HAI NEWS
NUMBER 110, DECEMBER 1999/JANUARY 2000
HIV/AIDS: Improving Access to Essential Drugs
This year alone, a total of 5.6 million people became infected with HIV, of which 570,000 were children below the age of 15 years. This brings the number of people living with HIV/AIDS to around 33.6 million. HIV gradually destroys the body's immune system, which normally defends and protects the body against a multitude of invaders, making it vulnerable to infections. Diseases that have been controlled in many parts of the world such as tuberculosis have returned with a vengeance to attack people with HIV/AIDS. Drugs play a crucial role in curbing the epidemic.
Drugs that are required fall into one of the following categories:
While these drugs are available, people living with HIV/AIDS are denied access to these drugs due to various reasons. According to UNAIDS, affordability is probably the single most important reason that people cannot obtain the drugs they need. Access to these drugs is also hindered by legal, infrastructural and cultural factors.
Table 1 shows the anti-infective agents and anti-cancer drugs needed by people living with HIV/AIDS.
Table 1: Anti-infective agents and anti-cancer drugs
Infection or malignancy 170 / 7 days Trimethoprim-sulfamethoxazole - 611 / 21 day treatment Fluconazole 7441 / year 5506 / year 5.15 / year 15 - 45 / year Vincristine 25.84 / 15 units 3.97 / vial Source: International Drugs Price Indicator Guide, 1996 , taken from Access to Drugs, UNAIDS Technical
Update, October 1998 As disease patterns vary according to region, the need for a drug differs among countries. For example, PCP is
more frequent in industrialised countries, thus a higher demand for pentamidine in these countries, while
tuberculosis is more frequent in developing countries. High prices inhibit access to many of the drugs listed in table 1. For instance, the treatment for herpes zoster,
is US$170 for a course of treatment lasting 7 days. Itraconazole and Fluconazole, both patented drugs, which
are needed to treat systemic mycosis, cost a staggering US$7,441 a year and US$5,506 a year, respectively.
In countries worst hit by the HIV epidemic, GNP per capita ranges from US$240 to US$3,400, thus making
these drugs unaffordable. However cost is not the only factor that prevents accessibility to these drugs. For certain opportunistic
infections such as TB, monitoring of the patient can be difficult. TB is the most common opportunistic infection
that complicates HIV infection in developing countries, and is responsible for one-third or more of
HIV-associated deaths in sub-Saharan Africa. Around 15 million persons worldwide are affected with both HIV
and mycobacterium tuberculosis. Treatment for TB extends over a six month period, making the monitoring of
the patient difficult. The emergence of multidrug resistant TB in industrialised countries is a worrying trend. Drugs are also needed to relieve the physical and mental pain and discomfort for people living with HIV/AIDS.
Table 2 lists some of the drugs for palliative care needed by people living with HIV/AIDS. Table 2: Drugs for palliative care
Symptom Promethazine suspension Chlorpheniramine tablet 0.1364 / 2ml 0.0060 / ml 0.0030 / tablet 0.0063 / tablet Not listed 0.03 / tablet Morphine 0.266 / ampoule Not offered Source: International Drugs Price Indicator Guide, 1996 , taken from Access to Drugs, UNAIDS Technical
Update, October 1998 The drugs listed above are available in the generic form at an affordable price. Nevertheless, access to these
drugs is sometimes hindered by international regulations. For example, methadone for treating drug addiction,
morphine and pethidine for controlling severe pain are controlled by international regulations which limit
distribution. Some drugs are classified as illegal narcotics, even when the palliative benefits at the late stage of
the disease outweighs the risk of addiction. Another group of drugs required is antiretrovirals. Antiretroviral drugs attack the causative agent by
suppressing the virus from multiplying. These drugs are new, expensive and if taken as a single drug, may
actually encourage the virus to become resistant. Thus, to minimise the risk of resistance, three drugs are
taken together, as triple combination therapy. A triple combination therapy costs US$12,000 per year, making them out of reach to the vast population of
those living with HIV/AIDS in developing countries. This is unfortunate as positive results as been found in
situations where they are used. For example, in Argentina, antiretrovirals are provided for those found to be
HIV-positive. This has resulted in a drop of new AIDS cases, from 71.6 per million people in 1996, to 41.3 per
million in 1998 - a remarkable reduction of over 40 per cent. The antiretroviral zidovudine has been found to reduce mother-to child transmission of the virus when taken
orally in late pregnancy and during delivery. The cost of treatment from 36 weeks gestation until after delivery
ranges from US$130 - 360. Nevertheless, for effective reduction in mother-to-child transmission, it is crucial for
antenatal services in developing countries to provide voluntary prenatal counselling and HIV testing. Positive action to ensure access to HIV/AIDS drugs Collecting information on drug prices and source can help in price negotiations and locating new supply
sources. Research undertaken has shown that the price of drugs varies from country to country. Table 3 shows the cheapest retail price in US$ of 100 units of three HIV / AIDS drugs - fluconazole, lamivudine
and zidovudine in five countries: Table 3: Cheapest retail prices of three HIV/AIDS drugs
India 1110 150 mg 55 150 mg 115 100mg 42 Source: Communication from HAI partners As noted above, there is huge discrepancy in the prices of drugs. The price of fluconazole ranges from US$55
in India to US$1,740 in South Africa. There are 17 suppliers of this drug in India, while only the originator's
product is available on the South African market. Market competition has reduced the price of the product in
India. Drugs prices are cheaper in India than in other countries because of the availability of generics on the market.
