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Africa/Global: Health Challenges & Threats
AfricaFocus Bulletin
October 13, 2015 (151013)
(Reposted from sources cited below)
Editor's Note
Last week was the first week since March 2014 that no new cases of Ebola
were reported in West Africa. And late last month the World Health Organization
announced official guidelines for beginning antiretroviral therapy
for all persons infected with HIV even before they show symptoms of
AIDS. Fully eradicating either disease and building sustainable
health system remain formidable challenges, however. At the same
time, U.S. policy to promote greater protection for large
pharmaceutical companies in trade negotiations poses a still rising
threat to global efforts to guarantee the universal right to health.
This AfricaFocus Bulletin contains one short article on the threat
to health in the least developed countries from hard-line U.S.
policy on protection for pharmaceutical companies, followed by links
with short excerpts from other recent articles on Ebola, the cost of
medicine and the current dysfunctional pharmaceutical system,
HIV/AIDS, and a promising advance in medical technology providing
cost-effective blood auto-transfusion in developing countries.
While progress has been made both on the long-term pandemic HIV/AIDS
and the West African Ebola epidemic more recently, neither battle is
completely won. Neither have the economic, personal, and societal
damages been repaired, nor the world's health systems prepared for
new epidemics, nor the necessary resources invested to guarantee the
universal right to health.
For previous AfricaFocus Bulletins on health and related issues,
visit http://www.africafocus.org/intro-health.php
The WHO Ebola Situation Report is available at
http://apps.who.int/ebola/ebola-situation-reports
Updates on AIDS are available at http://www.unaids.org
Frequent updates on the status of access to medicines are available
on the MSF / Doctors Without Borders website on this issue at
http://www.msfaccess.org/
++++++++++++++++++++++end editor's note+++++++++++++++++
LDCs be damned: USTR and Big Pharma seeks to eviscerate Least
Developed Countries' insulation from pharmaceutical monopolies
Professor Brook K. Baker, Health GAP and Northeastern U. School of
Law
HealthGap blog, October 12, 2015
http://www.healthgap.org/blog - Direct URL:
http://tinyurl.com/pbhd94q
Professor Brook K. Baker, Health GAP (Global Access Project) &
Northeastern U. School of Law, Program on Human Rights and the
Global Economy
Honorary Research Fellow, Faculty of Law, Univ. of KwaZulu Natal, SA
In November of 2001, at the height of the global AIDS pandemic,
every WTO member country in the world, including the United States,
voted unanimously in the Doha Declaration on the TRIPS Agreement and
Public Health that WTO Least Developed Countries members should be
granted an unconditional extension of any obligation to grant or
enforce patents, data protections, or exclusive marketing rights on
pharmaceutical products. These countries desperately needed access
to affordable generic medicines and freedom from the pillage of Big
Pharma's monopoly pricing. This sensible and humane transition
policy was confirmed by votes of the WTO TRIPS Council and General
Council in 2002.
Fast forward to 2015, and LDCs are again seeking an extension of
that same no-pharmaceutical-monopolies policy, which expires on
January 1, 2016. Their request has reportedly received approval in
nearly every capital of the world - except Washington D.C. (with
some weakening opposition from Australia, Canada, and Switzerland).
Nothing in the plight of least developed countries has changed -
they remain desperately poor, they continue to lead the world in
negative health statistics and early death, and they continue to
struggle with development challenges and inadequate capacity in
their industrial, technological, and administrative sectors. More
to the point, they continue to need access to affordable medicines,
and, if possible, new manufacturing capacity and expertise to
produce at least some medicines on their own.
What the LDCs seek is simple: rather than another time limited
extension (even a relatively long 15 year one like the one they
first got), is an extension that lasts as long as they remain an
LDC. Once an LDC member transitions to lower-middle income status,
its obligation to begin to process, grant, and enforce patents and
data protections on medicines would change. But in the meantime,
countries that were still LDCs could import cheaper generics legally
from abroad or manufacture them locally with no intellectual
property restrictions whatsoever.
What does the United States Trade Representative want - what pound
of flesh is it seeking from LDCs for an further extension that is
guaranteed to them by paragraph 7 of the Doha Declaration and by
Article 66.1 of the TRIPS Agreement? After all those documents
state that initial TRIPS transition periods, like LDCs had for
pharmaceuticals, were granted without prejudice to further
extensions and that WTO member "shall, upon duly motivated request
by a least-developed country Member, accord extensions [of LDC
TRIPS-compliance transition periods]." In this context, "shall"
means "must," no "ifs," "ands," or "buts."
