Concern is being raised by civil society and the public about how Sierra Leone’s government is handling the Ebola pandemic. Credit: Marc-André Boisvert/IPS

By Lansana Fofana
FREETOWN, Nov 6 2014 (IPS)

The fight against the deadly Ebola epidemic ravaging West Africa seems to be hanging in the balance as Sierra Leone’s Minister of Health and Sanitation Dr Abubakar Fofana told IPS that the government is overwhelmed by the outbreak.

“We were not prepared for this Ebola scourge. It took us by surprise and with our weak health system, we can only rely on support given to us by our international partners,” he told IPS.

According to a report published last week by British charity Save the Children, five people are infected every hour here and the situation is worrisome.

The government has, however, downplayed this, claiming the report is hugely exaggerated and that the situation is getting better in some parts of the country.

However, concern is being raised by civil society and the public about how the government is handling the outbreak.

Bernard Conteh, the director of the rights advocacy group Anti-Violence Movement, told IPS: “The authorities should be more pro-active. They should pay health workers, who are the frontline soldiers in this fight, reasonably well and ensure they are supplied adequate Personal Protective Equipments. This is not happening. Even the enforcement of the quarantine of Ebola suspects is not effectively done.”

On just one day, Nov. 2, 61 new cases were reported across the country bringing the nationwide toll to 4,059 people infected by the virus. This surpasses neighbouring Liberia which, until a month ago, was the worst-hit country. Liberia has recorded 2,515 cases while Guinea, where the epidemic first started, has 1,409 recorded cases of Ebola.

Since the outbreak of the epidemic in April, Sierra Leone has lost five medical doctors, more than 60 nurses and auxiliary health workers to Ebola. And the figure keeps going up.

The African Governance Initiative has also painted a grim picture of the outbreak here, saying that it is spreading nine times faster than it did two months ago. Of the 12 districts in the country and the capital Freetown, only Koinadugu in the north was Ebola-free — until recently. It now has at least six confirmed cases. Now, no part of Sierra Leone is unaffected but the virus.

The government has, however, been assisted by the international community. The United Kingdom has sent medical equipment and health workers, and has built test and treatment centres in parts of the capital. China has also sent medical aid, while Cuba has deployed dozens of medics on the ground.

But, there are still many challenges to be addressed. According to the medical charity MSF or Doctors Without Borders, the outbreak is far from over and more help is desperately needed.

“There is a huge gap in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation,” MSF says.

As the fight against the killer epidemic continues to prove difficult with the virus spreading fast, the government in Freetown has just implemented a year-long state of emergency. This comes just two days after an earlier 90-day state of emergency, implemented in July in response to the outbreak, ended.

Attorney-General and Minister of Justice Frank Kargbo told IPS the extension of the emergency period was necessary to help control the spread of the virus.

“No one knows when the Ebola epidemic will end. We believe that within this period and with our hard work, we will be able to contain the disease.”

Many attribute the rapid spread of the Ebola virus to people’s attitudes and, as MSF says, a lack of sufficient community education and mobilisation. Cultural practices and traditional beliefs are also greatly hampering the fight against Ebola.

“Our people still continue to touch, wash and bury their dead. This is an easy way to get infected, even though they have been told repeatedly not to do so,” the chairman of the National Ebola Response Committee, Alfred Palor Conteh, told IPS.

People also refuse to report to hospitals when they fall ill because of the fear of stigmatisation by their families and communities. Many believe that Ebola is fatal and that going to treatment centres will not help. Ebola survivors and discharged patients also face stigmatisation.

However, Health Health and Sanitation Minister Fofana said he was hopeful the situation would be brought under control soon with international help.

Edited by: Nalisha Adams

Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 15 2014 (IPS)

When Peninah Mamayi got her period last January, she was scared, confused and embarrassed. But like thousands of other girls in the developing world who experience menarche having no idea what menstruation is, Mamayi, who lives with her sister-in-law in a village in Tororo, eastern Uganda, kept quiet.

“When I went to the toilet I had blood on my knickers,” she told IPS. “I was wondering what was coming out and I was so scared I ran inside the house and stayed there crying.

“I just used rags. I feared telling anybody.”For girls, “pads are as good as schoolbooks” -- Dennis Ntale, 18, a student at co-ed Mengo Senior School in Kampala, Uganda

Not having access to or being able to afford disposable sanitary pads or tampons like millions of their Western counterparts, desperate Ugandan girls will resort to using the local ebikokooma leaves, paper, old clothes and other materials as substitutes or even, as a health minister told a menstrual hygiene management conference this week, sitting in the sand until that time of the month is over.

“We always try to give them something to use at school, just at school,” Lydia Nabazzine, a teacher at Mulago Private Primary School in Kampala, where about 300 out of 500 students are female, told IPS.

“When they go home we don’t know how they go about it, because we cannot afford funding up to home level.”

But the 2012 Study on menstrual management in Uganda, conducted by the Netherlands Development Organisation (SNV) and IRC International Wash and Sanitation Centre in seven Ugandan districts, found that over 50 percent of senior female teachers confirmed there was no provision for menstrual pads for schoolgirls.

When some girls have their period, they may miss up to 20 percent of their total school year due to the humiliation of not having protection, according to separate research from the World Bank. This profoundly affects their academic potential.

“Those days when I was menstruating I could be absent for up to five days a month until menstruation had stopped,” recalled Mayami.

It’s a continent-wide problem. The United Nations Children’s Fund says one in 10 African girls skipped school during menstruation. Some drop out entirely because they lack access to effective sanitary products.

A number of recent initiatives have, however, tried to address this.

On May 28 this year, the world marked the first Menstrual Hygiene Day to help “break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.”

On Aug. 14 – 15, East Africa’s first national menstrual hygiene management conference, which has the theme “breaking the silence on menstruation, keep girls in school,” has been taking place in Uganda’s capital Kampala.

At least 100 schoolteachers, schoolgirls – and boys – NGOs, including Network for Water and Sanitation (NETWAS) Uganda, civil society members and others are taking part in the two-day event. They’re calling on the government to put in place a menstrual hygiene management school policy. They also want the government to provide free sanitary pads to girls in schools, like neighbouring Kenya has done.

Despite keeping silent about the horrors of menstruation for months, Mamayi shared with the conference attendees the solution she found to that time of the month.

The student, now 13, had been walking home from school when some older pupils told her, “madam [the teacher] said menstruation is a normal thing for every girl.”

“So I asked them about it,” she told IPS.

“Now I’m using AFRIPads.”

Invented by the eponymous Uganda-based social business, AFRIPads are washable cloth sanitary towels designed to provide effective and hygienic menstrual protection for up to a year.

Mamayi said the re-useable pads work out to be 5,500 Ugandan shillings (2.11 dollars) a year, compared to the 30,000 shillings (11.49 dollars) that disposable pads would have set her back.

“Now when I go somewhere [when I have my period] I sit and am comfortable,” said Mamayi. “I’m not bothered by anything. I don’t worry whether I’ve got anything on my skirt. I don’t miss school.”

She added: “I’m going to tell my friends that menstruation is a normal thing in girls.

“I want my friend also to be free, to tell their parents to buy for them pads. Let them not fear.”

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Credit: Amy Fallon/IPS

Breaking the culture of silence around menstruation is the aim of a new book, Understanding and Managing Menstruation, launched by Uganda’s Ministry of Education and Sports at the conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys.

Maggie Kasiko, a gender technical advisor at the Ministry of Education and Sports, told IPS that the government hoped the book would reach as many students, teachers and parents across the country as possible.

“Not many girls have the opportunities to have their mothers and aunties around, so they start their menstruation without knowing,” she said, adding many parents and relatives were busy trying to earn a living for their families.

Dennis Ntale, 18, a senior five student at co-ed Mengo Senior School in Kampala, said he didn’t know what menstruation was when he encountered a fellow student with her period in class earlier this year, and tried to comfort her. It was only sometime later when he relayed the incident to his male friends and they told him she was “undergoing her MP [menstrual period].”

“They’re [teachers] not teaching this to the boys in schools,” Ntale told IPS.

“I believe boys should be informed about this because there are many of them out there who have no idea about this.”

He said for girls, “pads are as good as schoolbooks”.

“If you don’t have that pad she won’t be able to do a thing,” Ntale said. “[We should] make sure she has what will keep her in school.”

Kasiko said the Ministry of Education and Sports was continuing to ensure schools had separate facilities for boys and girls, with the girls having washrooms and changing rooms where they could bathe and change, had access to clean water, extra pads and Panadol.

But she said she didn’t see the government providing free pads to girls “in the short-term or the long-term”.

“Starting to distribute sanitary towels to each and every girl, every month, is quite a cost for the ministry when you look at all the other areas that the ministry needs to take care of,” she said.

“That, our guidelines for Universal Primary Education (UPE) is very clear, is a role of parents. It’s sanitary wear. Just like you buy a panty for your child, you should be responsible for buying a sanitary towel for your child.

Kasiko added: “But we’ll support the parents and work together with the parents to give them knowledge to ensure the environment is clean and girls stay in school.”

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

Ethiopians waiting inside a hospital in Addis Ababa on the weekend. The capital has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

By James Jeffrey
ADDIS ABABA, Apr 3 2014 (IPS)

For a while now, Magnetic Resonance Imaging or MRI scanners have typically been a luxury that both government and private hospitals in Ethiopia have struggled to afford to purchase for in-house use.

Addis Ababa, the Ethiopian capital with an ever-growing population of around 3.8 million, currently has only four stationary MRI scanners that provide services to 30 government and private hospitals, according to Zelalem Molla, a surgeon based in Addis Ababa.

Outside of the capital, only two MRI scanners exist. But the six scanners — in this Horn of Africa nation of some 92 million people — are old fashioned and far behind the technological curve in the West.

“It would be wrong to claim that the mobile MRI scanner would save lives,” says Zelalem, whose lunchtime chat with American entrepreneur Peter Burns III about the paucity of scanners sparked a business idea.“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the side-lines.” -- Alayar Kangarlu, MRI research centre, Columbia University

But, Zelalem notes, more MRI scanners — which use strong magnetic fields and radio waves to generate images of the inside of the body that can be analysed on computers — would crucially allow more doctors to diagnose illnesses far earlier when they are operable and potentially curable.

“Often it is not possible for doctors to diagnose illnesses such as tumours until they physically appear at a stage when the chances of saving a patient are slim — or it is too late,” Zelalem tells IPS.

However, actual figures about the number of people directly affected here by the lack of MRI scanners do not exist.

In the past, some Ethiopians have needed to travel to other African countries such as Kenya and South Africa, or to Europe to have scans. This even included Haile Gebrselassie, Ethiopia’s track runner, who used to go to Munich, Germany for scans to help diagnose running injuries.