The generic version of zidovudine in India costs US$42 while the branded version costs US$119 - a
remarkable difference in prices. The originator of a patented product has monopoly over the market and is able to practice price discrimination,
much to the detriment of the consumer. Epivir is the originator's brand of the drug lamivudine, which is under
patent.The price range of the drug varies from US$115 in India to US$455 in South Africa. Under such
conditions, one way of lowering prices to make the drug more accessible is through parallel importing. Parallel
importing involves a government or an importer shopping in the world market for the lowest priced version of a
drug rather than accept the price at which it is sold in their country. Another way of lowering prices for these important drugs is by allowing generic manufacturers to enter the
market during the patent life of the drug. This can be done through compulsory licensing. Compulsory licensing involves a government giving a manufacturer a license to produce a drug for which
another company holds a patent, in exchange for the payment of a reasonable royalty to the patent holder.
Both compulsory licensing and parallel importing, under certain conditions are allowed under the WTO/TRIPs
Agreement. In his opening speech at the Fifth International Congress on HIV/AIDS, Datuk Seri Dr Mahathir,
Prime Minister of Malaysia, upheld compulsory licensing and parallel importing as ways of making access to
HIV drugs more equitable. It is crucial that the physical infrastructure of health-care facilities be improved. Health-care facilities in some
countries are at present too sparse to ensure adequate usage of drugs even if these drugs were to be imported
at affordable cost. Adequate distribution systems need to be set up to ensure that drugs reach those who need
them. Personnel must also be trained in the proper use of drugs for HIV/ AIDS and be able to provide reliable
information in a sensitive manner. In many settings, reliable information is not available and drug use may
therefore be strongly influenced by uninformed friends and relatives, traditional healers and unqualified
entrepreneurs.
Drug
Wholesale price in
US$/Duration Herpes zoster
Acciclovir
Pneumocystis carinii
pneumonia (PCP)
Pentamidine
Systemic mycosis
Itraconazole
Tuberculosis prophylaxis
Isoniazid 300 mg
Tuberculosis treatment
Anti-TB drugs
Kaposi sarcoma
Bleomycin
Drug
Wholesale price in US$ Allergy, anxiety, itching
Promethazine injection
Depression
Amitryptiline 25mg tablet
Drug addiction
Methadone
Pain, cough, diarrhoea
Codeine 30mg tablet
Severe pain
Pethidine 50mg ampoule
Malaysia
South
Africa
Peru
New
Zealand Per capita GNP in
USD
4680
3400
2460
16480 Fluconazole
697
1740
650
NA Lamivudine
348
455
400
375 Zidovudine
135
110
171
276
Action by people living with HIV/AIDS has helped bring about a number of positive advances to access to drugs. Actions by people living with HIV/AIDS have resulted in:
In conclusion, while lowering prices will make drugs more accessible, it is not enough to stop there. For drugs to work effectively, they must be taken at the correct dosage, frequency and duration. The supporting health system must have the capacity to diagnose and monitor HIV infection and related conditions, and it must have trained health workers to supervise treatment and offer psycho-social support. Above all, people living with HIV/AIDS must themselves be involved and well informed about their treatment.
The writers acknowledge the use of the following documents in this article: Access to drugs, UNAIDS Technical Update, October 1998; AIDS Epidemic Update, December 1999, UNAIDS.
(Kiran Sagoo is Editor of HAI News and Dr K Bala is coordinator of HAI Asia.)
International
Health advocates meet to demand greater access to essential drugs
Calling for health to be priority in trade discussions, more than 350 people participated in a HAI/ Medecins Sans Frontieres (MSF)/Consumer Project on Technology (CPT) conference on access to medicines from 25-26 November in Amsterdam. Representing more than fifty countries, participants demanded governments to protect public health while negotiating trade agreements at December's World Trade Organization's Ministerial Conference in Seattle, US.
The meeting "Increasing Access to Essential Drugs in a Globalised Economy: Working towards solutions" highlighted the fact that people in poor countries have virtually no access to new essential medicines which are priced beyond their means. In addition, speakers pointed out that research and development by multinational drug companies for diseases found in developing countries has almost completely stopped.
During the two days, those taking part discussed ways to increase access to needed medicines, examined research and development policies and costs, reviewed current drug pricing policies and suggested strategies to promote generic drugs and medicines for neglected diseases.
The audience included health advocates, government officials, industry representatives, staff from international organisations including the WTO, WHO, UNDP and European Commission. The meeting was held as part of an ongoing campaign within the international public health community which calls for action to humanise the new trade agreements.
An open letter drafted by the conference's organisers which highlights the negative effects the TRIPs (trade-related aspects of intellectual property rights) agreement will have on public health and recommends actions to be taken at the Ministerial meeting was sent to participants of the WTO
Seattle meeting. (The full text of the letter can be found on the Internet at: http://www.msf.org/advocacy/accessmed/wto/reports/1999/letter)
HAI/MSF and CPT also sent lobbying teams to Seattle to make their demands clear to those attending the Ministerial Conference and to link up with other NGOs.
