Wednesday, September 7, 2016

The next great pandemic: What will it look like and where will it come from?

This was originally published on Global Health TV on August 23, 2016.
A few years ago, in a survey by epidemiologist Larry Brilliant, 90 percent of epidemiologists said that a pandemic that will sicken 1 billion, kill up to 165 million and trigger a global recession that could cost up to $3 billion would come in the next two generations. Currently, we’re living through three pandemics  HIV, Zika and cholera. What will the next pandemic look like and where will it come from?
Those are some of the questions science journalist Sonia Shah attempted to answer in an event marking the centennial of the Johns Hopkins University’s Bloomberg School of Public Health and in her book “Pandemic: Tracking Contagions from Cholera to Ebola and Beyond,” published earlier this year. The book should be required reading for anyone interested in the future of global health.
Shah spent six years trying to figure out how microbes turn into pandemic-causing pathogens. She looked at the history of pandemics, particularly cholera because it’s one of our most efficient pandemic-causing pathogens. She went to places where new pathogens are emerging to try to figure out what are the political and social drivers that push these microbes into human populations.

Tuesday, September 6, 2016

UN needs to look beyond patents for improving access to medicines

This was originally published on Devex on August 4, 2016.
The lack of access to medicine has become a regular feature of the health landscape in many developing countries. In the West African country where I’ve been spending time lately, stockouts of essential medicines happen regularly, not only in the public sector (where you might expect it) but also in projects well-funded by donors (where you might not).
The World Health Organization estimates that availability of selected generic medicines was only 38 percent and 46 percent in the public sector in low- and middle-income countries, respectively, and a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief.
Earlier this year, U.N. Secretary-General Ban Ki-moon appointed a High-Level Panel on Access to Medicines to assess this problem and come up with some solutions. Specifically, the purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”
But leaks from the panel’s highly secretive proceedings suggest that the secretary-general told the panel to focus on intellectual property and patents to the exclusion of other issues that hamper access to medicine — weak health systems, questionable government policies, a lack of health workers and a lack of resources.
The high-level panel has said that the leaks do not reflect the views of the panel, and that it is still actively working on the report.

Part of the problem, or the solution?

Far from being barriers to access to medicines, patents and intellectual property have improved access as new technologies developed in high-income countries have been licensed or donated to address those in low- and middle-income countries.
Over the past decade, governments across Europe and North America have devoted big resources to encouraging research on technologies for developing countries. In parallel, pharmaceutical companies have worked through a network of product development partnerships funded by governments and philanthropists to apply skills, expertise and knowledge from the commercial sector to diseases where there is no realistic prospect of shareholder returns. The quid pro quo is that the companies retain their intellectual property for use in markets where governments and insurers can provide that return.  
In 28 interviews on this issue commissioned as part of an ongoing series of reports on access to medicines on Health Issues India, with public health officials, academics or advocates in Brazil, Kenya and Senegal, only one of them (who identified themselves as an AIDS activist), in Brazil, identified patents as a problem. Several of them made the point that patents were not the problem or that patents were actually part of the solution.
A number of these public health experts said that patents are indispensable to promoting lifesaving medical research. If companies couldn’t protect their inventions through intellectual property laws, they’d have little reason to take the enormous risks involved in drug discovery.
Patents not only foster pharmaceutical innovation, but also inhibit counterfeiting and fake drugs, which are widely recognized as serious barriers to access to high-quality drugs.

Potential models 

There are many other barriers to access to medicine. In Kenya, the two most common barriers mentioned were weak health systems and cost of medicines and doctor consultations. Other reasons included late diagnosis and substandard drugs.
In Senegal, three public health officials identified the cost of doctor visits or user fees for diagnostics as the major impediments.
The hearings that the panel ran earlier in the year in London and in Johannesburg, South Africa, suggest that it is ignoring new public-private agreements on access which might address future problems over patent-protected health discoveries.
For example, four pharmaceutical companies in Kenya are selling treatments for noncommunicable diseases at prices far below those charged in Europe and North America as part of major agreements with governments and health providers. These agreements — much lower prices for those who can afford less, combined with a long-term commitment to high-volume treatment — could be models for the future.
One example is AstraZeneca’s Healthy Heart Africa program that, in its first year, conducted one million hypertension screenings in Kenya, opened over 250 health facilities, trained over 2,600 health care workers across 21 counties, diagnosed close to 150,000 patients with high blood pressure and started treatment for 25,000 patients. The program aims to treat 10 million people with hypertension in Africa over the next 10 years.

Call for change

One of the biggest barriers to access to medicines is lack of resources, particularly developing countries’ own funding of the health of its citizens (which is where most of the funding should be coming from).
In 2001, African leaders met in Abuja, Nigeria, and pledged to allocate 15 percent of their national budgets to health. The 2015 DATA Report weighed in on the extent to which African nations are meeting their own health needs. Between 2011 and 2013, just eight of the 47 countries for which there was data available spent 15 percent or more on health: Uganda, Rwanda, Malawi, Swaziland, Nigeria, Ethiopia, Liberia and Togo (based on data from the WHO). Twenty countries did not reach even the 10 percent level.
Until that changes, and the U.N. looks beyond patents for real solutions, access to medicines will continue to be a problem.

Friday, September 2, 2016

Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

Thursday, September 1, 2016

Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.