiling, since a flap of skin covers half his mouth, but his eyes crinkle when he talks and his muffled voice rings with an upbeat cadence. He’s sitting in a special ward of the Korean Hospital in Addis Ababa, Ethiopia’s most modern healthcare facility. 

Gelegay’s affability is notable because of what he’s gone through. The 34-year-old farmer from a village in Ethiopia’s Gojam region is a survivor of Noma, a rare flesh-eating infection that rots away the face.

When he was just two years old, Gelegay noticed black spots forming on his nose, which quickly spread downwards to his mouth. He received rudimentary treatment, but the diseased part of his face fell off.

Noma is only found amongst children (primary incidence is between the ages of one and four) in the poorest regions of the world, such as rural parts of sub-Saharan Africa and India. The World Health Organisation estimates there are 140,000 new cases globally each year.

Noma’s cause is abject poverty. According to the U.S. Government’s Global Hunger and Food Security Initiative, “Ethiopia is among the poorest countries in the world, with a per capita GDP of 471 dollars.” About 29.6 percent of this Horn of Africa’s 90 million people still live below the poverty line.

Noma only occurs in the poorest villages, where adequate healthcare is non-existent. And there are no official figures on the prevalence of the disease in Ethiopia. Malnourished children with a weakened immune system caused by a viral infection such as measles or malaria are prone to Noma when living in conditions of poor hygiene.

The infection can occur when a child living in poverty suffers a cut to the gums. The cut becomes infected and Noma quickly spreads across the face. Within 10 days, 85 percent of its victims are dead.

The survivors may not feel that lucky though, since they’re left with large portions of their face missing. The affliction then becomes social, not medical.

After Gelegay’s face healed, it wasn’t painful, but the disfigurement left him uncomfortable around people. “I used to be very embarrassed to mix with people. They just pushed me away,” he tells IPS.

Here, Noma survivors don’t go to school. They’re usually isolated by their community, their families, or themselves because they don’t feel comfortable around other people.

Yenenesh Yigsaw is a 19-year-old girl from Ethiopia’s Tigray region who also had Noma when she was two.

Yenenesh didn’t realise she was disfigured until she went to school, and soon stopped going.

“It was my decision. I hated being different from all my friends. I always had to walk around with my face covered, and was very embarrassed,” she tells IPS.

Local surgical resident Gersam Abera has never actually worked with or even seen Noma cases before now.

“Usually, they’ll just stay at home. They don’t even seek traditional treatment,” he tells IPS, adding that many people thought of the condition as a punishment from God and not a medical problem.

A few years ago, Gelegay and Yenenesh heard about Facing Africa, a charity group based in the United Kingdom that gives Noma survivors in Ethiopia free reconstructive surgeries.

Fifteen years ago, Englishman Chris Lawrence started the charity so he could help people in a way that he could see with his own eyes.

Lawrence describes his response to seeing Noma for the first time as “sheer anger.”

“Anger that a disease like this, which is caused by malnutrition and extreme poverty, should exist in the twenty-first century,” he tells IPS.

“Noma is not a disease that needs to exist. If it’s caught in the early stages it’s very easily cured.” Simple antibiotics stop the infection dead in its tracks.

“Either they die, or by the time a doctor sees them, half their face is gone,” Lawrence says.

Most people in rural Ethiopia lack local access to antibiotics, and there are no specific government initiatives for tackling Noma.

The infection can only be eliminated by massive upgrades to rural healthcare, sanitation, and nutrition, which can only be done by the government.

However, experts say rural healthcare has significantly improved since the government launched the Health Extension Programme in 2004/2005.

“This programme has massively increased access to the most basic of health services,” Garth Van’t Hul, country director at the charity group CARE Ethiopia, tells IPS. “It was a major contributor in decreasing mortality rates of under-five-year-olds.”

Gelegay has had three procedures to cover up a cavern in his face enveloping his nose and upper mouth, and Yenenesh had two on her cheek.

They both say life has improved since the procedures. Yenenesh has more friends, and people treat her better now.

Gelegay says meeting other patients with Noma has made him feel a lot better.

“At first I was very surprised because I thought I was the only one,” he says.

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Changes Coming to South Africa’s Patent System Thu, 12 Dec 2013 05:24:07 +0000 Brendon Bosworth Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

By Brendon Bosworth
CAPE TOWN, South Africa, Dec 12 2013 (IPS)

Paul Anley, chief executive officer of Pharma Dynamics, one of South Africa’s leading generic drug companies, wants to sell a cheaper version of popular birth control pill Yasmin. But he legally cannot because German multinational Bayer has patent protection on the drug in South Africa, even though its initial patent expired in 2010.

Generic versions of the contraceptive are available in the United States and Europe, where Bayer’s patent has been revoked.

Anley says South Africa’s patent system makes it easy for multinational pharmaceutical companies to make minor changes to their products and get multiple patents, each spanning 20 years, and keep generics off the market.

“Multinational pharmaceutical companies undertake a process of what we call patent ‘evergreening,’” Anley told IPS. “They will literally flood the patent office with hundreds of patents for every single molecule or product they sell, and they do it over a protracted period.”

Pharma Dynamics lost a court case against Bayer over the validity of Bayer’s patent, which relates to the rate at which the drug’s active ingredient dissolves, in March 2013. It is barred from selling its generic and has filed an appeal against the decision.

“Bayer will continue to vigorously defend its patents,” Bayer’s medical director, Dr. Gené van den Ende, told IPS in an emailed response. Van den Ende did not comment on allegations of evergreening.

Since 2002, Bayer has filed for 11 different patents in South Africa for one of the active ingredients in Yasmin.

Plenty of patents?

In September, South Africa’s Department of Trade and Industry released a draft national policy on intellectual property that proposes changing South Africa’s patent system.

Anley and patent reform advocates like HIV advocacy group the Treatment Action Campaign and Médecins Sans Frontières hope the proposals will curb the number of patents granted and increase access to cheaper medicines.

“We grant far more patents than other countries, both developing and developed,” Catherine Tomlinson, a researcher with Treatment Action Campaign, told IPS. “A lot of what we’re providing patents on is not actually meeting patent standards to provide something new and innovative.”

In 2008, South Africa granted 2,442 pharmaceutical patents, according to research by Carlos Correa at the University of Buenos Aires’ South Centre. Brazil granted just 278 patents between 2003 and 2008.

Supporters of patent reform point to the price difference between originator drugs in South Africa and generics available in countries like India – which has been strict in denying patents for formulations of new medicines – as a consequence of South Africa’s patent laws.

The Treatment Action Campaign found that generic versions of popular cancer drugs are available in India for between four percent and 44 percent of the cost of originator versions in South Africa, based on a comparison of 2012 prices.

India has made also use of compulsory licencing. In cases where government feels the price of a drug is too high, it can grant licenses that allow generics manufacturers to produce versions of drugs under patent protection without consent of the patent owner. The World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights Agreement allows for compulsory licencing.

As a signatory to the WTO agreement, South Africa can grant compulsory licences but has not done so in the past.

The draft national policy recommends introducing the use of compulsory licenses. But whether or not these are granted in the future depends on the interpretation of the courts, patent attorney Madelein Kleyn, who is the intellectual property manager for Oro Agri and a research fellow at Stellenbosch University’s Anton Mostert Chair of Intellectual Property Law, told IPS.

Long road to reform

Government’s draft intellectual property policy recommends introducing a search and examination process to the South African patent office that involves having experts assess the novelty or original merit of an invention.

Currently, those applying for patents in South Africa need to fill out the application documents correctly and pay the required fees. If a company or individual wishes to challenge the validity of a patent after it’s granted, the challenge must be done through the courts.

Intellectual property lawyers note that government does not have the staff required to perform search and examination procedures.

“The patent office, as it stands, currently lacks skilled force to implement such a system,” said Kleyn. “Patent examiners are highly qualified people who specialize in the different areas of technology and require an in-depth understanding of the patentability requirements to assess a new filed invention against the prior art of the specific technical area.”

Outsourcing this work to international or regional offices, as suggested in the draft policy, would make sense, she said.

Since patents can be revoked through the courts, and intellectual property professionals advise patent applicants to amend their claims based on foreign patent cases, the system in South Africa allows for strong and tested patents despite the lack of a search and examination process, Kleyn explained.

She recommended focusing on educating judges who deal with patent cases to make the legal system work more effectively instead. This shift would also be cheaper.

If introduced, the search and examination procedure would take a long time to alter the patent landscape.

“The system will not eliminate the weak patents that will be on the register by the time the system is introduced in say (being kind) five years,” wrote former deputy president of South Africa’s Supreme Court of Appeal Louis Harms in his comments on the draft policy. “This means that weak patents will still be around for 25 years.”

Anley, of Pharma Dynamics, agreed that the proposed changes would take time to take effect.

“We’re very encouraged that government recognises the problems facing generic pharmaceutical companies and has addressed most of them in the draft,” he said. “Our concern would be that the process of capacity building is a very long and difficult process.”