Copies of the Amsterdam conference's presentations are now available on HAI's website (http://www.haiweb.org/campaign/novseminar/seminar_announcement.html). For more information about the ongoing access campaign or the Amsterdam conference, contact the HAI-Europe office. (64/99)
[Postscript: The trade talks to be launched at the 3rd WTO Ministerial Conference did not materialise as member states could not reach a consensus.]
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HAI warmly congratulates Médecins Sans Frontières (MSF) on being awarded the Nobel Peace Prize for 1999. The acceptance speech is available on the web at: http://www.msf.org/events/1999/nobel/reports/speech/archive.htm |
Asia-Pacific
Ensuring access to HIV/AIDS drugs
In some countries in Asia, more than 57 percent of the population does not have access to basic health services. Essential drugs for HIV/AIDS vary from between a few US cents for palliative drugs to US$12,000 for standard triple antiretroviral therapy. How do we ensure access to HIV/AIDS drugs in a rapidly globalised world? Action for Rational Drugs in Asia (ARDA) Co-ordinator, Dr K. Bala, in his presentation at the 5th International Congress on AIDS in Asia and the Pacific, put forward his answer:
The presentation titled "The Impact of WTO/TRIPs Agreements on the Access to Essential Drugs for People Living with HIV/AIDS" is available on the web at: http://www.consumersinternational.org/trade/index.html. or from the Health & Pharmaceuticals Programme, CI ROAP, 250-A Jalan Air Itam, 10460 Penang, Malaysia. E-mail: ardaroap@tm.net.my (65/99)
India
Raising RDU awareness among rural consumers
The Consumer Rights, Education and Awareness Trust (CREAT), with the support of Consumers International Regional Office for Asia and the Pacific (CI ROAP), and the Karnataka State Pharmacy Council (KSPC), jointly organised a one-day workshop on rational drug use, in Vijayanagar, Bangalore, India on the 26th of September. Thirty-five delegates from rural consumer groups attended the meeting.
It was pointed out that in a country like India which faces a high illiteracy rate, it is crucial that consumers be made aware of what drugs are essential and use drugs rationally. It is unfortunate that doctors too, are unaware of the concepts of essential drugs, as it is neglected in the medical curriculum. This leads to the common problem of multiple prescription among doctors. The consumers' right to safety, information and choice can only be upheld through consumer empowerment.
The plan of action included the formation of HEALTH WATCH. This will comprise of students, doctors, and a few consumer activists who will be vigorously trained in the concept of rational drug use, and then advocate on behalf of consumer groups. CREAT, with the help of KSPC, will also undertake a prescription audit. Similar workshops will be held in the future. To assist consumer groups, a training module on conducting workshops and campaigning on rational drug use has been prepared in the Kannada language. The module is available from: Y.G.Muralidharan, Consumer Rights, Education and Awareness Trust, 239. 5th 'C' Main, Remco Layout, Vijayanagar, Bangalore-560 040, India. (66/99)
Experts meet to brainstorm on WTO Agreements and People's Concerns
An International Brainstorming Workshop on WTO Agreements and People's Concerns was held in New Delhi on 30th October and 1st November. This workshop, organised by the Centre for Study of Global Trade System and Development, was attended by sixty-five participants. In-depth analysis and deliberations were held on Trade Related Aspects of Intellectual Property Rights (TRIPs), Multilateral Agreement on Investment (MAI), and food security.
The workshop noted that international trade agreements have contributed to the widening of the socio-economic and technological gap between developed and developing countries. It is necessary for there to be an alternative framework with greater self-reliance. A Delhi Declaration and Statement of People's Concerns and WTO issues was formulated. Among proposals put forward were that:
The statement also addressed issues on agriculture and food security, and new issues such as competition policies, government procurement, electronic commerce and the social clause.
A full copy of the Delhi Declaration and Statement on People's Concerns and WTO issues can be obtained from the Centre for Study of Global Trade System and Development, A-388, Sarita Vihar, New Delhi 110 044, India. E-mail: wgkeayla@del6.vsnl.net.in, Tel. and Fax: + (91-11) 694 7403 (67/99)
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Quote Not until the creation and maintenance of decent conditions of life for all people are recognised and accepted as a common obligation of all people and all countries-not until then shall we, with a certain degree of justification, be able to speak of mankind as civilised. Albert Einstein, 1945 |
Nepal
RDU Education for All
The Resource Centre for Primary Health Care (RECPHEC) carried out a series of workshops on Rational Drug Use (RDU) for consumers between June 1997 and March 1999. The workshops which were conducted in Kathmandu, Biratnagar, Birgunj, Gorkha, Mahendranager and Dang, included a total of 168 participants, who were school teachers, journalists, grassroot health workers, NGO staff, consumer groups, drug retailers and the general public.
The workshops aimed on sensitising the target audience on the problem of irrational drug use and unethical promotion. It also aimed on educating the participants on appropriate purchase and storage of medicines, correct use of medicines, responsible self-medication, and rights and responsibilities of consumers for appropriate drug use. The workshops included interactive presentations by resource persons, which were followed by extensive floor discussions and group work. Handouts, graphic presentations, medicine samples, posters, bulletins and pamphlets were used as support tools. Results from a questionnaire survey carried out showed that participants found the workshops interesting and useful.
