Campaign for Fighting Diseases Blog

Compulsory licenses for ARVs not as straightforward as some suggest

It has recently been announced that Canada will finally begin exporting generic drugs under a compulsory license to Rwanda. The drug in question is an ARV called Apo-TriAvir, made by Apotex of Canada.

Five years after the compulsory license was first signed, the first pill might now start rolling off the production line.

 

The minister of health in Rwanda, in justifying the award to Canada, said "[we] could have imported generics from elsewhere [but] we wanted to bring Apotex in as a quality generic manufacturer."

 

Neither Apotex nor Rwanda mention that this has been made possible by the Government of Canada's $100 million subsidy.

What all this goes to show is that the production of high quality generic medicines that meet acceptable regulatory standards is a costly and time-consuming business.  As Apotex found out the hard way, it's difficult to turn a profit even with a generous government subsidy and guaranteed buyer.

Why, then, do health activists continually push compulsory licenses as the answer to the health problems of the developing world?  Surely it's nothing to do with ideology?

Bringing substandard anti-malarials to the world's attention

On the back of last week's PLoS study which revealed the horrifying extent to which sub-standard anti-malarial drugs are being manufactured in Africa, friends of the CFD have had a number of articles in newspapers around the world discussing the issue. 

In particular, these articles flag up the concern that the procurement policies of multilateral funding bodies such as the Global Fund actively encourage the production of these drugs.

In today's Sowetan, Africa Fighting Malaria's Jasson Urbach discusses steps that could be taken to address the problem, including removing market-distorting taxes and tariffs on imported medicines.

In Canada's Globe and Mail, Roger Bate calls on the Global Fund to change its policies to stop these drugs being purchased in Africa.

And Jeremiah Norris, in India's Daily Pioneer, suggests that the WHO's anti-counterfeiting IMPACT initiative should be widened to include substandard medicines, and that it should commission studies to determine the true rates of drug resistance in developing countries.

As yet, we only have a small idea of the extent to which substandard drugs have penetrated the African supply chain. Much more research needs to be done. But the auguries are not good.

Political Bias in WHO Health System Rankings

A new report from the CFD reveals the WHO health system rankings to be statistically dubious and biased towards taxpayer-funded systems.

Influential among policy-makers, the rankings are also widely cited in media reports as impartial measures of health system performance. Michael Moore predictably cited the US system’s low rank in his film SiCKO. But the USA ranks lower than Morocco and Costa Rica, which is clearly absurd!

Our analysis shows that the rankings do not measure health system performance – over half (62.5%) of their weighting concerns equality rather than quality of service.

A further 25% concerns life expectancy – which is affected by factors unrelated to the healthcare system such as tobacco use and other drug use, diet and even homicide rates.

In the only real measure of health system performance – ‘Responsiveness’ – the US comes out number 1 in the world.

Incredibly the rankings ignore commonly-used measures of healthcare systems such as disease-specific mortality and survival rates. They do, however, give a quarter of their weight to ‘Financial Fairness’, a measure which inherently favours taxpayer-funded systems.

Last month there was a health systems conference in Africa. This week Commonwealth health ministers meet in Geneva. Next month there is a European ministerial conference on health systems.

Ministers and policy-makers at such events should be aware of the WHO rankings’ flaws, and look elsewhere for fairer international comparisons of healthcare systems.

Click here for the report.

Substandard malaria drugs rife in Africa

Shocking new statistics reveal that 35% of antimalarial drugs in Africa fail basic quality tests.

The report in PLoS One, a scientific and medical research peer-reviewed journal, is based on a recent study of drugs purchased in six major African cities.

The survey found substandard drugs to be rife – the drugs accelerate parasite resistance and thus threaten to cause a major health crisis for the 700 million people at risk from malaria.

The Global Fund itself may be exacerbating the problem by a policy under which poor countries can purchase untested drugs.

A decentralized network of drug testing facilities is urgently required and could be funded by a fraction of the current budget for fighting malaria.