Ethiopia technically has free healthcare for all, which is provided by government-run hospitals. The reality, however, is that “there are not enough hospitals and most suffer from inadequate staffing, budgets and machinery,” Zelalem says. Private hospitals exist but as an option affordable to very few Ethiopians.

And the cost of an MRI scan proffered privately is a frightening figure for most Ethiopians, many of whom earn between 500 to 1,000 birr (28 to 56 dollars) a month.

The scale of demand at government-run hospitals for free MRI scans means patients can be left with the choice of having to wait and risking their health, or raising funds to pay for a scan at a private hospital or institution.

Such gaps in Ethiopia’s healthcare are areas of concern to the government and many NGOs as three of the eight United Nations Millennium Development Goals (MDGs) for 2015 are healthcare focused, concentrating on reducing child mortality, improving maternal health as well as combatting HIV/AIDS, malaria and other diseases.

But people like Burns are taking advantage of these gaps to do good while making a profit at the same time.

“This project represents the highest form of achievement edified by the mantra: ‘Doing well by doing good,’” Burns, who is based in Addis Ababa as a self-styled “ExPatrepreneur”, tells IPS.

Burns describes the project to provide the country with scanners as a for-profit enterprise with a charitable component.

“We will be offering a total of 25 percent of our scans for free to those that are unable to afford it,” Burns says.

So far, Burns says he will only bring one mobile MRI scanner to Addis Ababa and will sell its services on a pay-per-scan basis.

Ethiopia’s capital, Addis Ababa, has only four stationary MRI scanners, providing services to 30 government- and private-run hospitals. Credit: James Jeffrey/IPS

Also, there is a plan for a portion of profits to fund a not-for-profit venture called Doctors Within Borders, which aims to provide financial incentives to encourage Ethiopian doctors to remain within Ethiopia, as well as work in remote rural areas.

A previous private MRI scanner service in Addis Ababa set a precedent for profitability, Zelalem says. The business conducted about 30 scans a day — an MRI scan typically costs from about 115 to 150 dollars to conduct and process the images — totalling annual revenue of more than one million dollars. However, this scanner is fixed and patients are transported to it from various hospitals across the city.

“[In a developing economy] a government’s focus on financial market stability and security issues can result in healthcare issues remaining on the sidelines,” Alayar Kangarlu, who leads the physics and engineering group at the MRI research centre at Columbia University in New York, tells IPS. At the same time this creates an opening for private business, he notes.

And generating a healthy bottom line can have a beneficial role in healthcare provision, some say.

“NGO-based humanitarian healthcare usually struggles with sustainability and operates from grant to grant,” a worker within the health sector in Ethiopia, who wished to remain anonymous due to current work commitments, tells IPS.

Private enterprise, on the other hand, he notes, can achieve long-term sustainability thanks to profit generation. And it is usually more flexible, and more efficient due to greater accountability, than NGOs typically hampered by rigid fiscal rules on profit. Private enterprise can also free up capacity within public- or NGO-provided healthcare.

Admittedly profit generation within healthcare can turn sour and escalate wildly, he notes, as witnessed in the U.S., but Ethiopia’s healthcare system remains light years away from encountering such problems.

Burns remains confident that he can improve MRI scanner availability in Addis Ababa.

And if that is achieved, then the same business model could be applied to other major Ethiopia cities around the country — and go some way towards helping achieve the MDGs related to healthcare.

“Much can be accomplished through the small combined efforts of the many, and it is each of our responsibility to contribute,” Burns says. “This is one small step to serving just one of the many needs of a population in a place like Ethiopia.”

South Africa is battling to reduce its cases of multidrug-resistant TB (MDR-TB) with the success rate for those on treatment at about 40 percent. Miriam Mannak/IPS

By Brendon Bosworth
CAPE TOWN, Mar 12 2014 (IPS)

Despite an increase in diagnosis times, South Africa is facing a growing drug-resistant tuberculosis (TB) burden as nationally there remains a large gap between the number of patients diagnosed with multidrug-resistant TB (MDR-TB) and those who start treatment.

Between 2007 and 2012, recorded cases of MDR-TB, which is resistant to at least two of the primary drugs used to combat standard TB, almost doubled.

South Africa has improved its ability to test for drug-resistant TB by introducing GeneXpert, a rapid testing machine that can diagnose TB in sputum samples in less than two hours.“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it.” -- Gilles van Cutsem, Médecins Sans Frontières (MSF)

But in 2012, just 42 percent of patients diagnosed with MDR-TB began treatment, according to government figures. The success rate for those on treatment is about 40 percent.

“If we don’t do something about it now, MDR-TB is going to become XDR-TB [extensively drug-resistant TB],” Dr. Jennifer Hughes, a drug-resistant TB doctor with Médecins Sans Frontières (MSF), told IPS. XDR-TB is a strain of TB resistant to at least four of the main TB drugs.

“If we don’t start focusing on how we treat XDR-TB properly as well, we’re just going to drive further and further resistance as we go.”

Treatment Gap

Most of South Africa’s provinces have increased their treatment capacity for MDR-TB patients after the government introduced a 2011 framework for decentralising MDR-TB care. This allows patients to start treatment at sites closer to their homes instead of the country’s few specialised TB hospitals, where a typical stay is six months.

But provision of treatment at primary healthcare level needs to increase, Dr. Norbert Ndjeke, director of the Department of Health’s DR-TB, TB and HIV division, told IPS.

“[Decentralisation] is not moving at the speed we want it to,” admitted Ndjeke. There is no special budget for decentralisation and provincial governments choose how to prioritise their spending, he said.

The number of sites MDR-TB patients can start treatment in the Western Cape, Gauteng, Eastern Cape, and the Free State provinces has quadrupled due to decentralisation. The number of sites in the Western Cape, for instance, went from four to 17, while Gauteng now has five treatment sites instead of one.

Limpopo Province has not added new facilities, while North West and the Northern Cape provinces have doubled available treatment initiation sites, going from one to two, and two to four, respectively.

When properly implemented, decentralisation can cut the treatment gap.

In Khayelitsha, a large semi-informal township on the fringes of Cape Town, a combination of quicker testing and decentralisation has led to the time between diagnosis and treatment for drug-resistant TB dropping from 73 days to just seven days between 2007 and 2013, according to data by MSF. Ninety-one percent of patients diagnosed with MDR-TB in Khayelitsha in 2013 began treatment.

Ndjeke noted that provisional national data for 2013 indicates that 10,095 MDR-TB patients began treatment. Figures are not yet available for the number of patients diagnosed during that period, but in the first nine months of the year 7,271 patients were diagnosed with MDR-TB, possibly indicating a shrinking gap between treatment and diagnosis.

Accurate recording and reporting of patient numbers and outcomes remains a challenge, and the government is working to improve its systems, he said.

Large Burden

South Africa has the world’s third-largest TB burden, after India and China, according to the World Health Organisation. It also reports the world’s most cases of XDR-TB, a virulent form of the disease that is resistant to at least four of the main TB drugs and has a treatment success rate of less than 20 percent. An estimated one percent of the population of about 51 million develops TB every year.

“We have in South Africa one of the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we are not doing very well at detecting it and treating it,” said Gilles van Cutsem, MSF’s medical coordinator for South Africa and Lesotho, at a media briefing.

Doctors are concerned about the rise in transmission of drug-resistant TB.

When drug-resistant TB started emerging it was mainly due to patients not being able to complete their full course of treatment for standard TB, said MSF’s Hughes. But now most drug-resistant TB transmission happens through people breathing it in from others, she said.

New Drugs Offer Hope 

One of the main challenges for treating drug-resistant TB is that the available drugs come with side effects including nausea, vomiting and permanent deafness, which often deters patients from finishing their treatment course.

“The drugs are horrendous – it’s a terrible regime but it’s the best they’ve got,” Hughes told IPS. On average, patients need to take between 12 and 15 tablets daily for two years, she explained.

South Africa is running a clinical access programme for up to 200 XDR-TB – and pre-XDR-TB patients with limited treatment options for a new drug called Bedaquiline, the first drug designed specifically to treat TB in over 50 years.

One of the features of the drug, which is taken along with other drugs, is that patients get better a lot quicker, said Dr. Francesca Conradie, clinical advisor to Sizwe Hospital, a MDR-TB hospital in Gauteng.

“It’s the first in a pipeline of maybe four or five drugs that will revolutionise the way we treat MDR-TB,” said Conradie.

Based on the outcomes of this initial programme, South Africa’s Medicines Control Council will decide whether or not to register Bedaquiline for use for more patients.

A new regime of drugs for drug-resistant TB patients could be ready by 2022 based on the outcomes of existing trials, said van Cutsem.

By Martin Khor
GENEVA, Mar 9 2014 (IPS)

If you or some family members or friends suffer from cancer, hepatitis, AIDS, asthma or other serious ailments, it’s worth your while to follow the negotiations on the Trans Pacific Partnership Agreement and other similar bilateral trade agreements.

It’s really a matter of life and death. For the TPPA can cut off the potential supply of cheaper generic medicines that can save lives, especially when the original branded products are priced so sky-high that very few can afford them.

Recently, a cancer specialist in New Zealand (one of the TPPA counties) warned that the TPPA would prolong the high cost of treating breast cancer because of new rules to protect biotechnology-based cancer drugs from competition from generics. And this will affect the lives of cancer patients.

Some cancer medicines can cost a patient over 100,000 dollars for a year’s treatment. But generic versions could be produced for a fraction, making it possible for patients to hope for a cure and a reprieve from death.

In India, local companies are leading the fight to make medicines more affordable to thousands of patients suffering from breast, kidney, liver and

gastrointestinal cancer and chronic leukemia.

For example, an Indian company produced a generic drug for kidney and liver cancer 30 times cheaper than the branded product (140 dollars versus 4,580 dollars for a month’s treatment) after it was given a compulsory license.

India has a law that disallows patents for a newer form of drugs or known substances unless it improves the medicine’s efficacy or effectiveness. Under the World Trade Organisation (WTO) rules, countries are free to set their own standards for novelty, or whether a product is novel enough to be eligible for a patent.

Also, in many countries, the patent law allows for companies to obtain compulsory licenses to import or make generic versions of original medicines. Governments grant such licenses if the branded products are too expensive and the original companies do not offer attractive terms for a voluntary license to other firms.

Multinational companies have strongly opposed compulsory licenses or the Indian-type laws that allow for patents only for genuine innovations.

This is where the TPPA comes in. Mainly at the insistence of the United States, countries are being asked to accept standards of intellectual property, that go beyond the rules of the WTO’s.

Especially noteworthy is the U.S. insistence that the TPPA countries agree to give a type of intellectual property known as “data exclusivity” for five years to companies producing original medicines.