Details of the workshops have been published in the Journal of the Institute of Medicine, Volume 21, Number 1 & 2, Jan - Mar/Apr - Jun 1999. For more information, please contact: Resource Centre for Primary Health Care (RECPHEC), GPO Box 117, Kathmandu, Nepal. Email: Recphec@npl.healthnet.org (68/99)
Thailand
NGOs advocate for reduced test period for HIV/AIDS drugs
The alliance of NGOs on AIDS have advocated for the length of the safety monitoring programme (SMP) for drugs used in the treatment of HIV/AIDS in Thailand cut by half, so people will have access to treatment sooner. This long wait is viewed as a barrier to the use of the drugs in treatment programmes. A joint report by the WHO and MSF concluded that the high cost of drugs in Thailand is linked directly to the monopoly derived from the exclusive rights held by the original drug manufacturers, either from the patent or during the safety monitoring period.
Manufacturers of HIV/AIDS drugs enjoy exclusive marketing rights during this SMP period. Currently, 11 HIV/AIDS drugs are on the SMP list. The long SMP process has caused the suspension of several of the Government Pharmaceutical Organisation's drug development projects.
Saree Angsomwang from the Foundation For Consumers said that the alliance of NGOs on AIDS is looking into the Patent Act, which provides flexibility to ensure access to essential drugs, such as through compulsory licensing to prevent or alleviate severe shortage of medicines. (69/99)
North America
USA
New donations study cites progress and problems
An industry-funded study on drug donations has found that the majority of donations fulfill the basic criteria for appropriate donations although, it admits 'a substantial proportion failed to do so'.
Researchers at Harvard University examined all donations made by US drug companies between 1994-97, which were shipped by two private organisations based in the US. In total, data were compiled on about 16,566 drugs donated and distributed to 129 countries around the world.
Included in its findings was the fact that about seventy percent of the donated drugs had a remaining shelf life of more than 500 days. Thirty percent were found to have less than a year left until they expired (six percent had only 100 days.) Approximately ten to forty-two per cent of the studied drugs were found to be irrelevant as they were not included on the country's essential drugs list or WHO's model list.
However, even some essential drugs caused problems as donations. For example, a Tanzanian drug producer told the study's researchers 'it may be well and good for you to provide acetaminophen (paracetamol), but that is one of the things I make-one of the few things'. Such donations can have a negative impact on local production.
In keeping with other studies on inappropriate donations, the study's authors highlighted the disposal dilemmas caused by unwanted drugs. In conclusion, it recommended that more effort must be made to match recipient requests with donated medicines and to make sure all donated drugs have an adequate shelflife remaining before they are sent. It also called for drug companies to make copies of their donations policies available to the public. At present, only four of the ten companies involved in the study have such a policy.
The study's main finding were published in the 16 August bulletin of the World Health Assembly. The article is available at the following address: http://www.who.int/bulletin/fulltext/issue8/bu0030.
The full study can be downloaded from: http://www.hsph.harvard.edu/faculty/reich/donations/
(Scrip No. 2465, August 20, 1999) (70/99)
Europe
The Netherlands
HAI Europe members plan for 2000
From 26-28 November, members of HAI Europe met in Soesterberg, The Netherlands to discuss their work during the past year and to make plans for joint activities in the year 2000. Lobbying the European Commission to support initiatives aimed at increasing access to essential drugs, campaigning for greater transparency about drug information, strategising on European input for the People's Health Assembly and promoting new media to disseminate HAI's work were the main focuses of the weekend's discussion.
The regional coordinators and network participants from HAI Africa, Asia and Latin America (AIS) also took part in the meeting. Their contributions provided insights into common problems surrounding rational drug use as well as current information about unique situations within particular regions. For more information about the meeting, contact the HAI Europe office at Jacob van Lennepkade 334T, 1053 NJ Amsterdam, The Netherlands. (71/99)
Contributed by Lisa Hayes, Press & Publications Officer, HAI-Europe.
Africa
New video on coping with drug donations and drug supply problems
The Pharmaceutical Programme of the World Council of Churches/Community Initiatives Support Services (WCC/CISS) has produced a training video on drug donations that tells its story from the perspective of drug donations recipients.
'Partners in Healing' is set in a fictionalised, Church-run hospital in Nairobi, Kenya, where physicians, administrators, church leaders, expatriates, pharmacists, nurses and consumers grapple with the many problems that arise from inappropriate drug donations. The perspectives, interests and roles of these drug donation recipients are clearly portrayed, always with a human touch and often with humour.
The 50-minute video also highlights other problems that affect quality drug supply, management and dispensing, including poor training, poor staff deployment, nepotism, lack of co-operation and poor communication. The video ends by suggesting some ways that these problems can be addressed, with special emphasis on the formation of Pharmacy and Therapeutics Committees in hospitals.
'Partners in Healing' will appeal to healthcare professionals and consumers alike. It gives important information about medicines in a simple and entertaining way that will engage viewers and prompt questions and discussions. Interested persons can receive a copy of the video and companion discussion guide from the Pharmaceutical Programme of WCC/CISS. The cost is US$10 per video to cover duplication and shipping. Payments in international money orders should be made to the Pharmaceutical Programme of WCC/CISS, PO Box 73860, Nairobi, Kenya; Tel: 254-2-444832/445020; Fax: 254-2-440306. (72/99)
Contributed by Beryl Leach, HAI Africa Co-ordinator.
Uganda
Ugandans call for direct role for consumers in NDP review and implementation
Participants in a national workshop on Networking for Promotion of Rational Drug Use (RDU) meeting in Kampala in November resolved that consumers should have a direct role in the current review of Uganda's National Drug Policy and the National Drug Authority (NDA).