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Grappling to Give Uganda’s Fistula Patients Dignity Tue, 19 Nov 2013 10:39:23 +0000 Amy Fallon In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. Credit: Amy Fallon/IPS

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. Credit: Amy Fallon/IPS

By Amy Fallon
, Nov 19 2013 (IPS)

Ever since giving birth to a stillborn baby 15 years ago, Mary*, a peasant farmer from Mubende District in central Uganda, has continuously leaked urine.

“I am home all the time. I don’t go out to the market, I don’t go to church,” says the 35-year-old, speaking through a translator in a crowded ward at the Mulago National Referral Hospital in the country’s capital, Kampala.

Every time Mary drinks something, her bladder empties out the contents and she is forced to constantly pat herself dry with old clothes.

Mary has obstetric fistula. Defined as a hole between the vagina and the bladder, or between the vagina and rectum of a woman that results in the constant leakage of urine and/or faeces through the vagina. The medical condition is predominantly caused by prolonged or obstructed labour lasting more than 24 hours.

Mary’s labour lasted three days. As the nearest hospital was too far away, Mubende District is some 144 km west of Kampala, a traditional birth attendant took Mary to a small health facility when she went into labour. For 48 hours she remained there, trying to give birth to her child. On the third day she was taken to a district hospital where she was able to deliver her stillborn baby.

Abandoned by the father of her child, Mary was later ostracised by her own family.

“Even my sisters who I was living with shunned me. I am stigmatised because I smell all the time,” she tells IPS.

Mary’s story is “typical”, Dr. Susan Obore, an obstetrician who specialises in urogynaecology at the Mulago National Referral Hospital, tells IPS.

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. This means there are an estimated 140,000 to 200,000 women with fistula in the country, the Ugandan Ministry of Health (MoH) said in June.

“The true figures are not known because [women] do not come out, they are so stigmatised,” says Obore. “So what we see is probably the tip of the iceberg.”

Uganda grapples with an incredibly low number of surgeons who have the required training to carry out fistula repairs. Currently there are only 24 in this East African nation.

“Twenty-four in a population of about 34 to 37 million. It’s like a drop in the ocean,” national fistula specialist and specialist in the MoH, Peter Mukasa, tells IPS.

“Every hospital should be able to repair a woman with fistula.”

Mukasa says the country has 1,900 new cases a year and can operate on 2,000 women annually. But according to the MoH, the large backlog of fistula cases, coupled with the increasing number of new cases, has “surpassed the existing capacity of our health facilities to repair the cases.”

“We are in a static position; the backlog remains. It will take us so many years to eliminate this,” Mukasa says.

“As we speak now there’s a fistula being formed, one or two or three or four hundred women are getting obstructed (in labour).”

He says fistula repair costs on average about 400 dollars, including the cost of transport to hospital, hospitalisation and other care.

“It is a lot of money,” he concedes, adding that in Uganda the expense is mainly catered for by the United Nations Population Fund (UNFPA).

Ethiopia, where according to the World Health Organisation at least 8,000 women develop new fistulas every year, is home to the world’s first dedicated fistula hospital, the Addis Ababa Fistula Hospital. But Obore insists a similar facility is not needed in Uganda.

“We are hoping to kick out fistula, so there’s no reason why we should have a dedicated hospital,” she says.

“Empowerment of women is one of the best ways to prevent fistula,” Obore adds.

Those most vulnerable to contracting fistula are young, illiterate and rural dwellers.

Worldwide, there are over two million women in Africa, Asia and the Arab region living with untreated obstetric fistula, according to the global Campaign to End Fistula, a programme by UNFPA and various partners.

Between 50,000 and 100,000 new cases of fistula, treatable through reconstructive surgery, occur globally each year, according to UNFPA.

International NGO Uganda Village Project (UVP) run fistula repair camps three times a year at Kamuli Mission Hospital, in Kamuli, eastern Uganda. Patients are identified through radio shows, village outreach programmes, health centre referrals and by word of mouth. They are transported to hospital and operated on by surgeons from the Uganda Childbirth Injuries Fund, a United Kingdom-based organisation.

The last camp was held in early September and 15 patients had surgery. For nine of them, the surgery was successful. The remaining four women still require a second operation, which will take place during the next camp that begins on Jan. 18, says the managing director of UVP’s Iganga office, Kait Maloney.

Mary was not aware she could be operated on until she heard a radio announcement. The first surgery she had at a rural hospital was unsuccessful. She was referred to the Mulago National Referral Hospital, where she will be operated on in the coming months.

“I’m happy to have the surgery. I have no problem going for it,” she says.

But Mary says that even after she has the surgery she will still think about her fistula. She acknowledges that it is unlikely she will have another baby because of her ordeal.

*Name withheld to protect patient’s identity.

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Pacific Pact – a Minefield for Health Care Tue, 08 Oct 2013 00:18:17 +0000 Emilio Godoy Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

By Emilio Godoy
MEXICO CITY, Oct 8 2013 (IPS)

The Trans Pacific Partnership Agreement (TPP), the negotiation of which is set to conclude this year, could drive research into new drugs and improve access to medicines. Except – it won’t.

“The current health system is reaching its limit,” Judit Rius, manager of Médecins Sans Frontières/Doctors Without Borders Access Campaign in the United States, told IPS. “It is failing patients with rare diseases, for example.”

“That’s why the TPP could be a tool for promoting health and improving innovation and access, instead of fostering failed, costly systems based on monopolistic patents,” she added.

The TPP free trade accord went into force between Brunei, Chile, New Zealand and Singapore in January 2006. Eight other countries are now negotiating their incorporation: Australia, Canada, Japan, Malaysia, Mexico, Peru, the United States and Vietnam.
Of the 29 chapters under negotiation, the ones on intellectual property, investment and government procurement contain proposals, especially from the United States, to limit research and development of generic medicines, which are sold with the name of the active ingredient and can be produced once the patent for the original brand-name drug has expired.

Because they are less expensive, generic drugs are essential in the fight against disease, especially in poor developing countries.

The TPP talks have been shrouded in secrecy. But Rius said the aspects of the TPP that have been leaked to the press would hinder R&D in generic medicines, hurting the reduction of prices that has been achieved in recent years.

“Most affected by this would be patients, organisations that supply medicines, health and economy ministries, developing countries, and companies that produce generic medicines,” she said.

These laboratories are worried.

“The TPP could lead to the extension of patents and could hamper access to medicines,” José Luis Cárdenas, a lawyer who is an adviser to the board of Chile’s Industrial Association of Pharmaceutical Laboratories (ASILFA), told IPS.

“It is not realistic to think that developing countries are going to invest in R&D to produce new molecules,” given the investment capacity of multinational corporations, he said.

The 19th round of negotiations for the TPP took place in Brunei Aug. 23-30. Since then, the talks are no longer general but thematic. There are 21 working groups negotiating the 29 chapters, which include issues like agriculture, intellectual property, environment, services, telecommunications and investment.

Pharmaceutical patents give 20 years of protection, according to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) adopted in 1994 during the creation of the World Trade Organisation (WTO).

But the WTO’s 2001 Doha Declaration on the TRIPS Agreement and Public Health reaffirmed the flexibility of TRIPS member states in circumventing patent rights for better access to essential medicines. Under this declaration, governments may issue compulsory licenses on patents for medicines, or take other steps to protect public health.

Compulsory licensing is when a government allows someone else to produce a patented product without consent from the patent owner.

Washington wants the TPP to extend the length of chemical drug patent monopolies by five years and of biologics – products that includes a number of lifesaving drugs used to treat conditions such as cancer, diabetes and hepatitis C – by 12 years.

It is also pushing for data exclusivity, which gives companies monopoly rights over drugs by restricting the use of clinical trial data by drug regulators when approving generic or bioequivalent versions of drugs. This would keep the laboratories that make generic drugs from putting their products on the market as soon as patents expire.

In addition, it is pushing for the controversial practice of “evergreening” – the name given to the industry practice of seeking new patents after making small modifications to existing drugs.

Other measures on the table are patents for diagnostic, therapeutic and clinical procedures and the creation of a supranational mechanism to settle disputes between states and corporations.

These initiatives “affect access to medicine by the most disadvantaged segments of Mexican society due to the implications for the quality, safety and effectiveness of pharmaceutical products,” Gustavo Alcaraz, of Mexico’s National Association of Drug Manufacturers (ANAFAM), told IPS.

Alcaraz forms part of the Cuarto de Junto, a group of business delegates allowed by the economy ministry to monitor the negotiations without taking notes, after they sign a confidentiality agreement.

The secrecy surrounding the talks has kept civil society, academia, or health consumers from expressing their viewpoints on what is being negotiated.

Médecins Sans Frontières has called on the participating governments not to sign any agreement that undermines public health.

In 2011, non-governmental organisations and academics urged United Nations Special Rapporteur on the right to health Anand Grover to issue an urgent appeal to the governments involved in the TPP talks, on the grounds that the trade deal would severely impact the public health of the poor in developing nations.

In response, Grover sent a letter to the national authorities. But only Australia, Chile and New Zealand answered, defending the secrecy around the talks and voicing assurances that the right to health would be respected.

The effects of overzealous protection of intellectual property in health have been studied.