Instead of acceding to these clear TRIPS mandates, the USTR is
unwilling to discuss an extension for as long as an LDC remains an
LDC and instead is demanding a more miserly, time-limited extension.
The US has been unwilling to state its position publicly. Instead,
it has selectively listened to corporate "stakeholders" at home,
namely PhRMA and BIO, who oppose an unlimited extension because ...
well, because of what they say to back up every IP monopoly demand:
"We need more profits, even from the poorest countries in the world,
in order to research the next generation of life saving medicines."
Unfortunately, the USTR has not listened to access-to-medicines
advocates who wrote a letter urging US support for the LDC extension
over a month ago with no response to date. Nor is the USTR
listening to other "key" US stakeholders including Senator Sanders,
and Representatives Jan Schakowsky (D-Ill.), Rosa DeLauro (D-Conn.),
Jim McDermott (D-Wash.), Raúl M. Grijalva (D-Ariz.), Keith Ellison
(D-Minn.), Barbara Lee (D-Calif.), and Sam Farr (D-Calif.), elected
officials who have all have expressed unequivocal support for the
LDC request. Even the European Commission has voted unanimously in
favor of the unlimited extension.
At a meeting in Geneva with 15 Ambassadors from the LDC Group on
Friday October 9, Ambassador Michael Punke, Deputy United States
Trade Representative and U.S. Ambassador and Permanent
Representative to the World Trade Organization, and gave a
startling, unbelievably craven and subservient justification for the
US demand for a short-duration extension. He said that Big Pharma
was disappointed with the additional intellectual property and
pharmaceutical protections the US secured for it in Trans Pacific
Partnership negotiations and thus that the US could not give ground
on the LDC extension.
Right, the poorest countries in world should get shortchanged on
their desperately needed access to more affordable generic medicines
because Big Bio did not get 12 years of data exclusivity monopoly
protections on their $100,000-plus per-patient-per-year biologics.
The USTR's policy positions on the LDC extension request are deadly.
They cynically safeguard Big Pharma's global monopoly empire with
potential catastrophic effects on LDCs ability to strengthen their
human and technological well-being. At a time when we see migrants'
bodies washing onto European beaches, the USTR wants to make sure
that pharmaceutical capacity is stillborn in many of the countries
those migrants come from. This dour and ethically demented policy
position cannot stand.
Is President Obama's administration so out of touch with
humanitarian values and common decency that it wants the US to be
the sole country at the WTO to oppose a mandatory, unconditional
pharmaceutical extension for LDCs that is their legal right?
Links on Ebola (with very short excerpts)
(1)http://www.npr.org/sections/goatsandsoda - Direct URL:
http://tinyurl.com/q7trnqv
Amy Maxmen, "To Prevent The Next Plague, Listen To Boie Jalloh," NPR
Goats & Soda, Oct. 8, 2015
"This is a landmark week in West Africa. For the first time since
the Ebola outbreak, there were no new cases reported in Guinea,
Liberia and Sierra Leone.
There are many unsung heroes who deserve credit for this milestone.
One of them is Dr. Boie Jalloh, age 30. Ten days after he showed up
for his medical residency at 34th Military Hospital in Freetown,
Sierra Leone, he received a letter requesting his presence at the
hospital's newly constructed Ebola unit."
"To me, first and foremost, I wish the government and our
international partners would invest in medical education. We really
need more doctors and nurses here — we needed them before Ebola. You
can supply all the drugs you want, but people won't be able to get
those drugs if there is only one health care provider for 10,000
people. [Note: According to the World Bank, the number is 1.8 —
compared to 100 in the U.S.]"
(2) http://www.eboladeeply.org / Direct URL:
http://tinyurl.com/obf26pm
Brooks Marmon, "In Liberia, Paying Tribute to Those Who Sang Against
Ebola," Ebola Deeply, Sept. 22, 2015
Last week, the conference room of Monrovia's Young Men's Christian
Association (YMCA) was decked out in red, white and blue balloons:
the colors of Liberia's Lonestar flag. The event? A tribute by the
Musicians' Union of Liberia (MULIB) to the artists – singers, hip-co
stars, songwriters and other musicians – who joined the Ebola fight.