The resolution was one of the results of the first national-level workshop held to promote networking among organisations and individuals working on RDU in the country. Participants also agreed to network on public awareness activities to promote RDU, focusing on drug supply and distribution problems and drug affordability and sensitising consumers on their rights and responsibilities concerning quality of medicines and health care. Core groups were formed to organise follow-up around these activities and identify additional interested organisations.
The 47 participants at the workshop represented a cross section of NGOs, health care providers, government institutions, including the Ministry of Health, National Drug Authority, Uganda Police and Uganda Revenue Authority, WHO, UNDP, and the media.
Presentations covered a range of RDU issues, such as problems of uncontrolled drug promotion, challenges regulators face in ensuring a safe drug supply, how to recognise counterfeit, expired or substandard drugs and how to network on RDU. NDA officials explained the national drug policy and implementation programme and how the NDA works. Discussions highlighted consumer concerns about safety, access and affordability. Participants stressed that consumer awareness and increased information about RDU are needed, as well as collective networking by government and civil society.
The workshop was organised by the Uganda Consumers' Protection Association (UCPA) with support from HAI Africa. A workshop report will be available from UCPA. Persons interested in receiving a copy should contact: UCPA, PO Box 23783, Kampala, Uganda, Tel: 256 41 234002/3; Fax: 256 41 234003. (73/99)
| Statement from participants in the National Workshop on Networking for Rational Drug Use in Uganda
1. Preamble: We, the participants to the National Workshop on Networking for Rational Drug Use in Uganda make this statement in reference to the ongoing National Drug Policy review process. It is an incontestable fact that the Policy strongly impacts on the consumers of health services both human and animal. Despite the importance of such a policy to consumers, they are not involved in the review process. Participants at the workshop on Networking for Promotion of Rational Drug Use (RDU) in Uganda held on Wednesday 10th November 1999 resolved to make representations to the Ministry of Health to: 1. Press for representation of consumers on the National Drug Policy review committee(s) and; 2. Avail information immediately about the policy review to interested stakeholders to enable them to make appropriate recommendations. Once done, this will have important implications on the review process and the resultant revised National Drug Policy and Authority Statute. Rational drug use can only be achieved through consumer involvement. (74/99) |
Women using radio to spread RDU information
The Uganda Media Women's Association (UMWA) has an innovative rural outreach project (ROP) using radio programming to stimulate discussions in rural women's groups on key issues, which they record and then make new radio programmes based on these discussions.
One of the key issues is rational drug use (RDU), in which UMWA became more involved after attending a HAI workshop in Nairobi in 1997. To sensitise participating women's groups, ROP workers have collaborated with local health extension workers.
Other regular topics include human rights, civic education, family planning, and information on sexually transmitted diseases, HIV and AIDS, girl's education and community projects.
The ROP involves 30 women journalists who visit and work with 30 rural women's groups in 10 districts around the country. Each journalist brings taped radio programmes on topics of the day for women to hear, discuss and relate their own personal experiences. Experts may be invited to join these workshops. The journalist tapes these discussions, which are collected from all of the 30 group discussions and edited into new radio programming featuring rural women's views and concerns.
The recorded discussions are not just used in radio programming. The ROP journalists use the information in developing stories for the print media.
The radio is used for other types of information sharing and community participation on key issues. Women have been trained to form listenership groups. In these groups, a woman takes a radio set and taping equipment home. Using a programme schedule for Radio Uganda as a guide, she then tapes programmes that match the interests expressed by group members. The added value of taping and sharing radio programmes is that women can start, stop and play them back as needed to discuss and learn what information is being presented.
Women are also encouraged to form drama groups and to stage plays for their communities as a way of conveying information and their concerns on issues.
Since 1997, the 30 ROP journalists have each made eight visits to rural groups, reaching approximately 60,000 women. The project has been such a success that men of all ages, youth and children have also been attracted to it. To meet the challenge of such success, the ROP has prioritised issue areas and increased training on rural mobilisation skills. Most recently, ROP workers received training in community-based methodologies for promoting RDU, which was sponsored by HAI Africa.
In addition to this grassroots work, UMWA members (representing both electronic and print media) at the national level have been sensitised on RDU issues, including a national one-day seminar held in 1997 for the Uganda media. Members produce regular programmes on RDU that are broadcast on Radio Uganda in eight Ugandan languages. (75/99)
Contributed by Rosette Mutambi, UMWA member and volunteer HAI Africa subregional co-ordinator.
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HAI Calendar Analytical Group Meeting for The People's Health Assembly Penang, Malaysia, 7-9 March 2000 4th Planning Meeting for the People's Health Assembly Penang, Malaysia, 10-13 March 2000 53rd World Health Assembly Geneva, Switzerland, 15-20 May 2000 16th Consumers International World Congress Durban, South Africa, 13-17 November 2000 |
We wish our readers
a fulfilling and joyful 2000.
Drug groups and UN offices join to develop malaria cures
Major drug companies have joined international agencies in an unusual approach to keep research in antimalarial drugs from ending because of the drugs' poor commercial potential.
Each year 300 to 500 million people become ill from malaria and a million die, mostly in Africa.