An article published in 2009 by the Health Affairs journal states that “Our study suggests that CAFTA (Central America Free Trade Agreement)’s intellectual property rules on data exclusivity and patents are responsible for the removal of several lower-cost generic drugs from the market in Guatemala and for the denial of entry to a number of others.”

And as a result of the U.S.-Jordan free trade treaty, “Medicine prices in Jordan have increased 20 percent since 2001,” according to a report published by Oxfam in 2007.

“Higher medicine prices are now threatening the financial sustainability of government public health programmes,” added the report.

The details of the agreement are on the table at the annual Asia Pacific Economic Cooperation (APEC) Forum Summit, taking place Oct. 7-8 in Bali.

After a TPP meeting on intellectual property in Mexico City Sept. 23-Oct. 2, the United States and Japan are now considering proposing that the extension of patent terms only apply to developed countries, allowing shorter periods in developing nations like Malaysia and Vietnam.

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/CORRECTED REPEAT/Healthcare Loses Support in Somalia Mon, 30 Sep 2013 07:58:44 +0000 Ahmed Osman Medical officials in Somalia say that the withdrawal of international medical charity Médecins Sans Frontières from the country will have negative impact on lives of hundreds of thousands of people and further complicates the polio outbreak the country is facing. Credit: Ahmed Osman/IPS

Medical officials in Somalia say that the withdrawal of international medical charity Médecins Sans Frontières from the country will have negative impact on lives of hundreds of thousands of people and further complicates the polio outbreak the country is facing. Credit: Ahmed Osman/IPS

By Ahmed Osman
MOGADISHU, Sep 30 2013 (IPS)

Maryan Yusuf, 39, is weak and barely able to speak because of her excruciating pain. A few hours earlier she delivered a baby at Somalia’s Afgooye Hospital, where essential drugs are dwindling at an alarming rate.

“This is my fourth child delivered here. But I cannot get as much care and treatment as I used to. I am in pain now. I don’t know if I will be well again,” Yusuf told IPS as she lay on a hospital bed that had no mattress.

Afgooye Hospital, situated in the agricultural town of Afgooye, 30 km southwest of the Somali capital, Mogadishu, is one of the many health facilities that used to receive support from the international medical charity Médecins Sans Frontières (MSF), or Doctors Without Borders. Because of this support the hospital was able to provide free healthcare to the residents of Afgooye and surrounding areas."We understand the reasons for [the MSF] pullout but that now causing huge suffering in Somalia.” -- Abdelaziz Qafiifo, Ministry of Human Development and Social Services spokesperson

But it has been almost a month since MSF left Somalia because of security concerns for its staff, and a senior nurse at Afgooye Hospital told IPS that the hospital was running out of basic drugs and vaccines.

The 20-bed Afgooye Hospital has only one doctor and seven nurses, who provide what services they can to the hundreds of patients who come through the doors every week.

“This is the place people who want free healthcare turn to, but since MSF left and no agency has filled its place we cannot support the health needs of the people here and in the town’s periphery,” the senior nurse said.

The international charity had been one of the few providers of essential healthcare here for the last 22 years. Somalia has been through almost 20 years of war, and its citizens are affected by poverty and a lack of essential services.

The current government has had to function with limited financial resources and the continued threat of the extremist Islamist group Al-Shabaab, which has waged a number of recent terrorist attacks on the capital Mogadishu despite being ousted from key cities across this Horn of Africa nation.

In an earlier interview with IPS, presidential spokesperson Abdirahman Omar Osman explained that the government’s monthly “revenue is roughly three million dollars from Mogadishu’s seaport and the airport, and yet the budget we need to execute our daily activities is at least 20 million dollars each month.”

The health centres supported by MSF were provided with various services, including free basic healthcare, malnutrition treatment, surgery, epidemic response, water and relief supplies.

MSF said more than 1,500 staff worked for its medical programmes across Somalia, including in Mogadishu and the two outlying towns of Afgooye and Daynille, as well as eight other towns across the country.

“In 2012 alone, MSF teams provided more than 624,000 medical consultations, admitted 41,100 patients to hospitals, cared for 30,090 malnourished children, vaccinated 58,620 people, and delivered 7,300 babies,” MSF said in August in a statement announcing its decision to leave Somalia. In a statement to IPS, MSF said there is normal traffic of patients at the hospital, with normal levels of care.

But Somali doctors warn that the decision will adversely affect the lives of “hundreds of thousands of people”.

Mohmaoud Yarow, a health officer in Mogadishu, said the impact of the MSF withdrawal was immediate and health centres that had previously received support from the international charity now have hundreds of people in need of care and many lack the drugs with which to treat them.

“I can understand how difficult it has been for MSF to leave Somalia, but the impact the pullout has had on the country’s health sector is enormous … with time this could turn into a deadly health crisis,” Yarow told IPS in Mogadishu.

Local media reported in August that Al-Shabaab fighters seized control of a former MSF-funded hospital in Marere, Middle Jubba Region, along with the medical equipment and drugs.

Medical officials also say that the MSF pullout further complicates the polio outbreak the country is facing as the medical charity had provided essential vaccines against the disease.

Earlier this year, polio was detected in several areas in Somalia, including the eastern region of Puntland as well as southern and central parts of the country. The World Health Organisation has confirmed 101 cases here and a massive vaccination campaign against the viral disease was launched in August.

The Somalia government has said that it was “deeply saddened” by the MSF decision to withdraw and has reiterated its commitment to providing a secure working environment to all aid agencies in the country.

Abdelaziz Qafiifo, spokesperson for Somali Ministry of Human Development and Social Services, which is responsible for the health sector, told IPS: “It is unfortunate that the withdrawal of MSF is having an impact on the lives of the Somali people. We understand the reasons for its pullout but that decision, whatever may have been its justification, is now causing huge suffering in Somalia.”

The Somali government said that the MSF decision has created “a critical vacuum that needs to be filled” and could “lead to a catastrophic humanitarian crisis”, and has urgently called on the international community and donor countries to offer their support.

But until support comes, many here will have to live without access to treatment.

Daahir Owre, an elderly man from Daynile district, west of Mogadishu, said he was unable to get antibiotics for his wife’s leg infection at the Daynile Hospital because the nurses told him that they had run out of the drugs.

“I don’t know what I am going to do now. I had to walk five kilometres to get here but I cannot get medicine for my family because there are no supplies at the centre,” Owre told IPS as he walked away.

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Cameroonians ‘Dying’ for Fake Drugs Thu, 05 Sep 2013 08:45:15 +0000 Monde Kingsley Nfor In markets and on roadsides across Yaoundé, counterfeit and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Credit: Monde Kingsley Nfor/IPS

In markets and on roadsides across Yaoundé, counterfeit and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Sep 5 2013 (IPS)

When Francois Biloa fell ill with malaria, his family did what they had always done in the past – they gave him anti-malaria drugs and antibiotics bought from the local market. Only when his condition worsened and he became bedridden and fell unconscious, did his family take him to a local clinic in Cameroon’s capital Yaoundé.

According to the clinic’s health attendant, six out of every 10 patients there had been using illegal or counterfeit drugs readily available in this Central African nation’s market place prior to admittance.

“We bought medicine from a store because it worked for us with [previous] malaria attacks and it is very affordable. With just about two dollars we usually afford a [fake] Coartem packet, which is a full treatment for malaria,” Biloa tells IPS from his hospital bed.“Self-medication [with illegal and counterfeit drugs] result in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly." -- Williams Takang from the Yaoundé University Teaching Hospital

In pharmacies, a packet of Coartem costs seven to eight dollars, while on the illicit market a packet can be bought for less than three dollars. A medical consultation costs four dollars on average.

“But in this hospital, I am told my bill is now over 75 dollars. The doctor says that I have a resistant strain of malaria and also typhoid fever,” Biloa says.

“I felt like I was dying during my attempted treatment at home. I only started regaining energy and full consciousness after [coming to] this clinic.”

In markets and on roadsides across Yaoundé, fake and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Trading in these drugs is illegal. The are available as a result of weak regulation, poor health services and high medical costs.

There are no precise figures on the quantity of illegal drugs entering Cameroon, but up to 70 percent of drugs sold here are traded on the black market, says Christophe Ampoam of the National Council of the Pharmaceutical Society of Cameroon.

According to Ampoam, this trade in illicit medication is so well organised that government officials and the police are helpless to halt it.

“The trade in illicit drugs in Cameroon operates like a very powerful mafia-like network, which is very difficult to dismantle. It is estimated that investment in illicit sales of medicines is five times more lucrative than through the regular system. Local officials dread dismantling the network because it has also infiltrated the judicial and customs system,” Ampoam tells IPS.

“Corrupt regulatory and legal systems are easily exploited by criminal smugglers and additional rules have only increased corruption.”

Ampoam says that most of the counterfeit drugs are made in the Middle East and East and South Asia, yet many carry the inscription ‘Made in Germany’. They are smuggled into Cameroon by sea and through the porous borders this country shares with Nigeria and the Central African Republic.

“Although it is difficult to give an exact statistic on the percentage of illicit drugs found in local markets today, the availability of drugs in local markets, makeshift shops, on the streets and along the highways tells of the deplorable situation in Cameroon,” he says.

