Africa: Drug Availability, 07/05/00

Africa: Drug Availability, 07/05/00

Africa: Drug Availability Date distributed (ymd): 000705 Document reposted by APIC

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Region: Continent-Wide Issue Areas: +economy/development+ Summary Contents: This posting contains several documents focused on the need for affordable essential medicines for treatment of HIV/AIDS and other diseases.

The first document comes from South Africa's Treatment Action Campaign, the lead organization behind The Global March for Treatment Access on July 9, the first day of the AIDS Conference in Durban, South Africa. The march is supported by international groups such as Doctors without Borders (Medecins sans Frontiers), South African trade union leaders and others, with the cooperation of the conference organizers. The other documents are from a June conference in Nairobi on "Improving Access to Essential Medicines in East Africa."

A related posting today includes the latest updates from UNAIDS, released prior to the Durban AIDS Conference.

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Why we must struggle to provide treatment for people with HIV/AIDS By Mark Heywood

Full version posted on AF-AIDS (; Text below slightly condensed

Treatment Action Campaign (Article from Reconstruct, July 2nd 2000)

Contact: TAC: Promise Mthembu, 27-31-304367,; AIDS 2000: Karen Bennett, 27-31-3010400,; OR Zackie Achmat, 083-467-1152,; Fakzile Myeza, 27- 31-3010400,

On July 9th the first act to break the silence around HIV and AIDS at the International AIDS Conference will be a global march to demand access to affordable and effective treatments for people living with HIV or AIDS. The march will be led by the Archbishop of Cape Town, trade union leaders and people living with HIV/AIDS. Marchers will come from over 50 countries and include thousands from South Africa. The main messages of the march will be: Health is a human right! Health is essential to dignity! Stop profiteering from ill health! Make anti-HIV drugs affordable for all people who need them!

Most of these demands existed long before the emergence of the Human Immunodeficiency Virus (HIV). Indeed, the right to highest attainable standard of health is contained in the Universal Declaration of Human Rights. But the HIV/AIDS epidemic has brought the terrible effects of the privatization (piratisation?) of medicine and decades of neglect of public health to the fore. Millions of lives now depend upon whether the recognition that health is a human right is turned into an international plan of action. ...

For most people with HIV two major obstacles currently block the path to putting in place a plan that can rapidly (but carefully) expand access to treatments. These are: Pharmaceutical companies and their shareholders which set the price of essential drugs, and Governments who decide public policy on providing treatment for AIDS. Even though frequently at odds with each other they have become unholy gate-keepers for millions of lives. Tragically their actions amount to the same message: you have a right to health care but only if you can buy it! . To this we respond with the words of Anglo American Director Clem Sunter: we accept that the rich can buy a better house or car, but there's something unacceptable about being able to buy extra years of life.

Pharmaceutical companies

There are many non-medical causes of vulnerability to HIV infection and to AIDS. Poverty is the most pressing. However, once a person is infected with HIV access to medicine eventually becomes the bottom line for long-term survival. During the 1990s many breakthroughs were made in treatment for HIV and AIDS. However, responsibility for the emergence of a battery of anti-retrovirals (drugs that slow down the course of HIV infection) does not belong to drug companies alone. It belong to a range players, including, activists who put pressure on drug companies and governments to invest in research; committed scientists; people with HIV who were prepared to test the drugs. However, tragically the fruits of this common effort have landed in the hands of only one of the partners, powerful pharmaceutical companies, who now maliciously use their ownership of the end-result and their manufacturing capacity primarily to make huge profits from the drugs -- thereby making them unaffordable to 90% of people who need them. Faced with mounting criticism, these companies use arguments about intellectual property rights and the costs of research and development. This is a smokescreen. These arguments fall flat because the companies cannot support them with evidence on a drug-by-drug basis of the actual costs of research and development, manufacturing costs, costs of active ingredients etc. ...


