Thalif Deen

UNITED NATIONS, Oct 13 2008 (IPS) – The world s poorest nations continue to suffer from high prices for life-saving drugs and a shortage of generics specifically to treat HIV/AIDS despite assurances by the some of the major pharmaceutical companies to help lower costs.
Governments must act to bring prices down and improve availability, or else Target 8e [of the Millennium Development Goals] will be a U.N. failure, Margaret Ewen of the Amsterdam-based Health Action International (HAI) told IPS.

When Secretary-General Ban Ki-moon met with senior executives of 17 of the world s generic pharmaceutical and diagnostic companies last week, he stressed the need to increase access to cheaper vaccines and medicines to millions of people deprived of life-saving medications because of exorbitant prices.

Pointing out that the focus was primarily on HIV/AIDS, which is particularly ravaging the African continent, Ban said: We noted that despite the gains, the epidemic continues to outstrip our best efforts.

Only one-third of those who need antiretroviral treatment in low-and middle-income countries are getting it, he said. And each day, for every two people who are placed on antiretroviral treatment against AIDS, five more are infected.

Collectively, we still have more work to do, the secretary-general declared.
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Besides the reduction of extreme hunger and poverty by 50 percent by 2015, the U.N. s Millennium Development Goals (MDGs) also call for access to affordable essential medicines in developing countries known as Goal 8e.

Asked what progress has been made to achieve Goal 8, Ewen told IPS: At the half way stage to the MDGs, there is more a chasm than a gap between the goal of access to affordable essential medicines in developing countries and the current situation.

As data shows, medicine prices are too high and availability too low, she said. And many treatments are simply not affordable.

For example, in the private sector in Pakistan, the lowest paid unskilled government worker has to work about five days to buy a month s supply of omeprazole to treat an ulcer, even when purchasing the lowest priced generic.

Omeprazole is on the National Essential Drug List and supplied free in the public sector but availability was only 13 percent, she pointed out. This forces people to buy in the private sector at prices they cannot afford.

In Indonesia, a low-paid unskilled government worker has to work more than four days to buy just one salbutamol inhaler, an asthma medicine, in the private sector.

While a few governments have acted on the survey findings, many have not. This simply isn t good enough as people, especially the poor, are spiraling into debt or going without the treatments they need, Ewen said.

To help countries struggling with high prices for drugs, HAI and the World Health Organisation (WHO) are currently developing guidance on policy options to reduce prices.

We need to look at what policies work and don t work in various settings. We hope that by providing such information countries will act, Ewen said.

The Geneva-based WHO is also looking to scale-up efforts to improve the care of those with major chronic diseases, such as cardiovascular disease, diabetes and asthma, with emphasis on improving the availability and affordability of chronic disease medicines.

There definitely needs to be greater focus on chronic diseases as they kill an estimated 35 million people a year, according to WHO.

For the last eight years, both HAI and WHO have been working together to improve the availability and affordability of essential medicines.

To date, over 50 surveys have been conducted across the globe by ministries of health, researchers, and/or civil society groups.

The results from these surveys were reported in the MDG Gap Task Force Report released by the United Nations last month.

In the public sector, generic medicines are only available in 34.9 percent of facilities, and on average cost 250 percent more than the international reference price, according to the study.

In the private sector, those same medicines are available in 63.2 percent of facilities, but the cost on average is about 650 percent more than the international reference prices.

Prices are so high that people on a low wage have to work any number of days, or in some cases weeks, to buy treatments, the study said.

At the national level, the U.N. study calls for explicit targets in several areas, including the elimination of taxes and duties on essential medicines; updating of national policy on medicines; adoption of generic substitution policies for essential medicines; and ways to reduce trade and distribution mark-ups on prices of essential medicines.

At the global level, the study calls for measures to increase funding for research and development in areas of medicines relevant to developing countries; encourage pharmaceutical companies to apply differential pricing practices to reduce prices of essential medicines where generic equivalents are not available; and enhance the promotion of the production of generic medicines and remove existing barriers.

Asked if there has been any increase in the production of generics, Ewen said: I don t know if the production of generics has increased.

But generics are commonly produced my many manufacturers in India, Asia and China for the domestic market, with some manufacturers exporting them as well. And in some countries, some of the essential medicines are not available in generic versions.

Local manufacturers may not be producing them as they don t think there is enough profit, or they don t have the capacity [for example, three multinational companies have 80 percent market share for insulin], she said.

Ewen also said it is vital that generics are available as competition is needed to bring prices down.

But what is also important is that pharmacists dispense low-priced generics and patients use them, she added.

For this to happen, she said, people need to have confidence in generics. Regulatory agencies need to ensure only quality generics are available in the country, provide incentives for dispensing them, and educate health professionals and consumers so that generics are accepted and used.

This is needed to improve access to medicines, she added.

After his meeting with senior executives of pharmaceutical companies last week, the secretary-general said: We look forward to greater collaboration between the private sector and the U.N. to expand existing efforts in the spirit of Goal 8 of the MDGs on building a global partnership for development.

On HIV/AIDS, he said: We agreed that our work to increase access to HIV prevention and treatment had contributed to the development of health care systems, but that more strengthening needed to happen.

While this is primarily the responsibility of national governments, important efforts have already been made through partnerships with industry.

More can be done, especially to address shortages of the health workforce and improve managerial capacities, he declared.