This is extended to eight or 12 years for “biologics”, or medicines made with biotechnology. Many of the new medicines for treating cancers are biologics.

This will cause immense problems for patients waiting for cheaper medicines because “data exclusivity” prevents generic companies from relying on the safety and clinical trial data of the original company to get safety clearance for their generic products.

Thus, even if a generic company can prove that its medicine is bio-equivalent to the original medicine that has already passed the safety standard required by the health regulatory authorities, it will not be allowed to sell its medicine unless it comes up with its own safety and clinical trial data.

This goes against the current practice of generic medicines and safety standards. But the U.S. is insisting on this in the TPPA.

Few generic companies have the funds or technical ability to do their own clinical trials, and thus generic medicines could well be prevented from being used in TPPA countries for five to 12 years – even if the medicines are not patented.

That is the most significant aspect of the TPPA, and this is why so many groups of patients, health organisations and independent medical experts have been outraged and outspoken in their opposition to the agreement.

According to Jamie Love of Knowledge Ecology International, an expert on drugs and patents, the average cost of eight biologic cancer drugs registered with the U.S. drug authorities in 2011-2013 is 128,000 dollars (for a year’s treatment), with the most expensive being over 390,000 dollars. At such prices, hardly anyone in developing countries can afford these medicines.

In mid-February, eight prominent organisations including Medicins Sans Frontieres, Oxfam, Public Citizen, Health Gap and Knowledge Ecology International, issued a strong statement on their deep concern about the public health implications that the TPPA’s measures will have for millions of patients in need of access to affordable medicines around the whole Asia-Pacific region.

Said the groups: “The negotiations must take into account the health needs of all patients living in TPPA countries, and the U.S. must halt its efforts to limit countries’ freedom and flexibilities, otherwise the TPPA will jeopardize many, if not millions, of lives.”

Developments in India, which is not a TPPA country, show the patient-friendly policies that can emerge when public health concerns are given priority.

For instance, an Indian company is producing a generic version of the drug Gleevac, which is used to treat a chronic form of leukemia as well as gastrointestinal cancer, bringing the cost of treatment down from 70,000 dollars a year (in the U.S.) to 2,500 dollars a year in India.

This was possible because the Indian government denied the original company a patent on Gleevac because it was not judged to be novel enough, and an objection to that decision was rejected by the Indian Supreme Court.

Countries that join the TPPA will find it very difficult or impossible to undertake policies and practices similar to India’s, should the U.S. proposals in the intellectual property chapter be accepted.

Moreover, countries that don’t produce the generic drugs have the option to import them from India and other generics-producing countries. But if the TPPA imposes data exclusivity rules of the type desired by the U.S., it would be difficult to import and sell them.

Some countries are opposed to some of the U.S. proposals. The views and positions that defend public health must prevail, for after all, it is a matter of life and death.

Excerpt:

The Cameroon government says that the uncontrolled number of health clinics and training institutions are responsible for the death and worsening medical conditions of many here. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Jan 23 2014 (IPS)

The Cameroonian government has begun a crackdown on illegal medical facilities and plans to shut down more than 524 medical training centres and 600 private clinics operating unlawfully in this Central African nation. 

“We are starting activities to bring order to the medical sector that has gone out of control. Most of [the illegal medical institutions] lack the training, appropriate staff, equipment and infrastructure to operate either as a medical training institution or a clinic,” Biwole Sida, the national health inspector in the Ministry of Public Health, told IPS.

“The uncontrolled number of clinics and training institutions are responsible for the death and worsening medical conditions of many innocent Cameroonians,” Sida added.

In the student residential area of Bonamusadi, in Cameroon’s capital, Yaounde, IPS visited one such clinic that is open 24 hours a day and which provides a wide array of medical services, including prenatal and paediatric care.

But a patient who was rushed to this private clinic with burn wounds was turned away and taken to the nearby government hospital, Yaounde Central Hospital, as the clinic has stopped admitting emergency patients.

“We now operate only by appointment since the government announced [it was] closing down clinics,” Helen Evinga, the clinic attendant, told IPS.

Francois Penda, a medical officer at the emergency unit of the Yaounde Central Hospital, who attended to the burn patient transferred there by the private clinic, explained that it would not be a bad thing if the illegal clinics were shut down.

“Most patients come to the hospital on the verge of death after they wasted time in small private clinics, which are not even equipped technically and professionally to handle emergency cases,” he told IPS.

“A [burn] accident like this is so complicated and requires very delicate and sophisticated medical resources. Any unprepared attempt [to treat the wound] will complicate the patient’s chances of recovery,” Penda said.

Costs of Public Health Care Prohibitive

However, some private clinic operators claim they are providing a much-needed service as the cost of medical care in government hospitals and clinics is prohibitive.

“There is a great need for the services of private clinics in Cameroon. The government structures fell short to satisfy all classes of patients, and are usually saturated with patients, making it difficult for them to receive fair treatment,” Maxwel Fonyu, a laboratory technician and owner of small clinic in Yaounde, told IPS.

He argued that millions of people living in urban slums depend on the affordable medical assistance provided by these private clinics.

“In my clinic, for example, instead of demanding 10 dollars for a malaria test like in big hospitals, I only charge them one dollar to conduct malaria tests, and prescribe and sell medicines that are affordable and vital for their treatment,” Fonyu said.

Illegal Clinics Government’s Fault

Bidjogo Atangana, secretary-general of Cameroon’s National Medical Council, told IPS that the existence of the illegal and ill-equipped clinics was partially because of the government’s liberalisation of the sector some two decades ago.

“In the 1990s people were authorised to open health clinics as a Common Initiative Group (CIG) [a non-profit], which is one of the easiest means to acquire a licence for such ventures,” Atangana said.

Today the National Medical Council wants all medical centres that have been operating as CIGs to close down and obtain proper qualifications and medical licences, which many do not have.

“Nobody will hence own such a structure without authority from the Cameroon National Medical Council, and the training offered in some health institutions must also be checked,” Atangana said.

But according to Etienne Tsou from the health science faculty at Cameroon’s Catholic University, there is a need to regulate more than just the clinics, as most training institutions operate illicitly.

“I don’t see how a medical professional can be trained on the job and not have a formal education. Most retired nurses and doctors think they are qualified to open their own centres and train others when they don’t have what it takes,” he told IPS.

“The sector may lack qualified professionals, but putting the lives of innocent citizens in the hands of charlatans will lead to a bigger public health problem. There are, however, many Cameroonians with good graduate diplomas but their services are exported to countries that pay higher [salaries].”

Lack of Trained Staff

According to the Ministry of Health, about 5,000 Cameroonian medical doctors are currently plying their trade abroad.

Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, said that out of 4,200 medical doctors residing in Cameroon, only about half are practicing as medical doctors.

Of the other half, about 1,000 are on secondment to the Ministry of Health where they perform mostly administrative tasks. The remaining 1,100 are either with the Faculty of Medicine and Biomedical Sciences at the University of Yaoundé I, with NGOs or the private sector.

More than 500 medical doctors and 5,000 nurses graduate annually in Cameroon.

But Ekoe explained that the limited number of practicing medical doctors in the country makes the World Health Organisation doctor-patient ratio of one doctor per 10,000 inhabitants unrealistic in Cameroon – a country of about 21 million people.

“The real ratio is closer to one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Provinces, the ratio is closer to one doctor per 50,000 inhabitants,” Ekoe said.

Yenenesh Yigsaw (right) recovers from her latest reconstructive surgery with other Noma patients at a recuperation centre outside of Addis Ababa, Ethiopia’s capital. Credit: Nick Ashdown/IPS

By Nick Ashdown
ADDIS ABABA, Jan 22 2014 (IPS)

It’s hard to tell if Gelegay Tsegaye is smiling, since a flap of skin covers half his mouth, but his eyes crinkle when he talks and his muffled voice rings with an upbeat cadence. He’s sitting in a special ward of the Korean Hospital in Addis Ababa, Ethiopia’s most modern healthcare facility. 

Gelegay’s affability is notable because of what he’s gone through. The 34-year-old farmer from a village in Ethiopia’s Gojam region is a survivor of Noma, a rare flesh-eating infection that rots away the face.

When he was just two years old, Gelegay noticed black spots forming on his nose, which quickly spread downwards to his mouth. He received rudimentary treatment, but the diseased part of his face fell off.

Noma is only found amongst children (primary incidence is between the ages of one and four) in the poorest regions of the world, such as rural parts of sub-Saharan Africa and India. The World Health Organisation estimates there are 140,000 new cases globally each year.

Noma’s cause is abject poverty. According to the U.S. Government’s Global Hunger and Food Security Initiative, “Ethiopia is among the poorest countries in the world, with a per capita GDP of 471 dollars.” About 29.6 percent of this Horn of Africa’s 90 million people still live below the poverty line.

Noma only occurs in the poorest villages, where adequate healthcare is non-existent. And there are no official figures on the prevalence of the disease in Ethiopia. Malnourished children with a weakened immune system caused by a viral infection such as measles or malaria are prone to Noma when living in conditions of poor hygiene.

The infection can occur when a child living in poverty suffers a cut to the gums. The cut becomes infected and Noma quickly spreads across the face. Within 10 days, 85 percent of its victims are dead.

The survivors may not feel that lucky though, since they’re left with large portions of their face missing. The affliction then becomes social, not medical.

After Gelegay’s face healed, it wasn’t painful, but the disfigurement left him uncomfortable around people. “I used to be very embarrassed to mix with people. They just pushed me away,” he tells IPS.

Here, Noma survivors don’t go to school. They’re usually isolated by their community, their families, or themselves because they don’t feel comfortable around other people.

Yenenesh Yigsaw is a 19-year-old girl from Ethiopia’s Tigray region who also had Noma when she was two.

Yenenesh didn’t realise she was disfigured until she went to school, and soon stopped going.

“It was my decision. I hated being different from all my friends. I always had to walk around with my face covered, and was very embarrassed,” she tells IPS.

Local surgical resident Gersam Abera has never actually worked with or even seen Noma cases before now.

“Usually, they’ll just stay at home. They don’t even seek traditional treatment,” he tells IPS, adding that many people thought of the condition as a punishment from God and not a medical problem.

A few years ago, Gelegay and Yenenesh heard about Facing Africa, a charity group based in the United Kingdom that gives Noma survivors in Ethiopia free reconstructive surgeries.

Fifteen years ago, Englishman Chris Lawrence started the charity so he could help people in a way that he could see with his own eyes.

Lawrence describes his response to seeing Noma for the first time as “sheer anger.”

“Anger that a disease like this, which is caused by malnutrition and extreme poverty, should exist in the twenty-first century,” he tells IPS.