Although the market is vast, "people who need these drugs can't afford to pay," said Richard B. Sykes, chairman of Glaxo Wellcome, which plans to join the World Health Organization and the World Bank in a programme called the Medicines for Malaria Venture. The non-profit project, with a US$30 million yearly budget, plans to develop and register a new antimalaria drug every five years.
The sum budgeted is only a third of the estimated average US$500 million cost of discovering and marketing a new drug, but industry and public officials fear that without a new approach, no new antimalaria drugs will come in to market.
The joint venture "has been created because the increased costs of developing and registering pharmaceutical products, coupled with the prospects of inadequate commercial returns, have resulted in the withdrawal of the majority of research-based pharmaceutical companies," said the WHO Director General, Gro Harlem Brundtland.
In addition to WHO and the World Bank, the International Federation of Pharmaceutical Manufacturers Associations, the Rockefeller Foundation, the Global Forum for Health Research and Swiss and British government agencies are supporting the project. (The New York Times, November 18, 1999) (76/99)
Violating own ethics rules eight times by not disclosing drug company ties
The New England Journal of Medicine apparently violated its own ethics policy numerous times in the last three years, publishing articles by researchers with drug company ties and not disclosing the potential conflicts of interest, according to a report in the Los Angeles Times.
In an analysis of 36 'Drug Therapy' review articles since 1997, the Times identified eight articles by researchers with undisclosed financial links to drug companies that marketed treatments evaluated in the articles.
The interim editor in chief, Dr Marcia Angell, told the Times that the journal's practices were at odds with its guidelines on financial conflicts of interest. "We're going to try to do the right thing and bring our practice into conformity with our policy. There was a problem with the [Drug Therapy] series. There was a misinterpretation of exactly what our policy was."
Among the articles questioned in the 'Drug Therapy' series was a 1997 review of multiple sclerosis treatments. The lead author, Dr Richard A. Rudick of the Cleveland Clinic Foundation, received research funds, speaking fees and travel expenses from three drug companies whose treatments were discussed in the article.
The Journal's conflict of interest policy 'prohibits editorialists and authors of review articles from having any financial connection with a company that benefits from a drug or device discussed in the editorial or review article.' (Corporate Crime Reporter, US, Oct 25, 1999) (77/99)
India defers patent challenge decision
The Indian government has deferred a decision on whether to challenge a recently granted US patent for herbal antidiabetics based on mixtures of brinjal (aubergine), bitter gourd, jamun and a fourth plant known by a variety of names in India, including gur-mar.
The plants, particularly gur-mar, are widely used in Indian traditional medicine systems such as ayurveda for the treatment of diabetes, and this fact is documented in a number of texts which have been made available by government agencies on CD-ROM to ensure that information on India's biodiversity is easily accessible, The Hindu says.
An inter-ministerial meeting chaired by the Indian Secretary of the Department of Science and Technology decided that, although the antidiabetics patent was weak and could probably be successfully challenged, there was no point in doing so unless there were significant commercial implications for India. An assessment of the implications is to be carried out and a final decision made later.
India has frequently expressed concern over the potential conflict between intellectual property rights and the ownership of traditional/indigenous knowledge. It argues that TRIPs should be revised to reflect these concerns and to make it more compatible with the 1992 Convention on Biological diversity, which contained a requirement for the 'fair and equitable sharing of the benefits of all R & D arising from the use of a developing country's genetic resources'. (SCRIP No. 2472, UK, Sept 15, 99) (78/99)
HIV in pregnancy and early childhood
HIV infection is transmitted to 15-20 percent of babies born to HIV-infected women in European and American populations and 25-35 percent in Africa, India and Thailand. Transmission can occur during pregnancy, during the birth or through breastfeeding. The risk of transmission is increased if a woman has a higher viral load, more advanced clinical HIV disease or a lower CD4 cell count, and with prolonged rupture of membranes, premature birth or low birth weight, or events risking fetal exposure to maternal blood.
In an early randomised trial involving 409 pregnant women with HIV infection, zidovudine given to the mother orally starting at between 14 and 34 weeks of pregnancy and intravenously during delivery, and then orally to the neonate for 6 weeks, reduced vertical transmission rates at age 18 months by two-thirds compared to placebo (from 25.5 per cent to 8 per cent). Mild, self-limiting anaemia was the only complication seen in the zidovudine-treated neonates; the drug did not appear to cause unwanted effects in the long term (mean follow-up 4.2 years).
Further data supporting such case of zidovudine come from three recent placebo-controlled trials (a total of 1008 patients). In these studies, short courses of zidovudine (given orally to the mother: starting at between 36 to 38 weeks of pregnancy, continuing during delivery and, in one study, for a week after delivery) reduced the risk of transmission of HIV to the baby at 3-6 months by about 37-50 percent (from around 19-28 percent with placebo to 9-18 percent with zidovudine).
It is now standard practice to offer HIV-infected adults combination antiretroviral therapy, as this reduces morbidity and mortality compared to monotherapy. Withholding such an approach in pregnant woman with HIV is not justifiable, except perhaps in a woman whose CD4 cell count is high and viral load low.
