Special Guest Editor for Medical Progress Today:
This issue of Medical Progress Today is devoted to the global health and development issues raised by the G8 meeting in Gleneagles, Scotland, and is edited by Philip Stevens. Mr. Stevens is Director of Health Projects at the International Policy Network, a London-based development think tank, and also co-ordinator of the Campaign for Fighting Diseases. He has held research positions at the Adam Smith Institute and Reform, both influential Westminster think tanks. He holds degrees from the London School of Economics and Durham University, England.
Africa Tackles Graft, With Billions in Aid in Play
The New York Times, 7-6-05
Decades of sizable grants and loans have had little influence on poverty and disease in Africa, as they are often subverted by the absence of accountability measures and corrupt local officials. For instance, Nigeria's World Bank loans of as much as $1 billion a year, and $3.5 billion in direct aid over the last 20 years have not significantly improved Nigeria’s infrastructure—to say nothing of the country’s own $300 billion in oil and gas profits over roughly the same period. Foreign aid largely ends up in useless pet projects or in private bank accounts.
Reform will have to come from the bottom up in Africa—and there are already a few encouraging signs. Nigeria's National Agency for Food and Drug Administration, headed by Dora Nkem Akunyili, is one such beacon:
Four years ago, perhaps four-fifths of [Akunyili's] agency's regulators were corrupt, she said in a recent interview. Even worse, two in three drugs sold publicly were either unregistered or unsafe for consumers…. Every few weeks, Mrs. Akunyili's agency made a show of burning heaps of fake drugs collected at airports, seaports, illegal factories and distributing houses. A spot check last year showed the impact: only one in eight drugs was unregistered. Major pharmaceutical companies have now returned to Nigeria, and other African nations have agreed to lift their bans on Nigeria's drugs.
Ultimately, only reliable, corruption-free state institutions and the rule of law will attract the capital investments that can lift moribund Africa out of poverty.
In Malaysia, a battle erupts in AIDS fight
International Herald Tribune, 7-4-05
The Tribune reports on how differing cultural values can lead to problems in trying to contain HIV/AIDS. In Malaysia, Islamic groups are opposed to the distribution of condoms and needles as part of a government attempt to come to grips with the country’s AIDS problems, because they feel this will encourage immoral behavior.
“‘When you give free condoms and free needles, you give drug abusers the motivation to engage in risky behavior,’ said Mahfoz Omar, a leader of the Islamic Party of Malaysia, an opposition political party.
The Malaysian government should stick to its guns. Prevention strategies have paid wonderful dividends in Uganda and Senegal, even though these countries had numerous cultural hurdles to overcome.
Brazil aims for cheaper AIDS drugs
There is a lot of coverage this week about the Brazilian government’s decision to take the first steps towards breaking the patents of several anti-retroviral (ARV) AIDS drugs owned by US companies, in order to license cheaper local production and thereby save costs.
Many activists and NGOs welcomed the move, hoping that it will mean cheaper medicines:
"The impact of breaking the patent would be enormous," said Michael Bailey, a senior policy adviser for Oxfam International. "If a major country such as Brazil goes through with this, not only will it help ensure sustainability of their excellent treatment program, it will set a hugely important precedent for other countries."
Others are more skeptical:
"This is about stealing our intellectual property right and left and we're going to have to do something about it," said Robert Goldberg, a senior fellow at the Manhattan Institute for Policy Research, a New York-based conservative think tank. "If these were Microsoft's patents, there would be a firestorm."
Brazil’s rhetoric aside, this may simply be a case of the Brazilian government using industrial policy to build up its local pharmaceutical industry, using the concern for AIDS sufferers as a cover story.
At any rate, we can be certain that moves like this make private investment in AIDS research increasingly less attractive for private companies. In 1999 there were 125 drugs and vaccines in the R&D pipeline; today there are only 85. As resistance to current ARVs increases, future AIDS sufferers will pay dearly for Brazil’s nearsighted politicking.
