E-DRUG: Press Review Botswana FDC meeting (2)
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[a good comment from the field! We welcome active debate on E-drug! WB]
This situation is now generating into a political war between proponents of
multisource product manufacturers and those of innovator product
manufacturers.
The real issues are that all these donor funded projects should follow
respective government policies and procedures with regard to essential drugs
and procurement procedures. I believe most governments have their own
essential drug lists, and some possibly have HIV managment guidelines.
Additionally, they must have drug selection and procurment policies in
place. International procurement policies advocate for competitive bidding
and in such a scenario, the best quality product at the lowest posible cost
is what is purchased-It could actually end up being the innovator brand if
it is cost effective
The fight should therefore be for PEPFAR to allow the recepients to
determine what is best for them using their laid down policies and
procedures. In my view and experience, a big chunk of these drugs will end
up coming from the innovator brands who have heeded the access initiative
and lowered their prices. It is not a matter of saying the end justifies the
means, but that unstainable precedents are not set. The only way to keep
prices low is to continuously encourage competition from the multisource
manufacturers. It is therefore against free trade rules to declare upfront
that recipients should only purchased particular products from donor funds.
While I appreciate very much the efforts MSF are going to with this fight, I
would wish that they refocus from "generics" and look at whether PEPFAR is
following respective government policies and procedures on procurement and
free trade. It is not always the case that multisource products (generics)
are cheaper especially for ARVs.
Regarding FDCs, what we in the field are looking for are clincial outcome
results. We know from pharmacokinetics that it is very difficult to
formulate more than two drugs into one--Although FDCs apparently improve
adherence (Where is the evidence?), are there any
pharmaceutical/bioavailability issues of concern. Please make statements
from a point of clinical evidence (Not surrogate ones like uptake of the
programme).
Right now, a number of developing countries are already juggling up to five
donor funded ARV projects in one institution-each with its own fee and
acountability structure. The health professionals are now spending a lot of
valuable time filling different forms for different programmes and less time
with patients. Apart from that, committees have been set to determine which
patients are eligible for treatment first then which "programme" is
appropriate for them. When these highly qualifed health profesionals spend
hours in "eligibility meetings" and send social workers around to verify the
financial status of potential patients (a very costly affair indeed), the
patients have found ways of outsmarting them!
Dr Atieno Ojoo
Nairobi, Kenya
atisojoo@yahoo.co.uk
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