“Noma is not a disease that needs to exist. If it’s caught in the early stages it’s very easily cured.” Simple antibiotics stop the infection dead in its tracks.

“Either they die, or by the time a doctor sees them, half their face is gone,” Lawrence says.

Most people in rural Ethiopia lack local access to antibiotics, and there are no specific government initiatives for tackling Noma.

The infection can only be eliminated by massive upgrades to rural healthcare, sanitation, and nutrition, which can only be done by the government.

However, experts say rural healthcare has significantly improved since the government launched the Health Extension Programme in 2004/2005.

“This programme has massively increased access to the most basic of health services,” Garth Van’t Hul, country director at the charity group CARE Ethiopia, tells IPS. “It was a major contributor in decreasing mortality rates of under-five-year-olds.”

Gelegay has had three procedures to cover up a cavern in his face enveloping his nose and upper mouth, and Yenenesh had two on her cheek.

They both say life has improved since the procedures. Yenenesh has more friends, and people treat her better now.

Gelegay says meeting other patients with Noma has made him feel a lot better.

“At first I was very surprised because I thought I was the only one,” he says.

Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

By Brendon Bosworth
CAPE TOWN, South Africa, Dec 12 2013 (IPS)

Paul Anley, chief executive officer of Pharma Dynamics, one of South Africa’s leading generic drug companies, wants to sell a cheaper version of popular birth control pill Yasmin. But he legally cannot because German multinational Bayer has patent protection on the drug in South Africa, even though its initial patent expired in 2010.

Generic versions of the contraceptive are available in the United States and Europe, where Bayer’s patent has been revoked.

Anley says South Africa’s patent system makes it easy for multinational pharmaceutical companies to make minor changes to their products and get multiple patents, each spanning 20 years, and keep generics off the market.

“Multinational pharmaceutical companies undertake a process of what we call patent ‘evergreening,’” Anley told IPS. “They will literally flood the patent office with hundreds of patents for every single molecule or product they sell, and they do it over a protracted period.”

Pharma Dynamics lost a court case against Bayer over the validity of Bayer’s patent, which relates to the rate at which the drug’s active ingredient dissolves, in March 2013. It is barred from selling its generic and has filed an appeal against the decision.

“Bayer will continue to vigorously defend its patents,” Bayer’s medical director, Dr. Gené van den Ende, told IPS in an emailed response. Van den Ende did not comment on allegations of evergreening.

Since 2002, Bayer has filed for 11 different patents in South Africa for one of the active ingredients in Yasmin.

Plenty of patents?

In September, South Africa’s Department of Trade and Industry released a draft national policy on intellectual property that proposes changing South Africa’s patent system.

Anley and patent reform advocates like HIV advocacy group the Treatment Action Campaign and Médecins Sans Frontières hope the proposals will curb the number of patents granted and increase access to cheaper medicines.

“We grant far more patents than other countries, both developing and developed,” Catherine Tomlinson, a researcher with Treatment Action Campaign, told IPS. “A lot of what we’re providing patents on is not actually meeting patent standards to provide something new and innovative.”

In 2008, South Africa granted 2,442 pharmaceutical patents, according to research by Carlos Correa at the University of Buenos Aires’ South Centre. Brazil granted just 278 patents between 2003 and 2008.

Supporters of patent reform point to the price difference between originator drugs in South Africa and generics available in countries like India – which has been strict in denying patents for formulations of new medicines – as a consequence of South Africa’s patent laws.

The Treatment Action Campaign found that generic versions of popular cancer drugs are available in India for between four percent and 44 percent of the cost of originator versions in South Africa, based on a comparison of 2012 prices.

India has made also use of compulsory licencing. In cases where government feels the price of a drug is too high, it can grant licenses that allow generics manufacturers to produce versions of drugs under patent protection without consent of the patent owner. The World Trade Organisation’s Trade-Related Aspects of Intellectual Property Rights Agreement allows for compulsory licencing.

As a signatory to the WTO agreement, South Africa can grant compulsory licences but has not done so in the past.

The draft national policy recommends introducing the use of compulsory licenses. But whether or not these are granted in the future depends on the interpretation of the courts, patent attorney Madelein Kleyn, who is the intellectual property manager for Oro Agri and a research fellow at Stellenbosch University’s Anton Mostert Chair of Intellectual Property Law, told IPS.

Long road to reform

Government’s draft intellectual property policy recommends introducing a search and examination process to the South African patent office that involves having experts assess the novelty or original merit of an invention.

Currently, those applying for patents in South Africa need to fill out the application documents correctly and pay the required fees. If a company or individual wishes to challenge the validity of a patent after it’s granted, the challenge must be done through the courts.

Intellectual property lawyers note that government does not have the staff required to perform search and examination procedures.

“The patent office, as it stands, currently lacks skilled force to implement such a system,” said Kleyn. “Patent examiners are highly qualified people who specialize in the different areas of technology and require an in-depth understanding of the patentability requirements to assess a new filed invention against the prior art of the specific technical area.”

Outsourcing this work to international or regional offices, as suggested in the draft policy, would make sense, she said.

Since patents can be revoked through the courts, and intellectual property professionals advise patent applicants to amend their claims based on foreign patent cases, the system in South Africa allows for strong and tested patents despite the lack of a search and examination process, Kleyn explained.

She recommended focusing on educating judges who deal with patent cases to make the legal system work more effectively instead. This shift would also be cheaper.

If introduced, the search and examination procedure would take a long time to alter the patent landscape.

“The system will not eliminate the weak patents that will be on the register by the time the system is introduced in say (being kind) five years,” wrote former deputy president of South Africa’s Supreme Court of Appeal Louis Harms in his comments on the draft policy. “This means that weak patents will still be around for 25 years.”

Anley, of Pharma Dynamics, agreed that the proposed changes would take time to take effect.

“We’re very encouraged that government recognises the problems facing generic pharmaceutical companies and has addressed most of them in the draft,” he said. “Our concern would be that the process of capacity building is a very long and difficult process.”

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA
, Nov 19 2013 (IPS)

Ever since giving birth to a stillborn baby 15 years ago, Mary*, a peasant farmer from Mubende District in central Uganda, has continuously leaked urine.

“I am home all the time. I don’t go out to the market, I don’t go to church,” says the 35-year-old, speaking through a translator in a crowded ward at the Mulago National Referral Hospital in the country’s capital, Kampala.

Every time Mary drinks something, her bladder empties out the contents and she is forced to constantly pat herself dry with old clothes.

Mary has obstetric fistula. Defined as a hole between the vagina and the bladder, or between the vagina and rectum of a woman that results in the constant leakage of urine and/or faeces through the vagina. The medical condition is predominantly caused by prolonged or obstructed labour lasting more than 24 hours.

Mary’s labour lasted three days. As the nearest hospital was too far away, Mubende District is some 144 km west of Kampala, a traditional birth attendant took Mary to a small health facility when she went into labour. For 48 hours she remained there, trying to give birth to her child. On the third day she was taken to a district hospital where she was able to deliver her stillborn baby.

Abandoned by the father of her child, Mary was later ostracised by her own family.

“Even my sisters who I was living with shunned me. I am stigmatised because I smell all the time,” she tells IPS.

Mary’s story is “typical”, Dr. Susan Obore, an obstetrician who specialises in urogynaecology at the Mulago National Referral Hospital, tells IPS.

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. This means there are an estimated 140,000 to 200,000 women with fistula in the country, the Ugandan Ministry of Health (MoH) said in June.

“The true figures are not known because [women] do not come out, they are so stigmatised,” says Obore. “So what we see is probably the tip of the iceberg.”

Uganda grapples with an incredibly low number of surgeons who have the required training to carry out fistula repairs. Currently there are only 24 in this East African nation.

“Twenty-four in a population of about 34 to 37 million. It’s like a drop in the ocean,” national fistula specialist and specialist in the MoH, Peter Mukasa, tells IPS.

“Every hospital should be able to repair a woman with fistula.”

Mukasa says the country has 1,900 new cases a year and can operate on 2,000 women annually. But according to the MoH, the large backlog of fistula cases, coupled with the increasing number of new cases, has “surpassed the existing capacity of our health facilities to repair the cases.”

“We are in a static position; the backlog remains. It will take us so many years to eliminate this,” Mukasa says.

“As we speak now there’s a fistula being formed, one or two or three or four hundred women are getting obstructed (in labour).”

He says fistula repair costs on average about 400 dollars, including the cost of transport to hospital, hospitalisation and other care.

“It is a lot of money,” he concedes, adding that in Uganda the expense is mainly catered for by the United Nations Population Fund (UNFPA).

Ethiopia, where according to the World Health Organisation at least 8,000 women develop new fistulas every year, is home to the world’s first dedicated fistula hospital, the Addis Ababa Fistula Hospital. But Obore insists a similar facility is not needed in Uganda.

“We are hoping to kick out fistula, so there’s no reason why we should have a dedicated hospital,” she says.

“Empowerment of women is one of the best ways to prevent fistula,” Obore adds.

Those most vulnerable to contracting fistula are young, illiterate and rural dwellers.

Worldwide, there are over two million women in Africa, Asia and the Arab region living with untreated obstetric fistula, according to the global Campaign to End Fistula, a programme by UNFPA and various partners.

Between 50,000 and 100,000 new cases of fistula, treatable through reconstructive surgery, occur globally each year, according to UNFPA.

International NGO Uganda Village Project (UVP) run fistula repair camps three times a year at Kamuli Mission Hospital, in Kamuli, eastern Uganda. Patients are identified through radio shows, village outreach programmes, health centre referrals and by word of mouth. They are transported to hospital and operated on by surgeons from the Uganda Childbirth Injuries Fund, a United Kingdom-based organisation.

The last camp was held in early September and 15 patients had surgery. For nine of them, the surgery was successful. The remaining four women still require a second operation, which will take place during the next camp that begins on Jan. 18, says the managing director of UVP’s Iganga office, Kait Maloney.

Mary was not aware she could be operated on until she heard a radio announcement. The first surgery she had at a rural hospital was unsuccessful. She was referred to the Mulago National Referral Hospital, where she will be operated on in the coming months.

“I’m happy to have the surgery. I have no problem going for it,” she says.

But Mary says that even after she has the surgery she will still think about her fistula. She acknowledges that it is unlikely she will have another baby because of her ordeal.

*Name withheld to protect patient’s identity.

Patented drugs limit patients’ access to public health care. Credit: Kristin Palitza/IPS

By Emilio Godoy
MEXICO CITY, Oct 8 2013 (IPS)

The Trans Pacific Partnership Agreement (TPP), the negotiation of which is set to conclude this year, could drive research into new drugs and improve access to medicines. Except – it won’t.