Malaria money no good ‘if US funds agency not overhauled’
Africa Fighting Malaria, 7-1-05
President Bush has pledged $1.2 billion for fighting malaria in a range of countries. We should cautiously welcome this largesse, particularly as he has said the money will be used to finance insecticide treatments, bed nets, and the drug artemisinin. However, as Africa Fighting Malaria has argued, the money would not go far unless the leading US government development agency, USAID, is overhauled:
“USAID needs to start spending money on interventions that actually save lives — such as insecticides, bed nets, and medicines — rather than nebulous items such as ‘capacity building’ and ‘technology transfer,’” said Africa Fighting Malaria director Richard Tren.
The “vast majority” of USAID’s malaria program budget went to consultants, Tren went on to say. While the G8 nations are rightly focusing on governance reforms in African nations, they should spend the same energy on ensuring more accountability for donor institutions like USAID.
South Africa falling behind in aids treatment, says WHO
Johannesburg Business Day, 6-30-05
The British medical journal The Lancet has singled out South Africa as being the biggest stumbling block towards meeting the aforementioned “3 by 5” target, a view tacitly echoed by the WHO itself:
"We are encouraged by the South African government's plans, but we think ... (it) could go much, much faster," [WHO HIV/AIDS director Jim Yong Kim] said during a telephone interview from Geneva.
The SA health minister later responded by arguing that the “3 by 5” target was set in Geneva without sufficient consultation with countries such as hers, and as such, failed to take into account the priorities and capabilities of each individual country.
WHO likely to miss “3 by 5” AIDS drug target
Reuters News, 6-29-05
The biggest story of the week was the World Health Organization’s (WHO) admission that it is almost certain to fail to meet its “3 by 5” target – the plan to get 3 million HIV/AIDS sufferers onto antiretroviral treatment by the end of 2005. According to Jim Kim, director of the WHO's HIV/AIDS department:
"It is much slower than we thought," he told Reuters. "Three by the end of 2005 looks very unlikely." Kim could not say when the 3 million mark would be reached but was very hopeful it would be soon.
Left-leaning NGOs such as Action Aid immediately weighed in by claiming that the failure to meet the treatment targets was a result of a lack of ‘political will’. In fact, the failure of “3 by 5” was inevitable from the start, as it was an unrealistic target which incorrectly prioritized treatment over prevention.
Public health experts are virtually unanimous in concluding that prevention is of paramount importance in the fight against AIDS. The WHO’s “3 by 5” program, however, has lead to a skewing of resources away from prevention and towards the treatment of those who already suffer from the disease. As a result, new cases are piling up faster than they can be treated by dilapidated African healthcare systems. As such, the strategy of the “3 by 5” program is partly responsible for the increase in AIDS cases in Africa over the last few years.
G8, UN must act to get new AIDS drugs to poor – MSF
Reuters Foundation, 6-29-05
Unfortunately, many influential non-governmental organizations (NGOs) do not understand the incentives—i.e., profits—required for commercial outfits to risk billions of dollars on the research and development of new drugs. One NGO, Medicins Sans Frontiers – also known as Doctors without Borders – recently called for more developing countries to issue compulsory licenses in order “to head off a looming supply and cost crisis” of AIDS medicines. Worse, the NGO is calling on rich countries to compel their own drug companies to issue licenses to manufacture key medicines at firms located in developing countries.
Asking pharmaceutical companies to forgo profits at the whim of NGOs seems like the quickest and easiest way to end commercial research into the diseases of poverty completely. If you want to pay nothing for the next generation of AIDS drugs, nothing is what you’ll get.
Let’s hope saner heads prevail at the G8 this week and MSF’s bizarre proposals are roundly ignored.
43 ways to save the world
The Economist, 6-29-05
The Economist reports on the Gates Foundation’s recent decision to focus on developing 43 new technologies to combat disease in the poorest parts of the world. The proposals earmarked to receive some of Gates’ $450 million pot include innovative ways of delivering vaccines, improving nutrition and controlling insects. Some of the ideas on the table, for example, hope to find ways of creating needle-free vaccines that do not require refrigeration, and new ways of genetically or chemically controlling insects.
Certainly, such technologies would be a boon to mankind if they do make it into production. But, as The Economist notes, the fact that the product exists does not necessarily mean that it will necessarily reach those who need it:
How many of these ideas will translate into lives saved is, of course, impossible to say—and that is not only because of uncertainties about which of them will work. As the quest to deliver anti-retroviral drugs to poor people with AIDS shows, implementation is everything. Such drugs have been available for almost a decade, but only now are significant numbers of those who need them actually receiving them.