All over the world governments seem to have given up the battle to make treatments widely available for AIDS -- before the first shots have even been fired. First world governments can quickly mobilize massive amounts of money to fight wars in Yugoslavia and Kuwait. But their expressions of concern about AIDS in Africa are backed up with trivial amounts of money. Bombs are easier to manufacture and distribute than drugs even if they cost more. On the other hand high drug costs, poor health infrastructure and competing demands for scare public health resources trip off the tongues of Africa's Health Ministers as convenient excuses for consigning millions of people to premature illness and death. Sad to say, South Africa' s experience offers a case in point. Earlier this month the Minister of Health, Dr Manto Tshabalala Msimang, launched South Africa's latest five-year AIDS plan. The plan promises to improve access to treatment for people with HIV and AIDS. However, this aspiration still lacks content, vision or a plan. ...

The Minister of Health has courageously lambasted the pharmaceutical companies for profiteering from AIDS. Together with her SADC counter-parts she has threatened to use legal measures such as compulsory licensing to reduce the price of essential drugs. But, on the other hand, she has refused to countenance the use of anti-retroviral drugs by people who depend on the public health service, saying that even if the drugs were affordable, South Africa's fragile and weak health infrastructure would not permit their use. This may be true but it can be changed. These mixed messages dash the hopes of people with HIV. But they also have other serious negative consequences. The national HIV prevention strategy aims to encourage more people to volunteer for HIV counseling and testing. But, put crudely, why go to the doctor, if you are told in advance that the medicine cupboard will be bare? ...

But above all, it amounts to a dereliction of the government's constitutional responsibility to promote equality and take legislative and other measures to improve access to health care . In this respect, the response to AIDS is curiously at odds with the approach adopted by the government to dealing with other social problems. For example, the government has not refused to start building houses until it can house everyone. It has not refused to renovate schools until it can renovate every school. In the same fashion, a plan to provide treatment for illnesses caused by HIV, could not possibly provide essential drugs to everyone immediately. But it could quantify and identify needs; it could use the AIDS crisis as a lever for demanding international funding to more rapidly improve basic health infrastructure; it could spend less on defence and more on health; it could insist that AIDS related opportunistic infections are consistently treated, whilst finances and facilities are put in place to begin providing more effective treatments; it could provide drugs that prevent mother-to-child HIV transmission.

These are the issues that the Global March will aim to bring to the fore. No supporter of the Treatment Action Campaign believes that they are easy to resolve. But they will not go away.

Mark Heywood, E-mail Treatment Action Campaign


Medecins Sans Frontieres / Health Action International



For information on the international campaign for access to essential medicines, see the following web sites of MSF ( and HAI (,

Regional leaders call for action

Nairobi, June 16, 2000 - The international movement to increase access to life-saving medicines gained momentum today, as government and civil representatives from Kenya, Uganda, Tanzania, Ethiopia, and 17 other countries met to devise a regional strategy at a conference in Nairobi. The conference, "Improving Access to Essential Medicines in East Africa - Patents and Prices in a Global Economy," was organized by Medecins Sans Frontieres/Doctors Without Borders (MSF) and Health Action International (HAI)

"The data presented today confirm our suspicion that Kenyan drug prices are not only equal to, but actually higher than European prices," said Kirsten Myhr of Health Action International, who presented a pricing study at the conference.* "The figures show that the entire region is suffering from reverse equity - the poor are paying more than the rich."

Among the many examples cited in the new study is that of the potent antibiotic, ciprofloxacin, which was found to be twice as expensive in Uganda as in Norway. Similarly, an earlier study comparing retail prices of drugs showed the same disturbing pattern: ten out of 13 commonly used drugs are more expensive in Tanzania than in Canada. The huge disparity in average income between the two countries also means that a Tanzanian would have to work 215 days to buy these 13 drugs, while a Canadian would only have to work 8 days.

Another telling example is fluconazole, a treatment for AIDS-related meningitis. In Thailand, where generic competition has lowered prices, fluconazole costs only USD$0.30. However, this same drug costs USD$18.00 in Kenya, where it is patent protected. Dr Christopher Ouma, AIDS project coordinator for Medecins Sans Frontieres (MSF) in Kenya said: "I am tired of not being able to treat patients because the medicines are too expensive. Africans should not be dying because of inability to pay when effective medicines can be available at affordable prices. This is already the case in countries such as Thailand, India, and Brazil."