The World Health Organisation (WHO) estimates that worldwide 200,000 deaths per annum could be prevented if people did not use counterfeit drugs. According to the International Policy Network report, fake tuberculosis and malaria drugs alone are estimated to kill 700,000 people globally each year.

“Most of the drugs in circulation have been banned in certain countries because they are toxic or counterfeit. Some have the correct ingredients but in low quantities. Some of the drugs are samples or medicines donated by NGOs,” Ampoam explains.

Marlise Loudang, director of the pharmaceutical inspection service at the ministry of public health says that government teams in every region across the country are clamping down on the illegal trade, but so far efforts have been unsuccessful.

“Self-medication [with illegal and counterfeit drugs] is a big public health problem in Cameroon that affects almost every family. This stems from the easy access to drugs of doubtful origin and quality all over the national territory,” Loudang tells IPS.

Marcel Olinga is a vendor of counterfeit and illegal drugs and says that even though authorities have raided him, it has not deterred him from continuing. “Once in a while the police come around and seize my drugs, but it is a loss worth incurring because the raids are not regular and our main stocks are never where we sell.”

Olinga says he makes about 40 dollars a day.

“We receive many customers daily. Some come with prescriptions from doctors others seek our advice before buying and some simply demand what they want,” he tells IPS.

According the WHO, there are 13,514 patients for every doctor in Cameroon, although some say the ratio is higher, especially in rural areas. Poverty also limits many from seeking medication from hospitals and health clinics.

“Some patients run from costs of consultation in hospitals and fall in the hands of illegal drug vendors who are ready to sell drugs at prices far more below the legal market price,” Williams Takang from the Yaoundé University Teaching Hospital tells IPS.

“Self-medication [with illegal and counterfeit drugs] results in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly,” he says.

“The intake of fake and illegal medicines can lead to life-threatening consequences especially for diseases with high mortality rates like malaria. Unfortunately most of the patients suffering from these common diseases put themselves on medication without any prior medical consultations,” Takang says.

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No Sweet Consolation for Women Diabetics Sun, 19 May 2013 11:22:54 +0000 K. S. Harikrishnan By K. S. Harikrishnan

The disease itself may not discriminate on the basis of gender, but when it comes to healthcare for patients with diabetes, women in India find themselves at a disadvantage compared to men.

This was the conclusion of the study, ‘Impact of Gender on Care of Type 2 Diabetes in Varkala, Kerala’, which analysed gender roles, norms and values in a household and found women patients to be more vulnerable.

Women in India face disadvantages when it comes to diabetes. Credit: K.S. Harikrishnan/IPS

Women in India face disadvantages when it comes to diabetes. Credit: K.S. Harikrishnan/IPS

And this vulnerability influences all phases of diabetic care, according to the paper by Dr Mini P. Mani at the Achutha Menon Centre for Health Science Studies (AMCHSS) in Thiruvananthapuram, the capital of the southern Indian state of Kerala.

Even when they themselves suffer from diabetes, women cannot abandon the ‘caretaker role’ in the family and have to continue to prioritise the health of other family members above their own, the study found. Further, inequitable access to resources prevents early diagnosis of the disease in women.

Women pay more attention to the health of the men and children in the family, leaving them with less time to devote to their own wellbeing, said Rosy Raphy, who teaches at a school in Munambam, near the central Kerala town of Kochi.

“As someone who has lived with diabetes for 26 years,” Raphy told IPS, “I can say that I was not aware of the disease and did not take due care because I was preoccupied with matters of the family. As a result, my case got aggravated.”

Of particular concern to women and gynaecologists in the country is Gestational Diabetes Mellitus (GDM), a form of the disease that affects pregnant women.

The incidence of GDM has grown fourfold in the last 10 years, according to Dr B. Rajkumar, a doctor of Indian Systems of Medicine at the Keezhariyoor Government Ayurveda Dispensary in the state’s northern coastal district of Kozhikode.

“Earlier, pregnant women would engage in physical activity while doing housework. Today, the lifestyle of women has changed. Lack of exercise affects the body. And obesity, too, is a cause of gestational diabetes,” he said.

One in five pregnant women in Ahmedabad in the western Indian state of Gujarat were found to be suffering from GDM, according to a study by the Diabetes Care Institute in that city, whose results were reported in February.

“What is alarming,” the report said, “is that of the five women found to have diabetes, two were diagnosed with the silent killer while the other three went undetected.”

And women with GDM were at higher risk of developing diabetes later in life, warned an earlier study in Kerala’s neighbouring state of Tamil Nadu, conducted by a group of doctors led by endocrinologist Dr V. Seshiah.

“They are the ideal group to be targeted for lifestyle modification or pharmacologic intervention in order to delay or postpone the onset of overt diabetes. Hence, an important public health priority in the prevention of diabetes is to address maternal health both during the ante- and post-partum period,” the study noted.

Medical researchers believe that the disease, earlier considered an ailment of the rich, is on the rise in India. Close to 70 million people – half of them women – in this country of 1.21 billion are living with diabetes, and the number is predicted to go up to 101.2 million by 2030.

Nearly 60 per cent of diabetics in India have never been screened or diagnosed due to a lack of awareness, according to a 2012 report published by the Brussels-based International Diabetes Federation (IDF), an umbrella organisation of diabetes associations in 160 countries. The study also noted that nearly 63 per cent did not even know the complications that arise from the disease.

Doctors attending the four-day World Congress of Diabetes in April, organised by Diabetes India in Kochi, suggested India-specific treatment guidelines for helping the rapidly growing number of patients in the country.

Dr Jothydev Kesavadev, the organising secretary for the fifth edition of the congress and the moderator for glucose monitoring consensus guidelines, told IPS that low-income patients suffer the most as they lack medical insurance.

“Though there are international guidelines for the treatment of diabetes, there is an urgent need for country-oriented guidelines,” he said, “especially in areas of glucose monitoring and use of insulin in hospitals, besides taking into consideration the socioeconomic status of a patient and the country.”

Healthcare experts say that a combination of dietary pattern, sedentary lifestyle, obesity, and genetic predisposition puts Indians at a unique risk of acquiring diabetes.

Analysing the increasing percentage of diabetic patients in the country, Dr Meenu Hariharan, director of the Indian Institute of Diabetes in Thiruvananthapuram, told IPS that Indians were more prone genetically to diabetes than Europeans.

“Reduced physical activity and obesity accelerate the onset of diabetes in genetically predisposed people,” she said. Starch-rich diets and increased intake of tinned foods with a high content of preservatives are other culprits.

A host of studies and screening programmes have highlighted the fact that diabetes is spreading fast across the country.

Cases of diabetes are higher in the four southern states – Karnataka, Tamil Nadu, Andhra Pradesh and Kerala – than in other states, according to the results of a countrywide blood testing campaign conducted under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes by the country’s health ministry.

In Tamil Nadu, 11.76 per cent of people tested positive for diabetes, 10.2 percent in Karnataka, 8.83 per cent in Kerala, and 8.72 per cent in Andhra Pradesh, compared to just 2.95 percent in the central Indian state of Madhya Pradesh, which reported the lowest incidence of the disease.

Alarmingly, rural areas are also seeing a rise in diabetes rates, as a fall-out of rapid urbanisation. However, the incidence of the disease remains higher in cities than in villages, according to Dr V. Ramankutty, a well-known health activist and professor at Thiruvananthapuram’s AMCHSS.

Talking to IPS, he charted the rise in the incidence of the disease. A survey in the early 1970s, he said, found only 2.3 per cent of the urban population and 1.5 per cent of the rural population to be suffering from diabetes. But by 1992, the proportion had gone up to 8.2 per cent and 2.4 per cent for urban and rural areas, respectively. A repeat survey after five years found an even higher prevalence of the disease in urban areas, at 11.6 per cent.

But if it’s any consolation, insulin-deficient diabetes in children is less common in India than in Western countries, said Dr G.D. Thapar, former director of the Ram Manohar Lohia Hospital in New Delhi. In his book ‘How to Lead a Healthy Life despite Diabetes’, he emphasised how crucial breast-feeding is to prevent the disease in children.

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Stockout Risks of South Africa’s New ARV Programme Mon, 06 May 2013 07:15:20 +0000 Melany Bendix From Apr. 1, the South African Department of Health introduced fixed-dose ARVs. Activists and health professionals have welcomed the FDAs as easier and more convenient for patients. Credit: Nastasya Tay/IPS

From Apr. 1, the South African Department of Health introduced fixed-dose ARVs. Activists and health professionals have welcomed the FDAs as easier and more convenient for patients. Credit: Nastasya Tay/IPS

By Melany Bendix
CAPE TOWN, South Africa, May 6 2013 (IPS)

“If I don’t have my pills, I don’t know what will happen. I will probably get sick again, very sick. Maybe I will die this time,” says Xoliswa Mbana* as she readies her four young children for school in the impoverished informal settlement of Masiphumelele, in Cape Town, South Africa.

Two years ago Mbana, who was diagnosed HIV-positive in 2008, had a CD4 count of less than 200. Dangerously ill, she was convinced by nurses at her local clinic to begin antiretroviral (ARV) treatment.

