E-drug: AIDS drug price reductions for Senegal (cont)
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WARNING: LONG MESSAGE
Carmen....
I agree with your points. It would be very important to know exact prices
and what conditions the pharmaceutical companies have put on these price
reductions. But I see something that is immediate availability is
very good as lives can begin to be saved right away.
It seems to take time to get a generic line started and assure quality
control, etc. I am in favor of whichever can come sooner. I am trying to
advocate for immediate price reductions in Central America by the major
companies, but again with total transparency in all negotiations.
It might be important to negotiate simultaneously with generic producers and
with the laboratories to see who can really come up with the best deal in
the shortest amount of time.
I am including below my discussion of factors relating to treatment access
in Central America.
Richard Stern
Richard Stern, Ph.D.
Director
The Agua Buena Human Rights Association
Tel/Fax 506-234-2411
San Jos� Costa Rica
A Discussion About Factors Related to Treatment Access for People Living
with AIDS in Central Ameria,
Richard Stern
There are a number of issues I would like to raise in this article. First
and foremost, I continue to believe that most AIDS deaths in Central
America are now unnecessary and that a well organized effort on the part of
international Agencies such as UNAIDS and PAHO could prevent many deaths.
There are four main factors that I will discuss to support this point of
view.
1) The numbers of People Living with AIDS in Central Americans who are
urgently in need of medical treatment are relatively few, compared with
other parts of the world. Even though exact numbers are difficult to
obtain, we are talking about a total of perhaps 10,000 people in all of the
Central American peninsula (with fifty percent of these in Honduras) who
urgently need anti-retroviral treatment. At any one time a significant
number of these same 10,000 may require treatment for opportunistic
infections since they don't have access to ARV's. In Nicaragua and Belize
combined, there are less than 1000 people in the advanced stages of AIDS. El
Salvador and Guatemala, possibly have a combined total of 4000 more at this
stage of disease progression. Panama and Costa Rica are already providing
ARV therapy to almost all who are in advanced stages, thus I arrived at the
very rough estimate of 10,000.
2) There is a very well established infrastructure of medical clinics and
qualified physicians in many Central American countries. Each of the
countries I have referred to, has sufficient trained infectious disease
specialists, most already working in the public health sector, to be able to
attend to the needs of the AIDS affected populations. Most of these
physicians already provide quality level treatment to affluent people living
with AIDS through their own private practices. The infrastructure problem
that exists in much more economically devastated parts of the world, does
not exist in Central America. The relative ease with which the public
health systems in Costa Rica and Panama have managed to adapt to the need to
providing quality level care to the patients that they service supports this
argument as well.
On my recent trip to Nicaragua which is the poorest Central American
country, I was able to identify five physicians throughout the country who
are capable of supervising anti-retroviral therapy. This is more than enough
to take care of the 250 Nicaraguans who have been identified as being in the
advanced stage of AIDS. One physician already provides care in Managua to
over 50 patients, at his own clinic, and without charging fees, but he has
practically no medications. In Honduras, I have met two dedicated
physicians, one in Tegucigalpa and one in San Pedro Sula who are each
providing care to over 200 People with AIDS.
They do what they can to "scratch and claw" a few of the basic medications
for the patients,
There is no doubt that if adequate medications were provided it would be
possible to provide good medical service to almost all of those People with
AIDS who need it in these countries.
3) Throughout Central America, there exists an increasingly strong and
diverse network of NGO's which are directly led by People Living with AIDS.
In Costa Rica and Panama, where anti-retroviral medications are being given,
these groups have had great success in supporting efforts by the Public
Health sector to assure adherence to treatment regimes. Discrimination and
prejudice continue but groups of People Living with AIDS can play a pivotal
role in confronting and overcoming obstacles which they face in their
respective cultures.
There are now strong well organized groups also functioning in Nicaragua, El
Salvador, Honduras, and Guatemala and these groups have a lot to offer in
supporting public health efforts for access to medications. These groups
must continue to be strengthened and as yet they do not have contact with
all people with AIDS, but at least they exist and there a few very strong
leaders among them, who have come out publicly as living with HIV+, such as
Odir Miranda in El Salvador, Erickson Chiclayo in Guatemala, Guillermo
Murillo in Costa Rica, Orlando Quintero in Panama, and Flor Alvarado in
Nicaragua. These groups and individuals could be supported and mobilized so
that then can assist in the development of an emergency plan for increasing
access to medications.