In France, among children exposed to zidovudine, with or without lamivudine, there have been eight reported cases of mitochondrial dysfunction. This otherwise very rare, potentially fatal condition may present with neurological features (e.g. seizures, peripheral neuropathy) and other systemic effects (e.g. cardiomyopathy, bone marrow failure). The Committee on Safety of Medicines has decided that "there are insufficient data at present to establish a causal relationship between exposure to antiretroviral drugs and mitochondrial dysfunction in infants, but further investigation is needed". (Drug and Therapeutics Bulletin, Vol. 37, No. 9, Sept 99) (79/99)
Regional HIV / AIDS Statistics
Living with HIV /AIDS (000) Middle East the Caribbean Central Asia New Zealand Source: Statistics on AIDS - Adapted from AIDS Epidemic Update: December 1999; UNAIDS Population -
World Health Report 1999 (1997 Statistics) International Year of Older Persons Active Ageing Makes the Difference Myth: Older people have nothing to contribute and are an economic burden on society The widely held belief that older people having nothing to contribute also relies on the notion that only paid
occupations count. However, substantial contributions are made by older people in unpaid work including
agriculture, the informal sector and in voluntary roles. Many economies worldwide depend to a large extent on
these activities, but few of them are included in the assessment of national economic activities, leaving the
contribution made by older citizens often unnoticed and undervalued. Work in the so-called informal sector is
difficult to measure, as it is not part of the market economy and so often remains 'invisible'. In some countries, where up to 30 percent of the adult populations are infected with the AIDS virus; older
people will have to care for their adult children, after whose death they will have to raise their orphaned
grandchildren. Such care often remains 'invisible' because it has not been quantified and valued in national
accounts. There has been growing concern in many countries, particularly the industrialised, about the levels of state
expenditures for social protection and whether costs could be reduced by opening social protection to more
private sector competition. This worldwide debate has unfortunately placed the entire emphasis on the cost to
society of providing pensions and health care for older people rather than on the continuing and significant
economic contributions that older citizens make to society. The many decades of social security experience in Europe, North America, Australia, New Zealand and other
countries has proved that a collective approach to ensuring income security and health care for older persons
works. It is estimated that in many industrialised societies, more than half of the older population would fall into
the poverty trap if they did not have public pension benefits. The growing number of older people who expect health care and old age pensions should not be viewed as a
threat or a crisis. It is an opportunity, rather, to develop policies, young and old, in the future. Countries need to
develop strategies and frameworks for the coordination of health, social and economic reforms as well as to
raise the level of public understanding of the policy choices to be made. It is the need to examine and make
appropriate changes to health, social and economic policies, not the ageing of populations, that is the biggest
challenge facing societies today. (Ageing and Health, WHO, Geneva, 3/12/99) Inappropriate prescribing for the elderly Research published in the August 1999 Journal of the American Geriatrics Society found a high prevalence
of inappropriate drug prescribing in elderly patients enrolled in managed care programmes. Inappropriate prescribing was defined by the researchers as a patient receiving one of 43 mainly older drugs
or groups of drugs considered by nationally recognised experts as either ineffective or likely to place patients
at unnecessarily high risk of adverse drug reactions. In the study involving 2,193 patients, 871 (39.7%) had
received at least one inappropriate prescription, and 230 (10.4%) had two or more. The inappropriate use of benzodiazepines, drugs such as diazepam (Valium) and flurazepam (Dalmane), as
tranquillizers and sleeping pills is cause for great concern. These drugs are associated with cognitive
impairment, physical dependence, and decline in functional status when prescribed in the elderly, as well as
an increase in risk for both falls and hip fractures in older adults. In light of this it was very troubling that 166
(7.6%) of the 2,193 patients in the study were simultaneously being given more than one benzodiazepine.
There is no medical reason for prescribing two or more of these drugs at the same time. The results of this study are similar to other recent studies that have found that inappropriate drug
prescribing in older adults may be as frequent as 12-40% in nursing home residents and 14-23.5% in
community-dwelling elderly. This study's results also highlight a shortcoming of some managed care
organisations: failure to protect patients from inappropriate prescribing. (Worst Pills, Best Pills News, USA,
Vol. 5, No. 10, Oct. 1999)
Region
Adults & children
Population
Sub-Saharan
Africa
23.3 million
609 231 North Africa &
220 000
466 196 Asia and the
Pacific
6.5 million
3 113 894 Latin America
and
1.7 million
498 220 Europe and
880 000
870 128 North America
920 000
304 591 Australia &
12 000
22 316 TOTAL
33.532 million
5 884 576
Olle Hansson Award
To recognise the work of an individual from a developing country who best demonstrates the qualities of Olle Hansson in promoting the rational use of drugs.
'It is time to act! It is time to act for all of us who believe in human dignity and justice'.
- Olle Hansson
Olle Hansson
The Award is named in honour of Olle Hansson, a Swedish paediatric neurologist internationally known for his advocacy of SMON victims who were paralysed or blinded after using clioquinol, an antidiarrhoeal drug. Olle Hansson was a powerful campaigner against unethical promotion and marketing of drugs. In many ways, he represented the conscience of the medical profession. His influence was felt not only in Sweden and Japan, which have thousands of SMON victims, but also in Europe and developing countries. Olle Hansson will be remembered by all who campaign for the rational use of drugs.
Although he died of cancer on May 23, 1985, at the age of 49, he remains a continuing source of inspiration for public interest workers everywhere. May 23 is commemorated each year as 'Olle Hansson Day'.
The Award was first given in 1987. The recipients included Dr Mira Shiva of India and Dr Alfredo Bengzon of the Philippines.
Nominations
Nominations are invited for the Olle Hansson Award. This Award recognises the work of an individual from a developing country who has contributed the most to:
Nominations for the award, which can come from any individual or organisation, should contain:
Closing Date
Nominations will close on April 30, 2000.