“The current health system is reaching its limit,” Judit Rius, manager of Médecins Sans Frontières/Doctors Without Borders Access Campaign in the United States, told IPS. “It is failing patients with rare diseases, for example.”

“That’s why the TPP could be a tool for promoting health and improving innovation and access, instead of fostering failed, costly systems based on monopolistic patents,” she added.

The TPP free trade accord went into force between Brunei, Chile, New Zealand and Singapore in January 2006. Eight other countries are now negotiating their incorporation: Australia, Canada, Japan, Malaysia, Mexico, Peru, the United States and Vietnam.
Of the 29 chapters under negotiation, the ones on intellectual property, investment and government procurement contain proposals, especially from the United States, to limit research and development of generic medicines, which are sold with the name of the active ingredient and can be produced once the patent for the original brand-name drug has expired.

Because they are less expensive, generic drugs are essential in the fight against disease, especially in poor developing countries.

The TPP talks have been shrouded in secrecy. But Rius said the aspects of the TPP that have been leaked to the press would hinder R&D in generic medicines, hurting the reduction of prices that has been achieved in recent years.

“Most affected by this would be patients, organisations that supply medicines, health and economy ministries, developing countries, and companies that produce generic medicines,” she said.

These laboratories are worried.

“The TPP could lead to the extension of patents and could hamper access to medicines,” José Luis Cárdenas, a lawyer who is an adviser to the board of Chile’s Industrial Association of Pharmaceutical Laboratories (ASILFA), told IPS.

“It is not realistic to think that developing countries are going to invest in R&D to produce new molecules,” given the investment capacity of multinational corporations, he said.

The 19th round of negotiations for the TPP took place in Brunei Aug. 23-30. Since then, the talks are no longer general but thematic. There are 21 working groups negotiating the 29 chapters, which include issues like agriculture, intellectual property, environment, services, telecommunications and investment.

Pharmaceutical patents give 20 years of protection, according to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) adopted in 1994 during the creation of the World Trade Organisation (WTO).

But the WTO’s 2001 Doha Declaration on the TRIPS Agreement and Public Health reaffirmed the flexibility of TRIPS member states in circumventing patent rights for better access to essential medicines. Under this declaration, governments may issue compulsory licenses on patents for medicines, or take other steps to protect public health.

Compulsory licensing is when a government allows someone else to produce a patented product without consent from the patent owner.

Washington wants the TPP to extend the length of chemical drug patent monopolies by five years and of biologics – products that includes a number of lifesaving drugs used to treat conditions such as cancer, diabetes and hepatitis C – by 12 years.

It is also pushing for data exclusivity, which gives companies monopoly rights over drugs by restricting the use of clinical trial data by drug regulators when approving generic or bioequivalent versions of drugs. This would keep the laboratories that make generic drugs from putting their products on the market as soon as patents expire.

In addition, it is pushing for the controversial practice of “evergreening” – the name given to the industry practice of seeking new patents after making small modifications to existing drugs.

Other measures on the table are patents for diagnostic, therapeutic and clinical procedures and the creation of a supranational mechanism to settle disputes between states and corporations.

These initiatives “affect access to medicine by the most disadvantaged segments of Mexican society due to the implications for the quality, safety and effectiveness of pharmaceutical products,” Gustavo Alcaraz, of Mexico’s National Association of Drug Manufacturers (ANAFAM), told IPS.

Alcaraz forms part of the Cuarto de Junto, a group of business delegates allowed by the economy ministry to monitor the negotiations without taking notes, after they sign a confidentiality agreement.

The secrecy surrounding the talks has kept civil society, academia, or health consumers from expressing their viewpoints on what is being negotiated.

Médecins Sans Frontières has called on the participating governments not to sign any agreement that undermines public health.

In 2011, non-governmental organisations and academics urged United Nations Special Rapporteur on the right to health Anand Grover to issue an urgent appeal to the governments involved in the TPP talks, on the grounds that the trade deal would severely impact the public health of the poor in developing nations.

In response, Grover sent a letter to the national authorities. But only Australia, Chile and New Zealand answered, defending the secrecy around the talks and voicing assurances that the right to health would be respected.

The effects of overzealous protection of intellectual property in health have been studied.

An article published in 2009 by the Health Affairs journal states that “Our study suggests that CAFTA (Central America Free Trade Agreement)’s intellectual property rules on data exclusivity and patents are responsible for the removal of several lower-cost generic drugs from the market in Guatemala and for the denial of entry to a number of others.”

And as a result of the U.S.-Jordan free trade treaty, “Medicine prices in Jordan have increased 20 percent since 2001,” according to a report published by Oxfam in 2007.

“Higher medicine prices are now threatening the financial sustainability of government public health programmes,” added the report.

The details of the agreement are on the table at the annual Asia Pacific Economic Cooperation (APEC) Forum Summit, taking place Oct. 7-8 in Bali.

After a TPP meeting on intellectual property in Mexico City Sept. 23-Oct. 2, the United States and Japan are now considering proposing that the extension of patent terms only apply to developed countries, allowing shorter periods in developing nations like Malaysia and Vietnam.

Medical officials in Somalia say that the withdrawal of international medical charity Médecins Sans Frontières from the country will have negative impact on lives of hundreds of thousands of people and further complicates the polio outbreak the country is facing. Credit: Ahmed Osman/IPS

By Ahmed Osman
MOGADISHU, Sep 30 2013 (IPS)

Maryan Yusuf, 39, is weak and barely able to speak because of her excruciating pain. A few hours earlier she delivered a baby at Somalia’s Afgooye Hospital, where essential drugs are dwindling at an alarming rate.

“This is my fourth child delivered here. But I cannot get as much care and treatment as I used to. I am in pain now. I don’t know if I will be well again,” Yusuf told IPS as she lay on a hospital bed that had no mattress.

Afgooye Hospital, situated in the agricultural town of Afgooye, 30 km southwest of the Somali capital, Mogadishu, is one of the many health facilities that used to receive support from the international medical charity Médecins Sans Frontières (MSF), or Doctors Without Borders. Because of this support the hospital was able to provide free healthcare to the residents of Afgooye and surrounding areas."We understand the reasons for [the MSF] pullout but that decision...is now causing huge suffering in Somalia.” -- Abdelaziz Qafiifo, Ministry of Human Development and Social Services spokesperson

But it has been almost a month since MSF left Somalia because of security concerns for its staff, and a senior nurse at Afgooye Hospital told IPS that the hospital was running out of basic drugs and vaccines.

The 20-bed Afgooye Hospital has only one doctor and seven nurses, who provide what services they can to the hundreds of patients who come through the doors every week.

“This is the place people who want free healthcare turn to, but since MSF left and no agency has filled its place we cannot support the health needs of the people here and in the town’s periphery,” the senior nurse said.

The international charity had been one of the few providers of essential healthcare here for the last 22 years. Somalia has been through almost 20 years of war, and its citizens are affected by poverty and a lack of essential services.

The current government has had to function with limited financial resources and the continued threat of the extremist Islamist group Al-Shabaab, which has waged a number of recent terrorist attacks on the capital Mogadishu despite being ousted from key cities across this Horn of Africa nation.

In an earlier interview with IPS, presidential spokesperson Abdirahman Omar Osman explained that the government’s monthly “revenue is roughly three million dollars from Mogadishu’s seaport and the airport, and yet the budget we need to execute our daily activities is at least 20 million dollars each month.”

The health centres supported by MSF were provided with various services, including free basic healthcare, malnutrition treatment, surgery, epidemic response, water and relief supplies.

MSF said more than 1,500 staff worked for its medical programmes across Somalia, including in Mogadishu and the two outlying towns of Afgooye and Daynille, as well as eight other towns across the country.

“In 2012 alone, MSF teams provided more than 624,000 medical consultations, admitted 41,100 patients to hospitals, cared for 30,090 malnourished children, vaccinated 58,620 people, and delivered 7,300 babies,” MSF said in August in a statement announcing its decision to leave Somalia. In a statement to IPS, MSF said there is normal traffic of patients at the hospital, with normal levels of care.

But Somali doctors warn that the decision will adversely affect the lives of “hundreds of thousands of people”.

Mohmaoud Yarow, a health officer in Mogadishu, said the impact of the MSF withdrawal was immediate and health centres that had previously received support from the international charity now have hundreds of people in need of care and many lack the drugs with which to treat them.

“I can understand how difficult it has been for MSF to leave Somalia, but the impact the pullout has had on the country’s health sector is enormous … with time this could turn into a deadly health crisis,” Yarow told IPS in Mogadishu.

Local media reported in August that Al-Shabaab fighters seized control of a former MSF-funded hospital in Marere, Middle Jubba Region, along with the medical equipment and drugs.

Medical officials also say that the MSF pullout further complicates the polio outbreak the country is facing as the medical charity had provided essential vaccines against the disease.

Earlier this year, polio was detected in several areas in Somalia, including the eastern region of Puntland as well as southern and central parts of the country. The World Health Organisation has confirmed 101 cases here and a massive vaccination campaign against the viral disease was launched in August.

The Somalia government has said that it was “deeply saddened” by the MSF decision to withdraw and has reiterated its commitment to providing a secure working environment to all aid agencies in the country.

Abdelaziz Qafiifo, spokesperson for Somali Ministry of Human Development and Social Services, which is responsible for the health sector, told IPS: “It is unfortunate that the withdrawal of MSF is having an impact on the lives of the Somali people. We understand the reasons for its pullout but that decision, whatever may have been its justification, is now causing huge suffering in Somalia.”

The Somali government said that the MSF decision has created “a critical vacuum that needs to be filled” and could “lead to a catastrophic humanitarian crisis”, and has urgently called on the international community and donor countries to offer their support.

But until support comes, many here will have to live without access to treatment.

Daahir Owre, an elderly man from Daynile district, west of Mogadishu, said he was unable to get antibiotics for his wife’s leg infection at the Daynile Hospital because the nurses told him that they had run out of the drugs.

“I don’t know what I am going to do now. I had to walk five kilometres to get here but I cannot get medicine for my family because there are no supplies at the centre,” Owre told IPS as he walked away.

Excerpt:

In markets and on roadsides across Yaoundé, counterfeit and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
YAOUNDE, Sep 5 2013 (IPS)

When Francois Biloa fell ill with malaria, his family did what they had always done in the past – they gave him anti-malaria drugs and antibiotics bought from the local market. Only when his condition worsened and he became bedridden and fell unconscious, did his family take him to a local clinic in Cameroon’s capital Yaoundé.

According to the clinic’s health attendant, six out of every 10 patients there had been using illegal or counterfeit drugs readily available in this Central African nation’s market place prior to admittance.