Bernard Benson, better known as D.J. Blue, the manager of Hott FM,
one of Liberia's most popular radio stations, was the M.C. for the
event. He set the tone by noting, 'We took Ebola from 100 percent to
0.0 … no one must underestimate what Liberian music did. It
resonated to every Liberian, to the people that matter.' G. Bennie
Johnson, MULIB's vice president, echoed his words, adding that
'musicians have the power, real power, to do something good for this
country.'
Nearly a dozen videos accompanying Ebola awareness songs were
screened as part of the festivities."
[see full article at link above for embedded videos.]
Links on Cost of Medicines (with very short excerpts)
(1) http://www.doctorswithoutborders.org - Direct URL:
http://tinyurl.com/qchbgz5
MSF / Doctors without Borders, "The Cost of Medicine," Alert, Fall
2015, pages 10-12 on "Fundamental Changes Needed in the Biotechnical
Innovation System."
"A primary driver of biomedical innovation is public funding coupled with the granting of patents and other intellectual property rights that give pharmaceutical companies exclusive domain to make and sell a new medicine or vaccine for a stipulated period of time. This in turn gives companies monopoly control over the market for that product, allowing them to charge high prices and inhibiting competition that would drive down costs.
Companies therefore decide where to allocate resources based on the revenues they believe a particular product could generate, not the public health burden they could address. What this means in practical terms is that public health priorities and needs rarely determine how corporate efforts are directed. In the current ecosystem, companies watching their profit margins and stock prices are effectively dis-incentivized from focusing resources and attention on diseases and conditions that primarily affect people in the developing world, people who don't represent a lucrative market.
From our vantage point, it's a broken system that is both inefficient and ineffective at responding to the most pressing global public health needs. And our field teams witness these costs on a daily basis."
"In addition, there is a lack of transparency from the pharmaceutical industry, so we don't really know what the R&D costs are for specific products, what proportion of a given product was publicly financed, or how much it costs to manufacture. The accuracy of industry-funded estimates on the cost of developing a drug is questionable at best.
(2) http://www.msfaccess.org/ / Direct URL:
http://tinyurl.com/o7yj4ms
MSF Access, "TPP trade pact will deepen global crisis of
exorbitant drug prices unless dangerous terms are removed." Press
release, Sept. 25, 2015
"As public outrage about exorbitant drug prices features in new
headlines in the US and around the world, negotiators and trade
ministers from the 12 Trans-Pacific Partnership (TPP) countries are
converging in Atlanta to potentially finalize the trade pact, which
has been negotiated in secret over a period of more than five years.
Recent leaked copies of the TPP's intellectual property chapter
confirm the inclusion of harmful rules that will lock in high prices
and block affordable generic medicines for years. MSF urges all TPP
countries to firmly reject provisions that will deepen the global
crisis of unaffordable medicines and health products."
Also includes link to 4-page briefing paper on the TPP: "Trading
Away Health"
Links on HIV/AIDS (with very short excerpts)
(1)http://www.healthgap.org/blog - Direct URL:
http://tinyurl.com/qdbyf52
Health GAP, "Celebration and Call to Action - New WHO Guidelines on
HIV Treatment and PrEP
"(September 30, 2015) Health GAP welcomes the World Health
Organization's release of new global guidelines on HIV treatment,
recommending that all people living with HIV be started on HIV
treatment regardless of disease stage and encouraging expanded
availability of pre-exposure prophylaxis (PrEP) to groups at
particularly high risk of contracting HIV.
Earlier guidelines recommended that health care providers wait until
people with HIV reached a certain level of disease progression
before starting treatment, despite the fact that years ago many
wealthy countries including the United States had already begun
providing treatment immediately upon diagnosis to all people living
with HIV regardless of how advanced their disease. The shift in
guidelines comes after new results from the NIH-funded START trial,
which provided conclusive evidence of the benefits of immediate
initiation in May of this year."
"Only 15 million people are currently on treatment and 37 million
are infected, meaning that an additional 22 million people are now
eligible for immediate treatment. HIV testing has to be
significantly increased, people need to be enrolled in treatment
when they test positive, and they will need durable connection to
quality care."