“I didn’t trust the muti (a Zulu word for traditional medicine) at first because I had heard a lot of bad things about them. But I was dying; I had no choice. When I started to feel better I was so happy. The government must please not take my happiness away from me,” the 42-year-old tells IPS.

Mbana, who is among the 5.5 to 5.9 million South Africans the Joint United Nations Programme on HIV/AIDS estimates are living with the disease, is referring to her fear of being cut off from her life-saving pills. It is a fear that is not unwarranted.

Last May she was forced off treatment for three weeks because her local clinic ran out of ARV drugs. It was one of hundreds of distribution points across six of South Africa’s provinces that were struck by a serious supply shortage, the most recent of several stockouts that have plagued the state-funded ARV treatment programme since its launch in 2004.

It is the South African Department of Health’s (DoH) shaky ARV supply track record that has treatment activists sounding alarm bells over the Apr. 1 introduction of fixed-dose ARVs (FDAs).

Until now, state-funded ARV treatment has comprised three different pills taken at different times during the day. The new FDA combines the three key agents from these pills in a single pill that only needs to be taken once a day.

Although welcoming the FDAs as easier and more convenient for patients, activists and health professionals alike have warned that a stockout of the drug could have a catastrophic effect on the country’s public HIV/AIDS treatment programme — the largest of its kind in the world.

“With the individual ARV drugs, if there is a shortage of one ARV then people can still take the other two drugs, though it’s not ideal. However, if there’s a stockout of the fixed-dose pill, then patients will have no recourse,” Mark Heywood, executive director of health and social justice advocacy group Section 27, tells IPS.

Dr. Kevin Rebe of the Anova Health Institute, which runs the Health4Men programme focusing on HIV prevention and treatment, agrees.

“The risk of FDAs is that there isn’t really a good fall-back,” he tells IPS.

He points out that even a few missed doses could result in resistance to treatment: “You need to get 95 out of every 100 doses right, otherwise you risk treatment failing and the patient would then have to move on to a different, possibly more complex and more costly, treatment. So if there is a stockout (of FDAs), the implications could be severe.”

Professor Linda Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town, adds that a stockout could be a “serious health hazard” for dangerously ill people who have just started ARV treatment — people like Mbana, who could have died if there had been a stockout when she first began treatment in 2010.

Bekker is equally concerned that stockouts could set back hard-won gains in convincing HIV positive people to begin treatment and to then stick to a strict drug regimen.

“We really have to indoctrinate HIV infected patients on ARVs to be adherent. When non-adherence is then imposed on the patient through no fault of their own, this is very frustrating and alarming for patients,” she tells IPS.

Reducing the risks

Bekker believes the risks of an FDA stockout could be mitigated by accurately predicting the demand and ensuring adequate supply. While acknowledging this is easier said than done, she insists that strict supply management is the only way to ensure the success of the new FDA treatment regime.

“It is no mean feat to have started this large number of people on life-saving therapy and to then ensure they keep getting it for the rest of their lives. But we must do it and we must do it right.”

Rebe also stresses the importance of getting the FDA supply chain right and says the DoH’s initial plan looks promising.

“They seem to have been quite smart about it all, especially by introducing FDAs in phases: first for pregnant women, then patients on TB treatment, then those newly starting ARV treatment. Only once all these people are on FDAs will the others be moved over. This phased approach alone will go a long way in avoiding a stockout.”

Rebe points out that the DoH has also split the 2013/2014 FDA tender into multiple contracts. “This is good because if one supplier runs out the others should be able to pick up the shortfall,” he explains.

Joe Maila, DoH spokesperson, says bringing in additional suppliers would be considered only if the three current suppliers — Mylan, Cipla and Aspen — could not meet the demand.

Supply and demand is being monitored and managed at weekly meetings with both suppliers and provincial health authorities, he adds, enabling the department to “detect supply problems early and intervene.”

Importantly, Maila tells IPS, the department has stockpiled FDAs “as buffer stocks to alleviate shortages when these occur.”

Multiple benefits

The introduction of FDAs is also expected to significantly reduce the state’s annual bill for HIV/AIDS treatment.

The previous combination treatment cost around R120 (13.4 dollars) per person per month, whereas the cost of the new FDA is currently R93 (10.38 dollars) per month. With 1.9 million patients currently on state-funded ARV treatment, a saving of R27 (three dollars) per person per month is significant.

“The 2013 tender estimated that 30 million packs (of FDAs) will be purchased over two years, which will translate into an estimated saving of R810 million (90.5 million dollars),” Maila says.

Cost is just one of the many benefits of FDAs, which has convinced Rebe that the pros of this form of treatment far outweigh the cons.

“The three agents in the single-dose pills are the best we have right now…It’s also well proven that reducing the number of pills and the daily dosage is key to patients adhering to treatment regimens.”

A quick and easy single-dose pill is something Mbana is looking forward to when FDAs are eventually rolled out to her clinic in Masiphumelele. But for her, ensuring a steady supply of life-saving pills is more important than convenience.

“I don’t care if I have to take one tablet only one time a day or many tablets over the day, just as long as I have tablets to take.”

*First name changed on request

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Q&A: A Healthy Verdict from India Fri, 05 Apr 2013 14:06:47 +0000 Gustavo Capdevila

Gustavo Capdevila interviews GERMÁN VELÁSQUEZ, former WHO official

By Gustavo Capdevila
GENEVA, Apr 5 2013 (IPS)

India’s refusal to grant patent protection for the anti-cancer drug Glivec, developed by Swiss drugmaker Novartis, is a victory for the developing world, which depends on low-cost exports of generic medicines from the Asian giant, said public health specialist Germán Velásquez.

The triumph celebrated by the Colombian expert, who is a special adviser for health and development at the South Centre, was a landmark ruling against Novartis handed down Monday Apr. 1 by India’s Supreme Court.

The Geneva-based South Centre is an intergovernmental organisation of more than 50 developing countries that functions as an independent policy think tank.

Velásquez, who worked for over 20 years in the World Health Organization, explains in this interview with IPS his point of view on the legal battle in the courts in New Delhi and its consequences for developing countries.

Q: How do you interpret the ruling by the Supreme Court of India?

A: There are problems with the information that is being reported. Nearly everyone says that India rejected the patent for Glivec. That’s true, but it’s not all the verdict says.

Q: Could you explain?

A: At the heart of the verdict is the ratification of the criteria set by the Indian law for the approval of drug patents. That is, whether or not it meets the requisite of containing a genuine innovation.

Q: Could you describe the legal battle?

A: It all starts with the adoption of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), one of the treaties established at the same time the WHO was born, in 1995.

India was the only developing country to use the (entire 10-year) transition period to enforce TRIPS, in 2005, when it passed the patent act.

Q: What happened to the patent applications presented during that decade-long transition?

A: They accumulated, until there were around 10,000 applications, and it was not until 2005 that the patent office began to examine them. They included the application for the Glivec patent.

But the new standards turned out to be stricter, such as the one that indicates that the innovation can’t be just a small change to a molecule, but has to be something substantial. In short, the patent for local sales of Glivec was denied in 2006.

Q: How does the story continue from there?

A: Novartis challenged that decision and brought a lawsuit in a court in the city of Madras (the capital of the southern state of Tamil Nadu; the city was renamed Chennai in 1996.) But the High Court of that city, three years later, also rejected the application. That year, 2009, the company appealed the decision – and lost again.

Q: What options are left to the company?

A: This is the aspect that hasn’t been sufficiently reported. In a cynical, perverse and very serious move, Novartis says (prior to the ruling): “If they didn’t give me the patent, I’ll go to the Supreme Court, but to ask this time for the elimination of the strict criterion established in article 3 of the patent act.”

“If more flexible, lower standards are set, then my medicine will be in,” was its reasoning.

Q: So the dispute took on this other face?

A: Yes, because with the intention of introducing its drug by force, the transnational corporation was trying to modify the law of a country – and of a country like India. I think that its executives were being short-sighted when they made that decision. This has been very costly for them in terms of their image.

Q: How do you reach that conclusion?

A: It is clear that it was a misstep to denounce India’s patent law, with the risk of losing. The transnational industry in general had suffered a blunder in South Africa, when it was forced in 2001 to back down from legal action against a law that authorised the patenting of lower-price imported medicines in order to address the AIDS epidemic.

You could suppose that “Big Pharma”, as the major pharmaceutical companies are called, had learned the lesson. Especially knowing that Glivec was patented in 40 countries, including the United States, China and Russia.

Q: Are you insinuating that there may be a domino effect?

A: If Novartis loses in India, as it did on Monday, any of the governments of the 40 countries could ask themselves: “Why don’t I review that patent and revoke it?” That authority is granted by the legislation of all of those countries.

Q: What standing do those 40 countries that recognise the Glivec patent have?

A: Most of them are industrialised states, large markets. But they also include some that are currently experiencing severe economic difficulties, like Greece or Spain, whose authorities could ask themselves why they should pay 2,500 dollars a month per person for a treatment against cancer. They could say: “Why don’t I just have it produced as a generic drug, and invalidate this patent.”

I think the Novartis executives did not take that into account when they launched this legal battle. Obviously, after the first impetus, they continued on to the end, and today they’re going to see repercussions.