4) Most importantly, almost none of the anti-retroviral medications are
patented in Central America. My understanding of why this occurred is that
pharmaceutical companies, because of the small number of patients affected
by the disease in this part of the world, have never made it a priority to
patent their products because of red tape involved in this process. Or, in
some cases intellectual property laws have not even existed. To the best
of my knowledge there would no legal impediments to the generic production
and/or importation of the following medications: AZT(Zidovudina) , D4T
(Estavudine), ddI (Videx), Crixivan (Indinavir) 3TC (Lamivudine). In
fact, Costa Rica is already in process of purchasing generic versions of
AZT, D4T, ddI, and 3TC, in some case at prices that are approximately 25
percent of what the original Laboratories have been charging.
Brazil is now offering its triple therapy cocktail at roughly $300 per
month per patient using generics and preferential pricing. India is also
right around $200 per month according to what I have just been told by a
Harvard health economist. However, these are countries with populations of
PWA's much greater than that of all of Central America combined. What is
happening is that Central American PWA's have in a fashion been punished
because the relatively small numbers and small populations of the countries
have not provided sufficient motivation to their governments to seek
solutions. This also is discrimination. A person in Nicaragua or Belize who
has AIDS should not be denied be treatment simply because they are few in
number.
Of course the process of arranging for generic production and/or parallel
importing involves a lot of information gathering, planning, facilitation
between governments and potential suppliers. This requires perhaps the full
time attention of someone from UNAIDS and/or other international
organizations But UNAIDS should provide funds for one or two additional
employees who are qualified to gather needed information and meet with
government, private and pharmaceutical company segments in order to make
this idea more than just a theoretical possibility. Another important step
would be to make contact with generic producers in other countries who might
be willing to export to Central America. In Costa Rica, three laboratories,
Gutis, Stein and Apotex, have expressed their willingness to produce quality
level generics at affordable prices, and it is also possible that any of
these companies could export these medications to other Central American
nations. UNAIDS might consider collaboration with Doctors Medicos Sin
Fronteras in taking steps to insure the quality of any generic medications
that enter the market.
Referring to the major pharmaceutical companies (Bristol Mayer, Roche,
Merck, and Glaxo) who already sell their products in Central America, I
would like to mention the following. Many of the factors I have referred
to above would provide a case for why Central America might be a good place
to begin the significant price reductions talked about by the major
pharmaceutical companies for Africa.
Substantial delays are occurring in implementing this in Africa and it may
be years before it can be accomplished. We hear much about enormous
numbers of patients, lack of trained physicians, and lack of
infrastructure as
factors preventing the implementation of this program. (I would like to
mention that I do not have personal knowledge of Africa. Everyone said the
same thing about Costa Rica four years ago, yet once the medications were
here, the system adapted rapidly, the PWAs cooperated etc. Sometimes
I think these concerns are also excuses). No one region of the
world is more
deserving than any other region, but Central America, although it has less
than 1% of the number of people living with AIDS that Africa does, would
offer an immediate opportunity to implement these price reductions as a sort
of pilot project, and study the results, with the information obtained
hopefully benefiting African nations as well. We know that these
pharmaceutical companies have conditions attached to the price reductions
they are offering and the impact of these conditions must be studied
closely. However, if they are really offering 85% discounts as has been
stated, I see no reason not to at least begin to do this in Central America.
In summary I believe that UNAIDS, with the resources that it has, could
potentially save many lives by organizing a sustained effort in Central
America to support a plan involving governments, NGO's, physicians, and
People Living with AIDS in obtaining the medications that they need for good
medical attention. The real truth about the issue of access to medications
in Central America is not that the medications are too expensive, but that
there has been an almost complete lack of motivation on the part of
governments to seek feasible solutions that would help People with AIDS
receive what they need. But governments will act much quicker if there was
tangible technical support from UNAIDS, as well as PAHO.
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