"Unfortunately donors and major funders are acting as if
additional resources are not needed. Just a few days ago the US
announced a major initiative to expand treatment and to reduce
infections among young women, but it identified no additional
resources. 'Preliminary estimates show that the US must add at least
$300 million new dollars each year over the next few years to
existing global AIDS funding to help meet the new treatment and
prevention goals,' said Professor Brook Baker, Health GAP's Senior
Policy Analyst."
(2) http://www.thelancet.com/ - Direct URL:
http://tinyurl.com/nq5btzp
"Vancouver Consensus: antiretroviral medicines, medical evidence,
and political will," The Lancet, August 8, 2015
"In 1996, the global HIV community gathered in Vancouver, Canada,
for the XI International AIDS Conference and shared the clear
evidence that triple-combination antiretroviral treatment held the
power to stem the tide of deaths from AIDS. The HIV treatment era
had begun. As we gathered again in Vancouver in July, 2015, it was
clear that a new transformative moment is upon us. The Vancouver
Consensus statement,1 which emerged at the recently concluded 8th
International AIDS Society Conference on HIV Pathogenesis, Treatment
and Prevention (IAS 2015), signals the scientific affirmation that,
rather than limiting access to those who are immune compromised,
immediate access to antiretroviral medicines holds the power to
rapidly advance the fight to end AIDS.
The consensus—signed by more than 500 researchers, clinicians, and
civil society experts—is clear: 'All people living with HIV must
have access to antiretroviral treatment upon diagnosis. Barriers to
access in law, policy, stigma and bias must be confronted and
dismantled. And as part of a combination prevention effort, PrEP
(Pre-Exposure Prophylaxis) must be made available to protect those
at high risk of acquiring HIV. The strategic use of ARVs—through
treatment and other preventive uses—can save countless millions of
lives, reduce new infections, and move us vastly closer to our goal
of ending the epidemic. A new era of opportunity against this
epidemic has dawned, and we must seize it.'
...
Medical evidence is unambiguous. At this point, further delays
threaten not only millions of lives but also threaten a resurgence
of this pandemic. But if we act rapidly, we can drive down HIV
incidence, death, and long-term costs. Political will is needed to
complete the work of what can be one of the most effective public
health interventions in history."
Links on technical advances for developing countries
Sisu Global Health (http://www.sisuglobalhealth.com/)
A recent start-up led by three women from Michigan, Sisu Global
Health was initially based in Grand Rapids, Michigan, and has
recently moved to Baltimore, near the Inner Harbor.
"The Hemafuse [now being tested by doctors in Zimbabwe and Ghana] is
a manual autotransfusion device is that used to retransfuse a
patient's own blood during an internal hemorrhage, specifically
ruptured ectopic pregnancies or road traffic accidents. The current
procedure commonly used in Sub-Saharan Africa consists of salvaging
blood with a kitchen soup ladle and filtering it with gauze.
Compared to this soup ladle autotransfusion, Hemafuse takes 1/3 of
the time, 1/9 of the staff, and is significantly safer. The Hemafuse
functions much like a giant syringe to suction blood through a
filter when a handle is pulled up. When the handle is pushed down
the blood is transferred directly to a blood bag in a closed
system."
"This device is surgical - meaning that it can intervene during a
pivotal moment in an individual's care. Compared to most moments
when autologous blood transfusion occurs, the Hemafuse, as an
intervention, will be both more urgent and more evident in terms of
results. Its handheld, sleek design reduces both blood flow issues
and failure modes from a slippery, gloved hand mid-surgery. In many
of the surgical suites that we've been in, space is at a premium.
Improvements on hospitals and buildings are not keeping up with the
increase in patient admittance and population growth, meaning
smaller rooms for more people.
This device, as one Tanzanian doctor put it, will eliminate a
'messy' and sometimes futile process.
All opinions from these doctors point to the success of this device,
however, the glaring fact that autotransfusion, the recycling of a
person's own blood, has been debated solely in Western countries. Of
all the published material concerning African healthcare, only 1-2%
have contributions from the continent's own physicians.
Additionally, these articles and the repository services that
attempt to collect thousands of articles are often not
internationally indexed to include African medical papers. They come
from a continent that has been performing autotransfusion for years,
but whose voices have not been given the mechanism to be heard in
the medical community."
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with a
particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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