Diarrhea is one of the biggest killers of children under 5 in Africa today. Deaths can be easily prevented with cheap sachets of Oral Rehydration therapy. However, even simple technologies like these are not getting to those in need.
Perhaps, then, Mr. Gates’ grandiose scheme is missing the point: we need to create sustainable healthcare systems that get the basics right.
Gambia hails vaccination success
Despite the ongoing problems of delivering medicines to those in need in poor countries, well-organized vaccination programs can reap dividends. Perhaps the most successful program was Rotary International’s drive to eliminate polio in the 1980s.
Gambia can today report a more modest success – a vaccination program organized by the Global Alliance for Vaccines and Immunization (Gavi) has stopped the spread of Hib disease, which is a major cause of meningitis and pneumonia and kills nearly 500,000 people worldwide every year.
The study's author said it was remarkable that the disease was eradicated even though the doses were often given late, and almost a third of children did not receive the full course of vaccine.
Well done to all those involved.
WHO’s mission impossible
Manto Tshabalala-Msimang, Business Day, 7-5-05
Tshabala-Msimang, South Africa’s health minister – quoting an article on the subject I wrote back in January – defends her country’s AIDS program against criticism from the WHO. As she says, the “3 by 5” program is unrealistic and the WHO did not consult the affected countries before setting its goals.
If [South Africa] was that critical to the success of the WHO initiative, one would have expected that there would have been discussions between WHO and government to ensure that the initiative was realistic in its goals. Unfortunately, there was no consultation before the launch of the initiative in 2003. …
“Many people have questioned whether ‘3 by 5’ was a viable project in the first instance. Philip Stevens, of the International Policy Network, in London, raised many issues about this initiative in an article on these pages: ‘The failure of ‘3 by 5’ highlights the misprioritization of action by the WHO. Leading public health experts are virtually unanimous in concluding that prevention is of paramount importance in the fight against AIDS…. But instead of promoting prevention, the WHO promoted a wholly unrealistic treatment model. Depressingly, the failure of the initiative was entirely predictable.’ …
To increase distribution of antiretrovirals, WHO compiled a list of prequalified drugs, mainly cheap generic drugs, and promoted them to relief organisations and governments. Some of these drugs were subsequently withdrawn last year because of safety concerns.
Medicine groups cannot save the world
Richard Tren, Business Day, 7-5-05
Writing in response to Bristol-Myers Squibb’s decision to create a $40m pediatric AIDS treatment corps for Africa, Tren argues that drug companies should not be expected to carry the burden of health in low-income countries because their core competency is the research and development of new drugs:
Funding clinics and training doctors is not Bristol-Myers Squibb’s core competence. The job of it and other drug companies is to develop medicines and make sure they work. Berating them for not spending more on medical schools is a cheap shot. Also, one has to ask why so many African governments, with billions of dollars of aid over the past 40 years, have not done more to build medical schools and improve health care.
Drug resistance is emerging in Africa. As and when treatment is scaled up, resistance will spread and then, increasingly, second and third-line therapies will be needed. Finding long-term solutions to Africa’s AIDS problem needs continuing research into new therapies. Bristol-Myers Squibb understandably wants to get as much good media coverage for its treatment programmes, but children in Africa would be better off if it concentrated on developing new drugs.
The Future of healthcare in Africa
British Medical Journal, 7-2-05
This is an all-too predictable leading article from the increasingly leftist British Medical Journal that, on the eve of the G8 Summit, calls for more overseas aid in order to improve the health of the poor:
Sustainable financing from national budgets and real increases in overseas development assistance to Africa are critical if the continent is to join the rest of the world in improving global health and continuing the marked fall in mortality among children since 1960 seen elsewhere.
This spurious logic draws on the work of Tony Blair’s Commission for Africa, which argues that greater investment in health – partly financed by donor nations – is one of the best ways of pulling Africa out of poverty. This is a bogus argument. Notwithstanding the fact that aid is very frequently counterproductive, the best way to achieve self-sustaining healthcare systems is through the creation of wealth. This wealth will not come through foreign aid, but through the institutions of the free society, such as strong property rights, free markets, and the rule of law. If Africa is able to generate its own wealth, good health will follow.