“We bought medicine from a store because it worked for us with [previous] malaria attacks and it is very affordable. With just about two dollars we usually afford a [fake] Coartem packet, which is a full treatment for malaria,” Biloa tells IPS from his hospital bed.“Self-medication [with illegal and counterfeit drugs] result in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly." -- Williams Takang from the Yaoundé University Teaching Hospital

In pharmacies, a packet of Coartem costs seven to eight dollars, while on the illicit market a packet can be bought for less than three dollars. A medical consultation costs four dollars on average.

“But in this hospital, I am told my bill is now over 75 dollars. The doctor says that I have a resistant strain of malaria and also typhoid fever,” Biloa says.

“I felt like I was dying during my attempted treatment at home. I only started regaining energy and full consciousness after [coming to] this clinic.”

In markets and on roadsides across Yaoundé, fake and illegal drugs are stacked on wooden racks and tables, openly displayed for sale. Trading in these drugs is illegal. The are available as a result of weak regulation, poor health services and high medical costs.

There are no precise figures on the quantity of illegal drugs entering Cameroon, but up to 70 percent of drugs sold here are traded on the black market, says Christophe Ampoam of the National Council of the Pharmaceutical Society of Cameroon.

According to Ampoam, this trade in illicit medication is so well organised that government officials and the police are helpless to halt it.

“The trade in illicit drugs in Cameroon operates like a very powerful mafia-like network, which is very difficult to dismantle. It is estimated that investment in illicit sales of medicines is five times more lucrative than through the regular system. Local officials dread dismantling the network because it has also infiltrated the judicial and customs system,” Ampoam tells IPS.

“Corrupt regulatory and legal systems are easily exploited by criminal smugglers and additional rules have only increased corruption.”

Ampoam says that most of the counterfeit drugs are made in the Middle East and East and South Asia, yet many carry the inscription ‘Made in Germany’. They are smuggled into Cameroon by sea and through the porous borders this country shares with Nigeria and the Central African Republic.

“Although it is difficult to give an exact statistic on the percentage of illicit drugs found in local markets today, the availability of drugs in local markets, makeshift shops, on the streets and along the highways tells of the deplorable situation in Cameroon,” he says.

The World Health Organisation (WHO) estimates that worldwide 200,000 deaths per annum could be prevented if people did not use counterfeit drugs. According to the International Policy Network report, fake tuberculosis and malaria drugs alone are estimated to kill 700,000 people globally each year.

“Most of the drugs in circulation have been banned in certain countries because they are toxic or counterfeit. Some have the correct ingredients but in low quantities. Some of the drugs are samples or medicines donated by NGOs,” Ampoam explains.

Marlise Loudang, director of the pharmaceutical inspection service at the ministry of public health says that government teams in every region across the country are clamping down on the illegal trade, but so far efforts have been unsuccessful.

“Self-medication [with illegal and counterfeit drugs] is a big public health problem in Cameroon that affects almost every family. This stems from the easy access to drugs of doubtful origin and quality all over the national territory,” Loudang tells IPS.

Marcel Olinga is a vendor of counterfeit and illegal drugs and says that even though authorities have raided him, it has not deterred him from continuing. “Once in a while the police come around and seize my drugs, but it is a loss worth incurring because the raids are not regular and our main stocks are never where we sell.”

Olinga says he makes about 40 dollars a day.

“We receive many customers daily. Some come with prescriptions from doctors others seek our advice before buying and some simply demand what they want,” he tells IPS.

According the WHO, there are 13,514 patients for every doctor in Cameroon, although some say the ratio is higher, especially in rural areas. Poverty also limits many from seeking medication from hospitals and health clinics.

“Some patients run from costs of consultation in hospitals and fall in the hands of illegal drug vendors who are ready to sell drugs at prices far more below the legal market price,” Williams Takang from the Yaoundé University Teaching Hospital tells IPS.

“Self-medication [with illegal and counterfeit drugs] results in common health problems in local hospitals and the worst of these cases are in hospitals found in poor neighbourhoods and rural communities where the poverty level is very high and access to a doctor is costly,” he says.

“The intake of fake and illegal medicines can lead to life-threatening consequences especially for diseases with high mortality rates like malaria. Unfortunately most of the patients suffering from these common diseases put themselves on medication without any prior medical consultations,” Takang says.

The disease itself may not discriminate on the basis of gender, but when it comes to healthcare for patients with diabetes, women in India find themselves at a disadvantage compared to men.

This was the conclusion of the study, ‘Impact of Gender on Care of Type 2 Diabetes in Varkala, Kerala’, which analysed gender roles, norms and values in a household and found women patients to be more vulnerable.

Women in India face disadvantages when it comes to diabetes. Credit: K.S. Harikrishnan/IPS

And this vulnerability influences all phases of diabetic care, according to the paper by Dr Mini P. Mani at the Achutha Menon Centre for Health Science Studies (AMCHSS) in Thiruvananthapuram, the capital of the southern Indian state of Kerala.

Even when they themselves suffer from diabetes, women cannot abandon the ‘caretaker role’ in the family and have to continue to prioritise the health of other family members above their own, the study found. Further, inequitable access to resources prevents early diagnosis of the disease in women.

Women pay more attention to the health of the men and children in the family, leaving them with less time to devote to their own wellbeing, said Rosy Raphy, who teaches at a school in Munambam, near the central Kerala town of Kochi.

“As someone who has lived with diabetes for 26 years,” Raphy told IPS, “I can say that I was not aware of the disease and did not take due care because I was preoccupied with matters of the family. As a result, my case got aggravated.”

Of particular concern to women and gynaecologists in the country is Gestational Diabetes Mellitus (GDM), a form of the disease that affects pregnant women.

The incidence of GDM has grown fourfold in the last 10 years, according to Dr B. Rajkumar, a doctor of Indian Systems of Medicine at the Keezhariyoor Government Ayurveda Dispensary in the state’s northern coastal district of Kozhikode.

“Earlier, pregnant women would engage in physical activity while doing housework. Today, the lifestyle of women has changed. Lack of exercise affects the body. And obesity, too, is a cause of gestational diabetes,” he said.

One in five pregnant women in Ahmedabad in the western Indian state of Gujarat were found to be suffering from GDM, according to a study by the Diabetes Care Institute in that city, whose results were reported in February.

“What is alarming,” the report said, “is that of the five women found to have diabetes, two were diagnosed with the silent killer while the other three went undetected.”

And women with GDM were at higher risk of developing diabetes later in life, warned an earlier study in Kerala’s neighbouring state of Tamil Nadu, conducted by a group of doctors led by endocrinologist Dr V. Seshiah.

“They are the ideal group to be targeted for lifestyle modification or pharmacologic intervention in order to delay or postpone the onset of overt diabetes. Hence, an important public health priority in the prevention of diabetes is to address maternal health both during the ante- and post-partum period,” the study noted.

Medical researchers believe that the disease, earlier considered an ailment of the rich, is on the rise in India. Close to 70 million people – half of them women – in this country of 1.21 billion are living with diabetes, and the number is predicted to go up to 101.2 million by 2030.

Nearly 60 per cent of diabetics in India have never been screened or diagnosed due to a lack of awareness, according to a 2012 report published by the Brussels-based International Diabetes Federation (IDF), an umbrella organisation of diabetes associations in 160 countries. The study also noted that nearly 63 per cent did not even know the complications that arise from the disease.

Doctors attending the four-day World Congress of Diabetes in April, organised by Diabetes India in Kochi, suggested India-specific treatment guidelines for helping the rapidly growing number of patients in the country.

Dr Jothydev Kesavadev, the organising secretary for the fifth edition of the congress and the moderator for glucose monitoring consensus guidelines, told IPS that low-income patients suffer the most as they lack medical insurance.

“Though there are international guidelines for the treatment of diabetes, there is an urgent need for country-oriented guidelines,” he said, “especially in areas of glucose monitoring and use of insulin in hospitals, besides taking into consideration the socioeconomic status of a patient and the country.”

Healthcare experts say that a combination of dietary pattern, sedentary lifestyle, obesity, and genetic predisposition puts Indians at a unique risk of acquiring diabetes.

Analysing the increasing percentage of diabetic patients in the country, Dr Meenu Hariharan, director of the Indian Institute of Diabetes in Thiruvananthapuram, told IPS that Indians were more prone genetically to diabetes than Europeans.

“Reduced physical activity and obesity accelerate the onset of diabetes in genetically predisposed people,” she said. Starch-rich diets and increased intake of tinned foods with a high content of preservatives are other culprits.

A host of studies and screening programmes have highlighted the fact that diabetes is spreading fast across the country.

Cases of diabetes are higher in the four southern states – Karnataka, Tamil Nadu, Andhra Pradesh and Kerala – than in other states, according to the results of a countrywide blood testing campaign conducted under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes by the country’s health ministry.

In Tamil Nadu, 11.76 per cent of people tested positive for diabetes, 10.2 percent in Karnataka, 8.83 per cent in Kerala, and 8.72 per cent in Andhra Pradesh, compared to just 2.95 percent in the central Indian state of Madhya Pradesh, which reported the lowest incidence of the disease.

Alarmingly, rural areas are also seeing a rise in diabetes rates, as a fall-out of rapid urbanisation. However, the incidence of the disease remains higher in cities than in villages, according to Dr V. Ramankutty, a well-known health activist and professor at Thiruvananthapuram’s AMCHSS.

Talking to IPS, he charted the rise in the incidence of the disease. A survey in the early 1970s, he said, found only 2.3 per cent of the urban population and 1.5 per cent of the rural population to be suffering from diabetes. But by 1992, the proportion had gone up to 8.2 per cent and 2.4 per cent for urban and rural areas, respectively. A repeat survey after five years found an even higher prevalence of the disease in urban areas, at 11.6 per cent.

But if it’s any consolation, insulin-deficient diabetes in children is less common in India than in Western countries, said Dr G.D. Thapar, former director of the Ram Manohar Lohia Hospital in New Delhi. In his book ‘How to Lead a Healthy Life despite Diabetes’, he emphasised how crucial breast-feeding is to prevent the disease in children.

From Apr. 1, the South African Department of Health introduced fixed-dose ARVs. Activists and health professionals have welcomed the FDAs as easier and more convenient for patients. Credit: Nastasya Tay/IPS

By Melany Bendix
CAPE TOWN, South Africa, May 6 2013 (IPS)

“If I don’t have my pills, I don’t know what will happen. I will probably get sick again, very sick. Maybe I will die this time,” says Xoliswa Mbana* as she readies her four young children for school in the impoverished informal settlement of Masiphumelele, in Cape Town, South Africa.

Two years ago Mbana, who was diagnosed HIV-positive in 2008, had a CD4 count of less than 200. Dangerously ill, she was convinced by nurses at her local clinic to begin antiretroviral (ARV) treatment.