Q: What could those consequences be?

A: It should be a lesson for the rest of the countries of the developing South. They should try to follow India’s example and introduce in their legislation clauses like the ones contained in article 3d, which restricts and sets criteria with respect to what amounts to innovation, which is necessary in order to grant a patent. That there can’t just be a small change, which is sometimes merely cosmetic, to a molecule in the medication.

Q: What prospect is there for the spread of that criterion?

A: In India, the Philippines and Argentina, that prohibition already exists, while others are introducing it through alternative routes.

Q: And other consequences?

A: India will be able to continue to make generic versions of all new medicines that are not truly original, and it will continue exporting them without any problem. It’s necessary to take into account the fact that 95 percent of the antiretrovirals consumed in Africa come from that Asian country.

So that means the Indian Court’s ruling is extremely important, with very concrete repercussions for that medicine and some 10,000 others that are on the waiting list in the patent office in New Delhi.

Q: What percentage of those could get patents?

A: In 2010, Argentina approved 2,000 pharmaceutical patents, and China 4,000. But actually, just 40 or 50 products a year are true innovations.

Q: Why that enormous difference between patents that are granted and truly innovative products?

A: The pharmaceutical industry is facing huge difficulties in coming up with innovations.

So it clings to a very short-sighted way of thinking, very short-term, but enormously profitable. This consists of launching incremental innovations, as they are called – in other words, a small product with just a gradual change, but accompanied by a major marketing campaign.

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New Patient Profile and Treatment for Chagas Disease Fri, 21 Dec 2012 13:38:01 +0000 Estrella Gutiérrez Luz Maldonado contracted Chagas disease from contaminated fruit juice in her urban upper-middle class Caracas neighbourhood. Credit: Estrella Gutiérrez/IPS

Luz Maldonado contracted Chagas disease from contaminated fruit juice in her urban upper-middle class Caracas neighbourhood. Credit: Estrella Gutiérrez/IPS

By Estrella Gutiérrez
CARACAS, Dec 21 2012 (IPS)

Chagas disease, the third most serious infectious disease in Latin America, is developing a “new face” and moving into urban areas, while a new treatment may offer hope for millions of sufferers.

The new face of the disease is exemplified by Luz Maldonado, a 47-year-old teacher from Venezuela. Maldonado contracted Chagas disease by drinking contaminated fruit juice, in an outbreak that infected 103 people at a school in Chacao, an upper-middle-class neighborhood in Caracas. One child died, and the lives of the other people infected have been changed forever.

Micro-epidemics caused by contaminated food are a new phenomenon. And, according to the scientific sources consulted for this story, the disease is even more virulent when it is contracted this way, because thousands of parasites enter the bloodstream all at once. The largest of these incidents were reported in 2005 in Brazil, in December 2007 in Caracas, and in 2010 in the nearby town of Chichiriviche de la Costa.

Maldonado now lives with headaches, rashes, joint problems, memory loss, tachycardia, insomnia and depression, largely due to the side effects of the drugs she must take to fight the parasites.

Chagas disease is caused by Trypanosoma cruzi, a protozoan (single-celled) parasite that is transmitted by blood-sucking insects. According to the World Health Organization (WHO), it affects between 17 and 20 million people in Latin America.

In addition, almost 25 percent of the region’s population is at risk of contracting the disease, which kills at least 50,000 people a year.

According to WHO, Chagas disease is one of the world’s 13 most neglected tropical diseases, the third most serious infectious disease in Latin America, after HIV/AIDS and tuberculosis, and the parasitic infection with the highest morbidity and greatest socioeconomic impact in the region. The only country in Latin America to be declared free of the insect that spreads the disease, in mid-2012, is Uruguay.

However, all statistics on the disease are approximate, because “many cases are never diagnosed,” Belkisyolé Alarcón de Nola, the director of immunology at Venezuela’s Institute of Tropical Medicine (IMT), told Tierramérica*.

People whose infection goes undiagnosed either do not develop symptoms, or the symptoms are attributed to other illnesses. They may die decades later of heart failure or a stroke that is never linked to Chagas disease, explained Nola, a medical doctor and researcher who coordinates the follow-up of Chagas patients in Venezuela.

Today, “the image of Chagas disease as a rural disease of the poor has been dispelled,” she said. “We can have cases at any altitude, latitude or stratum, and we need to change the way we confront its vectors.”

Urban sprawl has invaded the natural habitat of the disease’s vectors, said Nola. Caracas, located in a valley at an altitude of 1,000 meters, “has these sort of green fingers that extend into it, and these are the areas that are most accessible for the vectors to reach people’s homes,” she explained.

Logging and the clearing of forests by the slash-and-burn technique have left little food for the “chipos”, as Triatoma infestans, the insect that spreads the disease, is commonly known in Venezuela. It goes by various names in different countries of the region, including vinchuca, chirimacha and chichi, and is referred to as the “kissing bug” in English.

“We have vectors everywhere and even more so with climate change, because the warmer the earth becomes, the greater the reproduction of the insects,” said Nola.

Transmission most commonly occurs when insects infected with the parasites bite humans, ingest their blood, and then immediately defecate. Chagas disease is contracted if the parasites in the insect feces enter the organism through a break in the skin, such as when people scratch the bites, or through other openings, such as the eyes, when people rub them.

In Caracas, there is also a secondary, “poor” vector, Panstrongyilus geniculatus, “which is clumsy and takes longer to defecate,” said Nola.

But this “poor vector” is adapting. “Drawn by the lights in homes in urban and peri-urban areas, it enters through kitchen windows, wanders over utensils and food and defecates where it pleases,” she said.

In the transition to oral infection through contaminated food, “there have been many small outbreaks, many of which have gone undiagnosed.” However, there has been no other outbreak like the one in Chacao, given its fully urban location and the large number of people infected, after drinking guava juice contaminated with infected insect feces at the municipal school.

There are two strains of the Trypanosoma cruzi parasite that cause Chagas disease. One is found from Mexico to the north of South America, and the other from Brazil to the southern tip of the continent. The first primarily damages the heart, while the second also damages the esophagus and colon.

The disease has three stages. In the first, acute stage, symptoms can be very marked or very mild and easily confused with other diseases. The second, known as the intermediate or latent stage, lasts a variable period of time – sometimes many years or even decades – and is asymptomatic.

In the final, chronic stage, “the myocardial tissue is destroyed and does not regenerate, and is replaced with fibrous tissue. The heart increases in size and no longer contracts effectively; it pumps less blood into the lungs, and cardiac insufficiency gradually sets in,” explained Nola.

There are only two drugs indicated by WHO to eradicate the parasites: nifurtimox, introduced in 1960, and benznidazole, developed in 1974.

But eradication is only partial when the parasites have lodged into deep tissue and in the chronic stage of the disease.

Moreover, the side effects of these drugs cause collateral damage. “The ones that are most feared are the neurotoxic effects, because they cause peripheral neuropathy symptoms, such as sensations of extreme cold or heat, extreme sensitivity of the feet, and severe headaches,” said Nola.

But the promising findings of two Venezuelan researchers, Julio Urbina and Gustavo Benaim, have led Argentina and Bolivia to conduct clinical trials based on their experiments, while in Venezuela, “we hope to conduct a pilot study as well,” she reported.

Benaim, head of the cell signaling and parasite biochemistry laboratory at the state-run Institute of Advanced Studies, told Tierramérica that the goal is “to attack the parasite without affecting the human being, like current treatment methods do,” as well as “to develop drugs for the chronic stage, which are currently non-existent.”

The study is based on a specific property of Trypanosoma cruzi: its membranes do not contain cholesterol, but rather ergosterol, another sterol. “If you eliminate the ergosterol, which is indispensible for it, you eliminate the parasite,” he explained.

There are drugs that block the synthesis of ergosterol, such as posaconazole, which is approved by the United States Food and Drug Administration, although only for the treatment of fungal infections.

The researchers linked this fact with another clinical observation: Chagas patients whose arrhythmia (irregular heartbeat) was treated with amiodarone showed substantial improvement. “When it is applied to the parasites it is lethal for them,” Benaim enthusiastically reported in his laboratory.

Amiodarone is already used to treat arrhythmia, and 30 percent of Chagas sufferers in the United States receive it. It is not completely harmless, since it contains iodine, but its side effects are much milder than those of current treatments, said Benaim.

“We studied the mechanism of action of posaconazole and amiodarone; both of them were already known to be sterol inhibitors, but we demonstrated that amiodarone also alters the calcium regulation of the parasites,” he reported.

“Combining them boosts their effect, makes it possible to lower dosages, and cuts down on side effects,” he added.

Another new antiarrhythmic drug, dronedarone, which contains less iodine and is more easily eliminated, was also tested in their laboratory and “proved to be very successful. It is more powerful and acts more rapidly” in destroying the parasite, said Benaim.

An article on the new treatment was published in October in Nature Reviews Cardiology. In addition to Chagas disease, it can also be effective against other diseases caused by parasites, such as leishmaniasis.