Announcement
The recipient will be chosen by an international panel of judges, and named on Olle Hansson Day, May 23.
The Prize
The award, which is given annually, carries a prize of US$2,000 and a commemorative certificate.
Management
The Olle Hansson Award Fund is managed by Consumers International Regional Office for Asia and the Pacific. CI is a federation of consumer organisations dedicated to the protection and promotion of consumer interests worldwide through research, information and education activities. CI links the activities of some 247 consumer organisations in 111 countries and represents the consumer interest at international forums.
For further information
Please write to: the Health & Pharmaceuticals Programme, CI ROAP, PO Box 1045, 10830 Penang, Malaysia.
Tel: (60-4) 229 1396; Fax: (60-4) 228 6506.
Hidden Voices, True Malaysian Experiences of AIDS, edited by Marina Mahathir and Wan Zawawi Ibrahim, published by Malaysian AIDS Council 1999, RM$15/US$4, 159 pp.
Hidden Voices is a compilation of personal interviews, letters, poems and paintings by Malaysians infected with the virus, as well as their family members, friends and care givers. The Malaysian AIDS Council, through this publication, attempts to break the silence of people living with HIV/AIDS and help alter perceptions about this disease.
This publication brings out the reality of human suffering when drugs are unaffordable and livelihood of families remain at stake. The discrimination that exists in the healthcare system, as described in the story of Kartini, shows that much remain to be done, before people living with HIV/AIDS can be given the support they need.
This publication is a valuable source of information for all those working in the health and development field.
Available from: Malaysian AIDS Council, No 12, Jalan 13/48A, The Boulevard Shop Office, Off Jalan Sentul, 51000, Kuala Lumpur, Malaysia.
Practical and Ethical Dilemmas in the Clinical Testing of Microbicides: A report on a symposium, Ed. Lori Heise, et al. International Women's Health Coalition, NY, 1998, 89 pp.
At a time of dire predictions about the spread of HIV and sexually transmitted diseases (STDs), particularly among women in the developing world, this report discusses some of the complex and controversial issues surrounding the development of HIV prevention technologies. Its contents focus on fundamental issues regarding trial design, standards of care, community involvement and informed consent concerning this new area of research. The report focuses on women-controlled prevention of HIV and sexually transmitted diseases and contains recommendations for action and useful addresses for those working in this field.
To receive a copy of the publication contact: Virginia Kallianes, Population Council, Robert Ebert Program on Critical Issues in Reproductive Health, 1 Dag Hammarksjold Plaza, New York, NY, US, 10017, tel: (+1-212)239 0625, fax: (+1-212) 755 6052.
Guide to drug financing mechanisms, by Jérôme Dumoulin, et al. World Health Organization, Geneva. 1998, 55 pp, price: Sw. fr. 19, price in developing countries: Sw. fr. 13.30.
Drugs are a fact of life in health services the world over. Yet half the world's population lacks regular access to necessary drugs. Ensuring that safe and effective drugs are accessible to those who need them is a responsibility of governments, but many factors-economic, legal, and cultural and political-influence drug accessibility.
While touching on all of these issues, this book deals particularly with economic influences on the pharmaceutical sector. It looks in detail from an economic perspective at drug selection, procurement, distribution and prescribing. It describes different approaches to each of these steps, listing the benefits and disadvantages in differing situations.
In many places drug supply is a haphazard process that reduces the effectiveness of health services and does little to improve health yet costs a great deal. The authors urge those involved in a national drug supply system to examine the way drug supply is financed and organised and, in light of the policies and strategies described here, to make sure the system reflects the most rational approach for their situation.
Copies are available from: Distribution and Sales Office, WHO, 1211 Geneva 27, Switzerland. (69/99)
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Whose Choice? Consumers Take Action on Genetically Modified Foods 15 March 2000 is the theme for the World Consumer Rights Day 2000 reflecting increasing consumer concern on genetically engineered food products proliferating in the global marketplace. As an occasion geared at fostering consumer solidarity and common action, we urge consumer organisations and other parties working for consumer interests, to join Consumers International in undertaking year-long campaigns and related activities on genetic engineering on food and agriculture and its implications for our lives. To assist in your preparation for WCRD 2000, Consumers International is producing a Campaign Kit that will be available by January-February. The Kit will consist of the following three parts which are previewed: What Consumers Need to Know Facts and Questions on GMOs, Glossary of GM Terms, Evaluating the Risks, Ethical and Social Concerns, Who Controls the Technology, Consumer Rights and GMOs Consumer Clout Getting Heard - A Global Voice, CI at Codex Alimentarius, Consumer Activism against GMOs, Regional Round-Up, Country Reports Tools for Action Ten Steps to Building a Campaign, Research Guide, Getting the Word Out (ideas for letter writing including sample questions), Networking and Resources WCRD is not a single day affair, therefore we should begin planning now for effective consumer action on GMOs, spanning the entire year. For further information, please write to: Manny C. Calonzo, Food Project Officer, CI ROAP, 250-A Jalan Air Itam, 10460 Penang, Malaysia. Phone: 604 - 2291396. Fax: 604 - 2286506. E-Mail: roapfood@tm.net.my
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| Editors: Kiran Sagoo, Dr K Bala
Production: Lin Min Min |