The causes of high prices of medicines in East Africa include strong patent protection, high tariffs, taxes, and a lack of generic competition. The issues of high taxes and tariffs and the stimulation of generic competition need to be addressed directly by national governments. Much of the discussion amongst conference delegates focused on strategies to enact legal safeguards to remedy abuses by drug companies. Within existing international trade rules, such safeguards include parallel importing (the right to shop around for the best prices of branded products) and compulsory licensing (granting limited production rights to generic producers).

"Within existing international trade regulations, Kenyans have the power to ensure that medicines are affordable and accessible," said Professor Carlos Correa, an intellectual property expert. "But, these essential legal safeguards have still not been built into the Kenyan Industrial Property Bill." This bill is designed to bring Kenya into compliance with WTO rules and will be considered by parliament in the coming weeks.

Dr. Amukowa Anangwe, Kenyan Minister for Medical Services, underlined the need to balance public health needs with private profit: "It is essential to ensure that the right to issue compulsory licenses and to allow parallel importing are included in our national legislation," he said.

Another report presented at the meeting, 'Patent protection and medicines in Kenya and Uganda,'* calls on governments to ensure these safeguards and to include the Ministry of Health and health professionals when negotiating and adopting trade agreements.

* 'Pharmaceutical Pricing: law of the jungle' by Kirsten Myhr, for Health Action International - June 2000.

* 'Patent protection of medicines in Kenya and Uganda' by Pascale Boulet, for Medecins Sans Frontieres, June 2000.


Opening speech by Minister for Medical Services, Hon. Dr Amukowa Anangwe, EGH, MP (excerpts)

Mr Chairman, disease knows no frontiers. It is destroying individuals, their families, our countries' economies and ultimately Africa's ability to fight poverty and progress. Despite the development of new treatments our people are dying from curable and treatable diseases. People are dying from curable and treatable diseases.

In the poorest areas of East Africa, up to half of the population is without access to basic essential medicines to treat life threatening and chronic diseases.

Africa is facing a daunting human and medical crisis. Every year, Malaria, Tuberculosis, and HIV kill approximately 5 million people. We are gathered here to focus on one element of this crisis How to save lives by improving access to essential medicines. It is indeed very encouraging to see people from so many countries coming together to help improve the health of our peoples.

To begin to address the challenge of improving access we first need 'commitment' from all those involved with access to drugs; governments in both, poor and wealthy countries, international organisations, the pharmaceutical industry and civil society. We are counting on this conference to help to build this commitment as well as to develop new strategies.

Ladies and Gentlemen, we are at the fore-front of the battle against infectious and 'killer' diseases. The United Nations estimates that HIV/AIDS affects 24 million people in Africa out of 34 million worldwide. Some 2.2 million people died of AIDS in 1999. Life expectancy in most affected areas has declined by almost 20% and more than half of those affected are young people aged between 16 and 24 years of age.

Ladies and Gentlemen, it is a basic human right to be healthy. Access to essential drugs plays a critical role in fulfilling this right. This is a priority for Kenya's National Drugs Policy which aims to ensure that safe and effective drugs reach all segments of the population at affordable prices. At the same time we acknowledge that there is a need to facilitate rational use of drugs, through sound prescribing, dispensing and use of medicines.

Quality assurance of drugs is another challenge. It is for this reason the National Quality Control Laboratory was established in 1996 to ensure quality control. Kenya has a dynamic local pharmaceutical industry with the potential to produce quality generic drugs. This creates interesting opportunities and we aim to encourage self sufficiency through local manufacturing of drugs for domestic use and for export. In the last five years we have made significant progress, but we still have a long way to go to improve access to medicines.