“A good sterol inhibitor can bring an end to these parasitic diseases, which are viewed as diseases of the poor, and are therefore neglected,” stressed the Venezuelan researcher. In the case of diseases like these, “it isn’t profitable to conduct research into treatments for them. That is the sad reality.”
* This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.

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Brazil Enters New Era of Co-Production of Anti-AIDS Drugs Thu, 06 Dec 2012 22:49:49 +0000 Fabiana Frayssinet By Fabiana Frayssinet
RIO DE JANEIRO, Dec 6 2012 (IPS)

A new kind of public-private partnership will begin in 2013 in Brazil to produce an antiretroviral drug, through a technology transfer agreement that will be in effect until the patent expires in 2017.

The productive development partnership is based on an agreement with New York-based drug maker Bristol-Myers Squibb, to produce atazanavir sulphate.

The drug will be made by Farmanguinhos, a technical-scientific unit of the Oswaldo Cruz Foundation (Fiocruz) and the Health Ministry’s largest pharmaceutical laboratory.

It will be distributed in the public health network as part of the antiretroviral (ARV) cocktail therapy that is provided free of charge to everyone who needs it in this country of 194 million people.

“It’s an important symbolic process,” Dirceu Greco, the director of the Health Ministry’s Department of Sexually Transmitted Diseases, AIDS and Hepatitis (DDST), told IPS, referring to the five-year agreement with Bristol-Myers Squibb, which will represent some 200 million dollars in savings for Brazil.

“The Health Ministry programme is part of a national plan to reduce the deficit in the country’s trade balance in the area of medicines,” Gaetano Crupi, president of Bristol-Myers Squibb Brazil, said in an interview with IPS. “Today atazanavir is 100 percent imported.”

“The government of Dilma Rousseff wants, first, to cut the trade deficit, and second, to save money in the long term by producing the drug at a national level,” he said.

This is the first time Brazil is entering into a partnership with a private company to produce a drug that is still protected by a patent, and that is very important in the national response to AIDS treatment, he added.

“The important thing about this partnership is that it will give us a greater degree of sovereignty in the production of a medication, because the technology will be incorporated by our country, and there will be savings as well, since the medicine will be offered to the government at a reduced price,” Health Minister Alexandre Padilla said.

Since 1996, Brazil has provided universal free ARV treatment, which now benefits some 217,000 people. The Sistema Único de Saúde (SUS – Single Health System), the public health network, treats 97 percent of people diagnosed with HIV/AIDS in the country.

Pedro Chequer, United Nations Joint Programme on HIV/AIDS representative in Brazil, said it was a stride forward “that this country maintains its policy of (universal) access with its own funds and largely with its own production of medicine.”

The Health Ministry distributes 20 ARV drugs at a cost of around 425 million dollars a year. Eight of them are produced by Productive Development Partnerships.

“In the midst of an economic crisis, continuing this strategy was a political decision in favour of the public,” Greco said.

The agreement for the production of atazanavir sulphate provides for the transfer of technology to a national laboratory, as well as the manufacturing and distribution of the drug for five years.

Farmanguinhos has acquired equipment for the production and will receive training from Bristol-Myers Squibb.

Atazanavir sulphate, which is in the protease inhibitor class of ARVs, will start to be distributed in packaging with the Farmanguinhos logo in 2013. But it will only begin to be produced with national technology in early 2015.

A total of 99 million 300-mg tablets will be distributed between 2013 and 2017.

“This will be the 11th ARV medicine produced in Brazil,” Greco said. “The main advance was to ensure that we could manufacture and distribute essential anti-AIDS medicines with public funds.”

“In my view, the idea of having a small state structure has serious consequences in the area of health,” he added.

Brazil, through Farmanguinhos, has agreements to supply medication to other developing countries, in Latin America and Africa, through what it considers one of the main arms of its foreign policy: South-South cooperation.

Crupi added that “What to do when the patent expires is a strategic decision that the government will resolve.”

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Q&A: How Innovative Funding Combats HIV/AIDS Sat, 01 Dec 2012 14:47:06 +0000 Julia Kallas

Julia Kallas interviews PHILIPPE DOUSTE-BLAZY, U.N. under-secretary-general in charge of innovative financing and chair of the UNITAID executive board

By Julia Kallas

On World AIDS Day, the fact that the number of children newly infected with HIV continues to decline is welcome news to UNITAID, the International Drug Purchase Facility hosted by the World Health Organisation.  But UNITAID is also well aware of how much more remains to be done for  children already living with the disease.

Philippe Douste-Blazy, of France, is a special advisor who promotes UNITAID and other sources of innovative financing for the achievement of the United Nations Millennium Development Goals (MDGs).Philippe Douste-Blazy, U.N. under-secretary-general special advisor on innovative financing for development and chairman of the executive board of UNITAID. Credit: Julia Kallas/IPS

“There was some progress made but there is still a lot to be done by the international community,” Douste-Blazy told IPS regarding the fight against HIV/AIDS. “Unfortunately we do not have enough money to achieve the MDGs by 2015,” he added.

Douste-Blazy spoke to IPS U.N. correspondent Julia Kallas about the progress that has been made in preventing mother-to-child transmission of HIV but also how the international community must continue providing childhood HIV treatments to developing countries. Excerpts from the interview follow.

Q: What is the current funding scenario for treating childhood HIV in developing countries?

A: About 3.3 million children are living with HIV today. Unfortunately we do not have enough money to reach the Millennium Development Goals (MDGs) in general but in particular to reach the health-related MDGs – HIV, tuberculosis and malaria.

We must find funding now because with the current economic crisis, we will see a dramatic decrease in Official Development Aid (ODA). It will be difficult for all countries to help. We cannot ask the Greek government, for example, to donate 3 billion dollars for development countries because they are seeing an increase in poverty themselves. So we are going to see an increase in childhood mortality.

We have to create innovative financing for development. For example, UNITAID has placed a small tax on plane tickets. This funding helps combat childhood HIV.

Children are rarely born with HIV in wealthy countries because mothers living with HIV are treated during pregnancy to ensure that their babies are born HIV-free. Still, more than 1,000 children are born HIV-positive every day – 99 percent of them in Africa. Only 28 percent are treated.

We analysed what companies were interested in producing antiretroviral drugs. Our long-term funding gave suppliers the incentive to manufacture child-friendly formulations so we were able to buy pills for five years. Several generic suppliers that entered the market brought the price of the pills down by 70 percent.

Before, no child was treated by periotic antiretroviral, but with an adult’s syrup, 18 times a day. Now with only two pills a day, children can be treated.

Q: World AIDS Day is on Dec. 1. Should we be celebrating major progress?

A: Yes. We can see that there was some progress made, but there is still a lot to be done by the international community. For the first time more than 50 percent of the 15 million patients who need antiretroviral therapy have access to it.

It is also huge progress that we have 7 million fewer new HIV infections around the world, in particularly in Sub-Saharan Africa. Unfortunately in Eastern Europe, Russia and Indonesia, however, the infection has increased.

Q: Can you talk about the development of the three-in-one fixed-dose combination AIDS medicines for children?

A: Since its creation UNITAID has been working on combating paediatric HIV by creating a market for quality child-friendly antiretroviral treatments. Before, there was no incentive for pharmaceutical companies to invest in child-friendly antiretroviral drugs. HIV treatments for children in low-income countries were syrups designed for adults – up to 18 foul-tasting doses a day.

So the three-in-one fixed-dose combination AIDS medicines for children are a major innovation, from 18 doses a day to a pill twice a day. It is huge progress. Every year UNITAID finances the treatments of more than 100,000. Now is the time to follow up on our work with paediatric HIV.

Q: How should the new post-2015 sustainable development agenda address HIV/AIDS, and what can be done more effectively?

A: We cannot continue if we do not have money. Every head of state, head of government or member of parliament says we are going to reach the MDGs. It is not true.

To combat HIV we need three things. First is prevention. We need to help prevent high-risk people such as prostitutes and homosexuals from becoming infected. Secondly, we must ensure universal access of treatment. Only 54 percent of adults and 28 percent of children are being treated today.

Finally, we need to raise funds to achieve the MDGs – we need more innovative financing. With UNITAID, we proved that this is possible.

Q: Can you talk more about the one-dollar plane tax idea created by you, former Brazilian president Lula and former French president Chirac? What needs to be done to get more countries involved in this project?

A: UNITAID’s funding model is based on an air ticket solidarity levy. Every American who goes to France is going to pay one extra U.S. dollar to support our program. It is the same thing in 15 other countries. In five years we raised 2.5 billion dollars, and it is predictable, sustainable funding.

For the traveller, it is painless – people who can pay for a plane ticket can easily pay an extra dollar. It is not even the price of a coffee. With this funding we help combat childhood HIV. Eight out of 10 children are treated thanks to this system. Now we are working to convince more countries to become involved in this program.

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Maldives Talks Condoms Sat, 22 Sep 2012 09:37:15 +0000 Feizal Samath Condom promotion campaign in Male: Credit: SHE

Condom promotion campaign in Male: Credit: SHE

By Feizal Samath
MALE, Sep 22 2012 (IPS)

For an orthodox Islamic country, the Maldives has made remarkable progress in halting the spread of HIV in the Indian Ocean archipelago through bold awareness programmes and the distribution of condoms.

