Two things for World AIDS day
There is so much going on just now in the run up to World AIDS day. I just want draw your attention to two things. The first is a Lancet editorial out today in response to the revised UN figures on HIV which have cause a bit of an international stir to put it mildly. I have copied the editorial below but you can also access it on the Lancet website The second is an Oxfam briefing paper (and just to be up front about things- I used to work for Oxfam) on the pharmaceutical industry published this week. (Activities by the pharmaceutical industry are widely believed to limit access to essential medicines including second line treatment for HIV/AIDS) The report, ‘Investing for Life’, looks at the world’s top 12 pharmaceutical companies (Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, Johnson & Johnson, Merck, Novartis, Pfizer, Roche, Sanofi-Aventis and Wyeth) including their drug pricing policies, their record in developing medicines relevant to poorer countries and their stance on protecting intellectual property rights. I have copied below the main findings of the report and if you want a copy for yourself, please email gginn@oxfam.org.uk - Thanks! Rhona
Lancet editorial: Global HIV/AIDS estimates-looking beyond the numbers
Ahead of World AIDS Day on Dec 1, UNAIDS released their annual global HIV/AIDS estimates for 2007. The new revised data show that the global HIV prevalence has levelled off and that the number of new infections has fallen from 40 million estimated last year to 33·2 million, in 2007. However, with 6800 new infections and 2500 deaths every day, AIDS is still a leading killer globally and remains one of the primary causes of death in Africa, especially in sub-Saharan Africa.
The downward revision is largely due to improved methodology, an increase in sentinel surveillance sites and population-based household surveys, and changes in key epidemiological assumptions used to calculate the estimates. Revised figures for India account for much of the decrease, followed by several sub-Saharan African countries, including Nigeria, Mozambique, Zimbabwe, Kenya, and Angola. For the first time the report also documents the progress being made by prevention and treatment programmes as seen by a decline in new infections in some countries and a reduction of mortality and improvement of life expectancy in others.
However, critics have speculated that figures are always overstated to gain funds and political support. Stephen Lewis-the ex-UN special envoy for HIV/AIDS in Africa-denounced the UN as “sloppy” and “irresponsible” for undermining the public’s confidence in the reliability of the numbers. But these allegations show a lack of understanding of the complexities regarding data collection and analysis. Like all global estimates there are always levels of uncertainty especially in this epidemic where there is extreme heterogeneity. Focusing on the numbers alone also misses the point. The global trends described in this report are equally important. In the future it is likely that there will be two different kinds of epidemics-a generalised one centred in sub-Saharan Africa and a concentrated one in specific high-risk groups worldwide. Responding to these different epidemics correctly will be key.
In a battle with a disease that has had too few signs of hope, this report signals some good news. Being more certain of the numbers should help policymakers, civil society, and governments to plan, mobilise resources, and implement activities more effectively to overcome HIV. These new figures should also strengthen commitment and action in the face of a pandemic that can be defeated. The Lancet
The Oxfam Report Investing for Life
The report reveals shortcomings where the industry:
- Has failed to implement a systematic and transparent tiered-pricing policy, where prices for all essential medicines are set according to people’s ability to pay
- Continues largely to neglect research and development into diseases that predominantly affect poor people in developing countries
- Continues to be inflexible in protecting intellectual property, including challenging poor countries in court to stop them using legal public health safeguards;
- Continues to rely too heavily on donations to get affordable medicines to people, even though this is unsustainable and sometimes counter-productive.
Oxfam says the industry is failing to ensure universal access to medicines because it refuses to put the issue at the heart of its business model. As a result, it is failing to capture the full potential of emerging markets touted as the “new frontier” for its business success. According to a major consultancy firm, a loss of faith in the industry on the part of its investors has so far cost pharmaceutical’s shareholders $1 trillion dollars.
Drug pricing
Oxfam notes that some companies are offering differentiated prices but this is extremely limited and mainly for high-profile diseases such as HIV and AIDS. However, these offers are not systematic worldwide and are often still priced well above the means of people living in developing countries. Oxfam says that drug companies often adapt pricing in developing countries solely as a reflection of the publicity that surrounds the disease or the country. For instance, Abbott Laboratories was selling Kaletra - a second line anti-retroviral medicine - at $2,200 per patient per year in low middle-income countries like Guatemala, where a person’s average wage is $2,400 a year. Only until Thailand, in response to the needs of poor HIV patients, issued a compulsory license to reduce the price of Kaletra to $1,000, did Abbott reduce the price of Kaletra worldwide to $1,000 per patient per year. Also in Thailand, French giant Sanofi-Aventis offered its cardiovascular disease medicine Plavix at a price that was 60 times more expensive than Emcure, the Indian generic version. In March 2007, it responded to Thailand’s use of compulsory licensing by offering a 70% cut.
Research and development
Oxfam’s report says that companies are still not investing enough into researching and developing medicines for diseases that predominantly affect poor people in developing countries. Between 1999 and 2004, there were only three new innovative drugs targeted at diseases affecting the developing world out of 163 medicines brought to the market.
Intellectual property issues
On the industry’s approach to intellectual property rights, where high levels of intellectual property protection have not resulted in new cures for diseases that affect poor people. Despite this, the report notes that the industry continues to insist that the global intellectual property regime does not prevent poor people from accessing affordable medicines. Oxfam says not only is the industry’s view narrow-minded and wrong, but that the evidence is overwhelming that generic competition is the most effective and proven method to reduce drug prices. In recent years companies have mounted legal challenges or exerted direct pressure to protect their patents against the legitimate use of safeguards in Thailand, Brazil and India.
Conclusion
The report concludes by arguing that companies will need to revamp their approaches on pricing structures, R&D investment and patent policies in order to serve these markets and make its medicines more accessible to poor people. Companies should adapt to the realities of developing country markets because up to 80 per cent of people in developing countries are vulnerable to falling or staying below the poverty line if they have to bear the cost of expensive medicines, particularly where treatment is long-term. (Note from Rhona: again, please email gginn@oxfam.org.uk if you want a full copy of the report-it is 56 pages)
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