During the 53rd, World Health Assembly, which was held last month in Geneva, Switzerland, Dr. Gro Harlem Brundtland, the WHO director-general, expressed concern over inaccessibility of important drugs to millions of people who need them most: 'they might as well be on another planet'.

The Kenyan government agrees with Dr. Brundtland. We are living in an era, which is marked by the most spectacular scientific innovations benefiting people's health. In this era, it is unacceptable that millions of people are denied access to medicines, which could save their lives. It is time to take action, to balance public health and private and commercial interests. Medicines should not be regarded as any other product. We should ensure that public health is made a priority when translating international trade treaties into national law.

At this year's World Health Assembly, the African Ministers of Health issued a statement on access to HIV/AIDS drugs. We welcomed the recent UN and private industry proposal to lower the prices of anti-retroviral medicines for people living with AIDS. But, the ministers also called for an approach, which will ensure that any such reductions will enable people to have access to drugs on a sustainable basis.

Mr. Chairman, Ladies and Gentlemen, the World Trade Organisation agreement on trade-related aspects of intellectual property rights
the so called TRIPS agreement is the most important international agreement on patents, copyrights and trademarks. However, TRIPS increases patent protection and patents can push the prices of new medicines up. As the patent-holder has a monopoly, he can ask whatever price he wants. The rich can afford, the poor cannot.

People with AIDS related meningitis in Kenya, for instance, are dying because the price of the only effective treatment is beyond their means. Patent protection keeps the price high treatment for one day costs 18 US dollars in Kenya, compared to 0.30 US cents per day in Thailand. In Thailand, the medicine is not patent protected, and is produced locally.

For the average Kenyan earning 300 US dollars per year, US 18 dollars per day treatment is absolutely out of reach.

Patents reward years of research and development. They are at the same time supposed to benefit the public. The TRIPS agreement helps create a balance by providing for exceptions to exclusive rights to protect public health. It is important that governments make use of these exceptions, by including them in their national laws.

A first exception is compulsory licensing which enables governments to issue licenses to national producers without the permission of the patent-holder. This can lead to a seventy-five per cent drop in prices.

Secondly - Parallel importing allows buyers to go in search of the cheapest supplier of patented medicines. So that if for example, the foreign company that holds the patent is charging less in South Africa than Kenya, we could buy the same drug at the lower price from South Africa.

In principle, patents are supposed to encourage research and development. But in the global drug industry there is a bias toward diseases in rich countries such as the lifestyle disease of being overweight. Research is expanding to help people lose weight, but the diseases that are killing our people are forgotten.

Take the example of malaria, which claimed more than one million lives last year worldwide. Although malaria accounts for 3% of illness in the world, only 0.1 % of the world's research funds were devoted to it.

Malaria is a major public health concern in Kenya. Every day, 72 children under the age of five die of the disease. And malaria is increasingly resistant to existing drugs. However, because of the lack of research, new treatments are extremely sparse. There is evidently, too little profit to be gained from the 300 million poor people who have fallen victim to this disease.

Now, lets look at the big picture in terms of TRIPS. All members of the WTO are obligated to adapt their national laws to the TRIPS Agreement. Developing countries like Kenya had until January 2000. Least developed countries like Uganda and Tanzania have until 20006. If countries do not become TRIPS compliant by those deadlines, they could face trade sanctions.

Kenya applied for an extension to the January 1, 2000 deadline for TRIPS implementation, but this was refused. Last May, the revised Kenyan Industrial Property Bill, 2000, regulating intellectual property rights in Kenya, has been published. The Bill, will soon go to parliament to be discussed and adopted. This will make Kenya the first country in East Africa to become TRIPS compliant.

As the process begins, the Ministry is committed to balance patent protections with public health needs, to ensure access to medicines. For this reason, it is essential to ensure that the right to issue compulsory licenses, and to allow parallel importing are included into our national legislation. We hope that our legislation may then inspire other legislators in the region. ...


Message-Id: <> From: "APIC" <> Date: Wed, 5 Jul 2000 12:40:10 -0500 Subject: Africa: Drug Availability

Editor: Ali B. Ali-Dinar

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