The British Medical Association makes similar dubious demands for more aid here: http://www.news-medical.net/?id=11503
World Health Organization’s AIDS strategy a deadly failure, says think tank
Campaign for Fighting Diseases, 6-29-05
The Campaign for Fighting Diseases (CFD) seeks to raise awareness among policymakers and the wider public about the realities of diseases suffered in the poorest regions of the world and the need for effective and viable solutions for these diseases. CFD criticises the WHO for focusing on ARV treatment rather than prevention.
Encouraged by western activists and NGOs, the WHO has focused myopically on scaling up antiretroviral treatment for those already suffering from HIV/AIDS, while paying relatively little attention to preventing infections in the first place.
As a result of this gross strategic error, the global incidence of HIV/AIDS is rising faster than dilapidated African health systems can cope with. The WHO's ‘3 by 5’ programme is therefore contributing to the deepening of the AIDS crisis.
Power to the African People
Julian Morris, The Spectator, 6-29-05
In The Spectator
(UK) Morris analyses the G8 issue of Africa and concludes that more aid from Western countries will make poverty perpetual. Failing governments propped up by Western aid have left millions of people with no access to clean sources of water and fuel, resulting in unnecessary disease and suffering:
“Wood and dung are the primary sources of energy in Kenya and much of Africa — providing heat for the home and cooking. Clean fuels such as natural gas and electricity, not to mention central heating and air-conditioning, are luxuries reserved for plutocrats, politicians, and NGOs. Why do so many Africans rely on dirty energy sources? For the same reason that they are poor: their oppressive governments prevent them engaging in mutually beneficial economic activities. It is illegal in most African states to start a business without a license. And licenses are available only to those with government connections.
“Even if it were possible legally to operate a business, few would have the necessary capital. While their governments have been borrowing as if there were no tomorrow, most Africans cannot obtain a loan at any reasonable rate of interest. Those same oppressive, corrupt and incompetent governments prevent them obtaining good title to their land and thus they have nothing to offer as collateral.”
Brazil’s dangerous denial
Roger Bate, Tech Central Station, 6-27-05
Bate argues that Brazil’s threats to issue compulsory licenses for AIDS drugs will damage the research and development of new medicines:
Brazil is in dangerous denial. It denies responsibility for paying for HIV drugs and responsibility over letting its poorest die from entirely preventable water-borne disease. Only those who want fewer HIV drugs can welcome Brazil's actions, everyone else should be worried.
Who is WHO representing?
Richard E. Wagner, Philip Stevens, This Day (Nigeria), 6-10-05
This article is a useful counterpoise to the WHO’s emphasis on aid first, and economic growth second. The authors argue that the WHO is unaccountable, wasteful, and promotes a socialistic, centralized vision of health that is demonstrably failing to get to grips with the global AIDS and malaria pandemics.
Recently, health officials and lobbyists returned to their ministries and offices around the world after two weeks in Geneva at the annual meeting of the World Health Organization, where they approved its priorities and its $3.2bn budget for the coming year.
These delegates should have spent a useful fortnight ensuring that the WHO is giving its best to the world’s poorest and sickest people. In reality, they have endorsed a self-obsessed organization that neglects the poor in favor of the fashionable health concerns of its rich-country sponsors.
In a world in which life-expectancy is increasing as a result of rising personal prosperity, the WHO should be devoting its limited budget to the transnational diseases which pose the greatest threat to global health. …
But, instead, the sessions were devoted to a host of issues mainly of concern to rich countries, such as the benefits of breastfeeding and ‘the promotion of healthy lifestyles.’
$5 billion could save 6 million kids
The Lancet, 6-28-05
A study reported in The Lancet
finds that, for just over $5 billion, 6 million children younger than five could be saved in poor countries each year, provided the money was spend on validated treatment and prevention programs. Again, the presumption of these researchers is that throwing government money at a low-income country problem will solve it. Decades of evidence suggests otherwise.
However, this study does usefully highlight the point that millions of lives are needlessly lost because of a lack of access to cheap, relatively simple medical interventions.
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