A few years ago, condoms were available in the Maldives only at drug stores and on production of a doctor’s prescription. Anyone found carrying a condom in the streets  was liable to be arrested by police.

But, a five-year project mounted by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), reports progress in creating awareness of safe sex issues and the use condoms by providing them free. The GFATM is supported by the Bill and Melinda Gates Foundation.

The GFATM programme in the Maldives addressed the sexually active among the 300,000 Maldivians, but focused on the 110,000 foreign workers in the country – mostly Bangladeshis, Indians and Sri Lankans employed in construction and in the country’s famed luxury resorts.

“We did a lot of work in the five years of the programme, which ended in August,” Ivana Lohar, HIV/AIDS project manager at the United Nations Development Programme in the Maldives, told IPS. “We believe that one more round of global funding would help to sustain the momentum.”

The challenge, Lohar said, is to ensure that the Maldives remains a low HIV prevalence country despite the presence of high-risk groups. As of December 2011, only 15 HIV cases were reported among Maldivians, while there were 289 cases among the foreign  labour force.

At the spanking new Voluntary Counselling and Testing Centre set up in the heart of capital by the Society for Health Education (SHE), a local non-government organisation (NGO), both local residents and foreign workers can avail of the free services.

Asna Luthfee, programme associate at SHE, says her work has included training 40 migrant workers as peer educators to promote awareness at hotspots where foreign workers congregate and provide condoms on request.

SHE offers a range of services through a sexual and reproductive health clinic, including screening for thalassaemia, DNA testing, counselling and psychosocial support. “We distribute oral pills, emergency contraceptives and condoms. We don’t ask people whether they are married or not – we distribute on request,” Luthfee said.

“There is also counselling if testing for HIV shows positive, and these cases are referred to the government,” Luthfee said. The programme, in which SHE and UNAIDS are partners, has been successful enough to be seen as a model for the region, she added.

Mohamed Yahiya, an accountant from Bangladesh who also works as HIV peer educator, said a government decision made earlier in the year to allow workers who contract HIV in the country to stay on and get free treatment, has helped immensely.

“Many were scared to talk about their HIV status fearing deportation, but the new government guidelines have eased those concerns,” he said. Foreign workers, however, undergo mandatory testing on arrival and those testing positive are refused entry.

The campaign has had its ups and downs because of pressure from the public and  religious groups that accused organisers of promoting promiscuous sexual behaviour.

“Though religion has its own inhibitions, Maldivian society is open and able to understand the need for awarenesss,” says Lohar. “We are not trying to interfere with religious beliefs, but flagging a serious public health issue. AIDS is a devastating condition that can impact the economy.”

A spokesman (officials may not be named under briefing rules) for the National AIDS Programme (NAP) said stigma and discrimination are still prevalent and public surveys in 2008 and 2009 showed that them to be  barriers to effectively addressing HIV and AIDS.

The UN-funded Biological and Behavioural Survey on HIV/AIDS – 2008 had noted that the potential for HIV transmission is “accelerated by non-use of condoms and the sharing of unsterile needles and syringes among injectors.”

Unprotected sex is high in all the risk groups. Aside from the risk behaviours themselves, a growing concern is the early age at which commercial sex and injecting drug use start in the Maldives, the study found.

The Maldives, warned the report, “is showing signals of a possible future epidemic which need to be closely monitored by the national programme, including injecting drug use in prisons and rehabilitation centres and risk behaviours found among the 18-24 year age group (selling and buying of sex, group sex, male-to-male sex, sex with non-regular partners, and injecting drug use).”

The NAP spokesman said that religious groups and scholars are supportive of public health efforts to prevent diseases and in this context using condoms is advised. “Prevention efforts are well supported by the religious scholars, and recently they have been involved as partners in HIV prevention work,” he added.

A major component of the programme was the conduct of migrant fairs where free testing for HIV/AIDS was provided. The latest of these fairs, which was held in August,  had collaboration from  government agencies, embassies and high commissions.

“Though most workers don’t understand English, these cultural shows break barriers and provide foreigners access to services, overcoming stigma and discrimination,” Luthfee said.

“Workers are provided information in their own language and when they return to their home countries they go back armed with knowledge on health issues,” said Yahiya.

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‘Cambodia Can’t Afford New Dengue Vaccine’ Thu, 13 Sep 2012 07:10:39 +0000 Vincent MacIsaac Dengue patients at Cambodia's National Paediatric hospital. Credit: Erika Pineros/IPS

Dengue patients at Cambodia's National Paediatric hospital. Credit: Erika Pineros/IPS

By Vincent MacIsaac
PHNOM PENH, Sep 13 2012 (IPS)

Public health experts in Cambodia are unenthused by reports of trials for a dengue vaccine conducted in neighbouring Thailand, saying it will be too costly for those who need it most – children in the least developed and developing countries.

“Of course, they cannot come out with a vaccine that costs 20 cents,” Dr. Philip Buchy, head of the virology unit at the Pasteur Institute of Cambodia, told IPS.

Buchy was referring to the Paris-based pharmaceutical company Sanofi SA’s dengue vaccine efficacy trials, the results of which were published in the British medical journal Lancet, this month.

Dr. Stephen Bjorges, leader of the vector-borne disease team at the World Health Organisation (WHO) in Cambodia, agrees. Even if Sanofi succeeds “funds would need to be mobilised” to cover the cost of inoculating children in Cambodia, he said.

A dengue epidemic that raged through Cambodia during the first eight months of the year landed more than 30,000 people in hospital, the majority of them children.

According to the Lancet report, Sanofi’s vaccine offers some protection against three of the four serotypes of the dengue virus – about 30 percent against serotype one and from 80 to 90 percent against serotypes three and four.

However, Sanofi’s vaccine does not protect against serotype two, which was circulating in the study area during the trial, giving the vaccine an overall efficacy rate of 30.2 percent, the report said.

Large-scale phase-3 trials are underway on 31,000 children and adolescents in Latin America and Southeast Asia, Sanofi said in a press statement timed with the release of the Lancet report.

According to the Reuters news agency, the company has already invested more than 430 million dollars in a new factory in France to produce the vaccine.

WHO’s Bjorges said that if the phase 3 trials proved the vaccine was effective, its initial market likley would be tourists from wealthy nations and the military, a view Buchy agrees with.

Buchy doubted, however, that an effective vaccine was around the corner. “The vaccine is not for tomorrow,” he said. “Dengue epidemics still have good days ahead of them.”

Still, both doctors expect increasing investment in vaccines and vaccine-related research as global warming expands the range of the mosquito that transmits dengue into southern Europe and the United States.

Developed countries are beginning to factor the costs of dengue treatment into their long-range healthcare budgets, while pharmaceutical companies have identified a potentially lucrative, emerging market, Buchy said. “Global warming is providing a shortcut for vaccine research.”

“Interest in vaccines is going to grow exponentially now that there is some success with a vaccine,” Bjorges said.

The European Union provided more than 10 million dollars for three dengue-related research projects in Southeast Asia earlier this year, including one in Cambodia to investigate the role that asymptomatic carriers play in transmission, Buchy said.

“If we can identify a gene that is protective this may allow us to develop drugs for treatment and vaccination,” he added.

Funding for prevention and control of epidemics in poor countries remains scant, however. The budget for Cambodia’s national dengue control programme is about 500,000 dollars, most of it provided by the Asian Development Bank.

Bjorges says one reason for the lack of funding for prevention and control is that it has shown little success. “Dengue control is 50 years old and everything that has been thought of has been tried.”

Breeding sites have to be eradicated weekly in order to prevent the mosquito that transmits the virus from emerging from its larvae, and this requires changes in human behaviour that have proven difficult to sustain on a weekly basis, Bjorges explained.

Another problem may be that those who allocate global health funds rely on short-term cost-benefit models, Bjorges said. They are under pressure to produce quick, quantifiable results for the funds they allocate, and dengue prevention and control projects do not fit these models, he explained.

Buchy was less pessimistic about the possibility of changing human behaviour. “Behaviour change is possible, but it requires more investment in education.”

Buchy’s view is echoed by Prof. Duch Moniboth of Cambodia’s National Pediatric Hospital that treated 1,673 children for dengue in the first seven months of this year. “There is not enough education about dengue – how to prevent infection and how to eradicate breeding sites.”

New research, however, suggests that dengue is far more prevalent in Cambodia than previously calculated, underscoring the need for increased investment in prevention.

The disease is underreported partly because Cambodia’s dengue surveillance system relies on data from state-run hospitals and charitable children’s hospitals. Cases treated at private hospitals and clinics are not reported to the health ministry.

Charitable hospitals treating dengue patients in Cambodia have been pleading for donations after being inundated with patients in May. The National Paediatric Hospital has been relying on nursing students to treat children who spill into the hallways and the foyer around the main stairwell.

The hospital receives a mere 20 dollars per patient, regardless of how long the child stays, Moniboth said. On average, doctors receive monthly salaries of about 125 dollars, while nurses are paid about 75 dollars, he said.

With such meager funding for healthcare what is needed is a cheap vaccine, Moniboth said.

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