“I didn’t trust the muti (a Zulu word for traditional medicine) at first because I had heard a lot of bad things about them. But I was dying; I had no choice. When I started to feel better I was so happy. The government must please not take my happiness away from me,” the 42-year-old tells IPS.

Mbana, who is among the 5.5 to 5.9 million South Africans the Joint United Nations Programme on HIV/AIDS estimates are living with the disease, is referring to her fear of being cut off from her life-saving pills. It is a fear that is not unwarranted.

Last May she was forced off treatment for three weeks because her local clinic ran out of ARV drugs. It was one of hundreds of distribution points across six of South Africa’s provinces that were struck by a serious supply shortage, the most recent of several stockouts that have plagued the state-funded ARV treatment programme since its launch in 2004.

It is the South African Department of Health’s (DoH) shaky ARV supply track record that has treatment activists sounding alarm bells over the Apr. 1 introduction of fixed-dose ARVs (FDAs).

Until now, state-funded ARV treatment has comprised three different pills taken at different times during the day. The new FDA combines the three key agents from these pills in a single pill that only needs to be taken once a day.

Although welcoming the FDAs as easier and more convenient for patients, activists and health professionals alike have warned that a stockout of the drug could have a catastrophic effect on the country’s public HIV/AIDS treatment programme — the largest of its kind in the world.

“With the individual ARV drugs, if there is a shortage of one ARV then people can still take the other two drugs, though it’s not ideal. However, if there’s a stockout of the fixed-dose pill, then patients will have no recourse,” Mark Heywood, executive director of health and social justice advocacy group Section 27, tells IPS.

Dr. Kevin Rebe of the Anova Health Institute, which runs the Health4Men programme focusing on HIV prevention and treatment, agrees.

“The risk of FDAs is that there isn’t really a good fall-back,” he tells IPS.

He points out that even a few missed doses could result in resistance to treatment: “You need to get 95 out of every 100 doses right, otherwise you risk treatment failing and the patient would then have to move on to a different, possibly more complex and more costly, treatment. So if there is a stockout (of FDAs), the implications could be severe.”

Professor Linda Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town, adds that a stockout could be a “serious health hazard” for dangerously ill people who have just started ARV treatment — people like Mbana, who could have died if there had been a stockout when she first began treatment in 2010.

Bekker is equally concerned that stockouts could set back hard-won gains in convincing HIV positive people to begin treatment and to then stick to a strict drug regimen.

“We really have to indoctrinate HIV infected patients on ARVs to be adherent. When non-adherence is then imposed on the patient through no fault of their own, this is very frustrating and alarming for patients,” she tells IPS.

Reducing the risks

Bekker believes the risks of an FDA stockout could be mitigated by accurately predicting the demand and ensuring adequate supply. While acknowledging this is easier said than done, she insists that strict supply management is the only way to ensure the success of the new FDA treatment regime.

“It is no mean feat to have started this large number of people on life-saving therapy and to then ensure they keep getting it for the rest of their lives. But we must do it and we must do it right.”

Rebe also stresses the importance of getting the FDA supply chain right and says the DoH’s initial plan looks promising.

“They seem to have been quite smart about it all, especially by introducing FDAs in phases: first for pregnant women, then patients on TB treatment, then those newly starting ARV treatment. Only once all these people are on FDAs will the others be moved over. This phased approach alone will go a long way in avoiding a stockout.”

Rebe points out that the DoH has also split the 2013/2014 FDA tender into multiple contracts. “This is good because if one supplier runs out the others should be able to pick up the shortfall,” he explains.

Joe Maila, DoH spokesperson, says bringing in additional suppliers would be considered only if the three current suppliers — Mylan, Cipla and Aspen — could not meet the demand.

Supply and demand is being monitored and managed at weekly meetings with both suppliers and provincial health authorities, he adds, enabling the department to “detect supply problems early and intervene.”

Importantly, Maila tells IPS, the department has stockpiled FDAs “as buffer stocks to alleviate shortages when these occur.”

Multiple benefits

The introduction of FDAs is also expected to significantly reduce the state’s annual bill for HIV/AIDS treatment.

The previous combination treatment cost around R120 (13.4 dollars) per person per month, whereas the cost of the new FDA is currently R93 (10.38 dollars) per month. With 1.9 million patients currently on state-funded ARV treatment, a saving of R27 (three dollars) per person per month is significant.

“The 2013 tender estimated that 30 million packs (of FDAs) will be purchased over two years, which will translate into an estimated saving of R810 million (90.5 million dollars),” Maila says.

Cost is just one of the many benefits of FDAs, which has convinced Rebe that the pros of this form of treatment far outweigh the cons.

“The three agents in the single-dose pills are the best we have right now…It’s also well proven that reducing the number of pills and the daily dosage is key to patients adhering to treatment regimens.”

A quick and easy single-dose pill is something Mbana is looking forward to when FDAs are eventually rolled out to her clinic in Masiphumelele. But for her, ensuring a steady supply of life-saving pills is more important than convenience.

“I don’t care if I have to take one tablet only one time a day or many tablets over the day, just as long as I have tablets to take.”

*First name changed on request

By Gustavo Capdevila
GENEVA, Apr 5 2013 (IPS)

India’s refusal to grant patent protection for the anti-cancer drug Glivec, developed by Swiss drugmaker Novartis, is a victory for the developing world, which depends on low-cost exports of generic medicines from the Asian giant, said public health specialist Germán Velásquez.

The triumph celebrated by the Colombian expert, who is a special adviser for health and development at the South Centre, was a landmark ruling against Novartis handed down Monday Apr. 1 by India’s Supreme Court.

The Geneva-based South Centre is an intergovernmental organisation of more than 50 developing countries that functions as an independent policy think tank.

Velásquez, who worked for over 20 years in the World Health Organization, explains in this interview with IPS his point of view on the legal battle in the courts in New Delhi and its consequences for developing countries.

Q: How do you interpret the ruling by the Supreme Court of India?

A: There are problems with the information that is being reported. Nearly everyone says that India rejected the patent for Glivec. That’s true, but it’s not all the verdict says.

Q: Could you explain?

A: At the heart of the verdict is the ratification of the criteria set by the Indian law for the approval of drug patents. That is, whether or not it meets the requisite of containing a genuine innovation.

Q: Could you describe the legal battle?

A: It all starts with the adoption of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), one of the treaties established at the same time the WHO was born, in 1995.

India was the only developing country to use the (entire 10-year) transition period to enforce TRIPS, in 2005, when it passed the patent act.

Q: What happened to the patent applications presented during that decade-long transition?

A: They accumulated, until there were around 10,000 applications, and it was not until 2005 that the patent office began to examine them. They included the application for the Glivec patent.

But the new standards turned out to be stricter, such as the one that indicates that the innovation can’t be just a small change to a molecule, but has to be something substantial. In short, the patent for local sales of Glivec was denied in 2006.

Q: How does the story continue from there?

A: Novartis challenged that decision and brought a lawsuit in a court in the city of Madras (the capital of the southern state of Tamil Nadu; the city was renamed Chennai in 1996.) But the High Court of that city, three years later, also rejected the application. That year, 2009, the company appealed the decision – and lost again.

Q: What options are left to the company?

A: This is the aspect that hasn’t been sufficiently reported. In a cynical, perverse and very serious move, Novartis says (prior to the ruling): “If they didn’t give me the patent, I’ll go to the Supreme Court, but to ask this time for the elimination of the strict criterion established in article 3 of the patent act.”

“If more flexible, lower standards are set, then my medicine will be in,” was its reasoning.

Q: So the dispute took on this other face?

A: Yes, because with the intention of introducing its drug by force, the transnational corporation was trying to modify the law of a country – and of a country like India. I think that its executives were being short-sighted when they made that decision. This has been very costly for them in terms of their image.

Q: How do you reach that conclusion?

A: It is clear that it was a misstep to denounce India’s patent law, with the risk of losing. The transnational industry in general had suffered a blunder in South Africa, when it was forced in 2001 to back down from legal action against a law that authorised the patenting of lower-price imported medicines in order to address the AIDS epidemic.

You could suppose that “Big Pharma”, as the major pharmaceutical companies are called, had learned the lesson. Especially knowing that Glivec was patented in 40 countries, including the United States, China and Russia.

Q: Are you insinuating that there may be a domino effect?

A: If Novartis loses in India, as it did on Monday, any of the governments of the 40 countries could ask themselves: “Why don’t I review that patent and revoke it?” That authority is granted by the legislation of all of those countries.

Q: What standing do those 40 countries that recognise the Glivec patent have?

A: Most of them are industrialised states, large markets. But they also include some that are currently experiencing severe economic difficulties, like Greece or Spain, whose authorities could ask themselves why they should pay 2,500 dollars a month per person for a treatment against cancer. They could say: “Why don’t I just have it produced as a generic drug, and invalidate this patent.”

I think the Novartis executives did not take that into account when they launched this legal battle. Obviously, after the first impetus, they continued on to the end, and today they’re going to see repercussions.

Q: What could those consequences be?

A: It should be a lesson for the rest of the countries of the developing South. They should try to follow India’s example and introduce in their legislation clauses like the ones contained in article 3d, which restricts and sets criteria with respect to what amounts to innovation, which is necessary in order to grant a patent. That there can’t just be a small change, which is sometimes merely cosmetic, to a molecule in the medication.

Q: What prospect is there for the spread of that criterion?

A: In India, the Philippines and Argentina, that prohibition already exists, while others are introducing it through alternative routes.

Q: And other consequences?

A: India will be able to continue to make generic versions of all new medicines that are not truly original, and it will continue exporting them without any problem. It’s necessary to take into account the fact that 95 percent of the antiretrovirals consumed in Africa come from that Asian country.

So that means the Indian Court’s ruling is extremely important, with very concrete repercussions for that medicine and some 10,000 others that are on the waiting list in the patent office in New Delhi.

Q: What percentage of those could get patents?

A: In 2010, Argentina approved 2,000 pharmaceutical patents, and China 4,000. But actually, just 40 or 50 products a year are true innovations.

Q: Why that enormous difference between patents that are granted and truly innovative products?

A: The pharmaceutical industry is facing huge difficulties in coming up with innovations.

So it clings to a very short-sighted way of thinking, very short-term, but enormously profitable. This consists of launching incremental innovations, as they are called – in other words, a small product with just a gradual change, but accompanied by a major marketing campaign.

Excerpt:

Luz Maldonado contracted Chagas disease from contaminated fruit juice in her urban upper-middle class Caracas neighbourhood. Credit: Estrella Gutiérrez/IPS

By Estrella Gutiérrez
CARACAS, Dec 21 2012 (IPS)

Chagas disease, the third most serious infectious disease in Latin America, is developing a “new face” and moving into urban areas, while a new treatment may offer hope for millions of sufferers.

The new face of the disease is exemplified by Luz Maldonado, a 47-year-old teacher from Venezuela. Maldonado contracted Chagas disease by drinking contaminated fruit juice, in an outbreak that infected 103 people at a school in Chacao, an upper-middle-class neighborhood in Caracas. One child died, and the lives of the other people infected have been changed forever.

Micro-epidemics caused by contaminated food are a new phenomenon. And, according to the scientific sources consulted for this story, the disease is even more virulent when it is contracted this way, because thousands of parasites enter the bloodstream all at once. The largest of these incidents were reported in 2005 in Brazil, in December 2007 in Caracas, and in 2010 in the nearby town of Chichiriviche de la Costa.

Maldonado now lives with headaches, rashes, joint problems, memory loss, tachycardia, insomnia and depression, largely due to the side effects of the drugs she must take to fight the parasites.

Chagas disease is caused by Trypanosoma cruzi, a protozoan (single-celled) parasite that is transmitted by blood-sucking insects. According to the World Health Organization (WHO), it affects between 17 and 20 million people in Latin America.

In addition, almost 25 percent of the region’s population is at risk of contracting the disease, which kills at least 50,000 people a year.

According to WHO, Chagas disease is one of the world’s 13 most neglected tropical diseases, the third most serious infectious disease in Latin America, after HIV/AIDS and tuberculosis, and the parasitic infection with the highest morbidity and greatest socioeconomic impact in the region. The only country in Latin America to be declared free of the insect that spreads the disease, in mid-2012, is Uruguay.

However, all statistics on the disease are approximate, because “many cases are never diagnosed,” Belkisyolé Alarcón de Nola, the director of immunology at Venezuela’s Institute of Tropical Medicine (IMT), told Tierramérica*.

People whose infection goes undiagnosed either do not develop symptoms, or the symptoms are attributed to other illnesses. They may die decades later of heart failure or a stroke that is never linked to Chagas disease, explained Nola, a medical doctor and researcher who coordinates the follow-up of Chagas patients in Venezuela.

Today, “the image of Chagas disease as a rural disease of the poor has been dispelled,” she said. “We can have cases at any altitude, latitude or stratum, and we need to change the way we confront its vectors.”

Urban sprawl has invaded the natural habitat of the disease’s vectors, said Nola. Caracas, located in a valley at an altitude of 1,000 meters, “has these sort of green fingers that extend into it, and these are the areas that are most accessible for the vectors to reach people’s homes,” she explained.

Logging and the clearing of forests by the slash-and-burn technique have left little food for the “chipos”, as Triatoma infestans, the insect that spreads the disease, is commonly known in Venezuela. It goes by various names in different countries of the region, including vinchuca, chirimacha and chichi, and is referred to as the “kissing bug” in English.

“We have vectors everywhere and even more so with climate change, because the warmer the earth becomes, the greater the reproduction of the insects,” said Nola.

Transmission most commonly occurs when insects infected with the parasites bite humans, ingest their blood, and then immediately defecate. Chagas disease is contracted if the parasites in the insect feces enter the organism through a break in the skin, such as when people scratch the bites, or through other openings, such as the eyes, when people rub them.

In Caracas, there is also a secondary, “poor” vector, Panstrongyilus geniculatus, “which is clumsy and takes longer to defecate,” said Nola.

But this “poor vector” is adapting. “Drawn by the lights in homes in urban and peri-urban areas, it enters through kitchen windows, wanders over utensils and food and defecates where it pleases,” she said.

In the transition to oral infection through contaminated food, “there have been many small outbreaks, many of which have gone undiagnosed.” However, there has been no other outbreak like the one in Chacao, given its fully urban location and the large number of people infected, after drinking guava juice contaminated with infected insect feces at the municipal school.

There are two strains of the Trypanosoma cruzi parasite that cause Chagas disease. One is found from Mexico to the north of South America, and the other from Brazil to the southern tip of the continent. The first primarily damages the heart, while the second also damages the esophagus and colon.

The disease has three stages. In the first, acute stage, symptoms can be very marked or very mild and easily confused with other diseases. The second, known as the intermediate or latent stage, lasts a variable period of time – sometimes many years or even decades – and is asymptomatic.

In the final, chronic stage, “the myocardial tissue is destroyed and does not regenerate, and is replaced with fibrous tissue. The heart increases in size and no longer contracts effectively; it pumps less blood into the lungs, and cardiac insufficiency gradually sets in,” explained Nola.

There are only two drugs indicated by WHO to eradicate the parasites: nifurtimox, introduced in 1960, and benznidazole, developed in 1974.

But eradication is only partial when the parasites have lodged into deep tissue and in the chronic stage of the disease.

Moreover, the side effects of these drugs cause collateral damage. “The ones that are most feared are the neurotoxic effects, because they cause peripheral neuropathy symptoms, such as sensations of extreme cold or heat, extreme sensitivity of the feet, and severe headaches,” said Nola.

But the promising findings of two Venezuelan researchers, Julio Urbina and Gustavo Benaim, have led Argentina and Bolivia to conduct clinical trials based on their experiments, while in Venezuela, “we hope to conduct a pilot study as well,” she reported.

Benaim, head of the cell signaling and parasite biochemistry laboratory at the state-run Institute of Advanced Studies, told Tierramérica that the goal is “to attack the parasite without affecting the human being, like current treatment methods do,” as well as “to develop drugs for the chronic stage, which are currently non-existent.”

The study is based on a specific property of Trypanosoma cruzi: its membranes do not contain cholesterol, but rather ergosterol, another sterol. “If you eliminate the ergosterol, which is indispensible for it, you eliminate the parasite,” he explained.

There are drugs that block the synthesis of ergosterol, such as posaconazole, which is approved by the United States Food and Drug Administration, although only for the treatment of fungal infections.

The researchers linked this fact with another clinical observation: Chagas patients whose arrhythmia (irregular heartbeat) was treated with amiodarone showed substantial improvement. “When it is applied to the parasites it is lethal for them,” Benaim enthusiastically reported in his laboratory.

Amiodarone is already used to treat arrhythmia, and 30 percent of Chagas sufferers in the United States receive it. It is not completely harmless, since it contains iodine, but its side effects are much milder than those of current treatments, said Benaim.

“We studied the mechanism of action of posaconazole and amiodarone; both of them were already known to be sterol inhibitors, but we demonstrated that amiodarone also alters the calcium regulation of the parasites,” he reported.

“Combining them boosts their effect, makes it possible to lower dosages, and cuts down on side effects,” he added.

Another new antiarrhythmic drug, dronedarone, which contains less iodine and is more easily eliminated, was also tested in their laboratory and “proved to be very successful. It is more powerful and acts more rapidly” in destroying the parasite, said Benaim.

An article on the new treatment was published in October in Nature Reviews Cardiology. In addition to Chagas disease, it can also be effective against other diseases caused by parasites, such as leishmaniasis.

“A good sterol inhibitor can bring an end to these parasitic diseases, which are viewed as diseases of the poor, and are therefore neglected,” stressed the Venezuelan researcher. In the case of diseases like these, “it isn’t profitable to conduct research into treatments for them. That is the sad reality.”
* This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.

A new kind of public-private partnership will begin in 2013 in Brazil to produce an antiretroviral drug, through a technology transfer agreement that will be in effect until the patent expires in 2017.

The productive development partnership is based on an agreement with New York-based drug maker Bristol-Myers Squibb, to produce atazanavir sulphate.

The drug will be made by Farmanguinhos, a technical-scientific unit of the Oswaldo Cruz Foundation (Fiocruz) and the Health Ministry’s largest pharmaceutical laboratory.

It will be distributed in the public health network as part of the antiretroviral (ARV) cocktail therapy that is provided free of charge to everyone who needs it in this country of 194 million people.

“It’s an important symbolic process,” Dirceu Greco, the director of the Health Ministry’s Department of Sexually Transmitted Diseases, AIDS and Hepatitis (DDST), told IPS, referring to the five-year agreement with Bristol-Myers Squibb, which will represent some 200 million dollars in savings for Brazil.

“The Health Ministry programme is part of a national plan to reduce the deficit in the country’s trade balance in the area of medicines,” Gaetano Crupi, president of Bristol-Myers Squibb Brazil, said in an interview with IPS. “Today atazanavir is 100 percent imported.”

“The government of Dilma Rousseff wants, first, to cut the trade deficit, and second, to save money in the long term by producing the drug at a national level,” he said.

This is the first time Brazil is entering into a partnership with a private company to produce a drug that is still protected by a patent, and that is very important in the national response to AIDS treatment, he added.

“The important thing about this partnership is that it will give us a greater degree of sovereignty in the production of a medication, because the technology will be incorporated by our country, and there will be savings as well, since the medicine will be offered to the government at a reduced price,” Health Minister Alexandre Padilla said.

Since 1996, Brazil has provided universal free ARV treatment, which now benefits some 217,000 people. The Sistema Único de Saúde (SUS – Single Health System), the public health network, treats 97 percent of people diagnosed with HIV/AIDS in the country.

Pedro Chequer, United Nations Joint Programme on HIV/AIDS representative in Brazil, said it was a stride forward “that this country maintains its policy of (universal) access with its own funds and largely with its own production of medicine.”

The Health Ministry distributes 20 ARV drugs at a cost of around 425 million dollars a year. Eight of them are produced by Productive Development Partnerships.

“In the midst of an economic crisis, continuing this strategy was a political decision in favour of the public,” Greco said.

The agreement for the production of atazanavir sulphate provides for the transfer of technology to a national laboratory, as well as the manufacturing and distribution of the drug for five years.

Farmanguinhos has acquired equipment for the production and will receive training from Bristol-Myers Squibb.

Atazanavir sulphate, which is in the protease inhibitor class of ARVs, will start to be distributed in packaging with the Farmanguinhos logo in 2013. But it will only begin to be produced with national technology in early 2015.

A total of 99 million 300-mg tablets will be distributed between 2013 and 2017.

“This will be the 11th ARV medicine produced in Brazil,” Greco said. “The main advance was to ensure that we could manufacture and distribute essential anti-AIDS medicines with public funds.”

“In my view, the idea of having a small state structure has serious consequences in the area of health,” he added.

Brazil, through Farmanguinhos, has agreements to supply medication to other developing countries, in Latin America and Africa, through what it considers one of the main arms of its foreign policy: South-South cooperation.

Crupi added that “What to do when the patent expires is a strategic decision that the government will resolve.”

By Julia Kallas
UNITED NATIONS, Dec 1 2012 (IPS)

On World AIDS Day, the fact that the number of children newly infected with HIV continues to decline is welcome news to UNITAID, the International Drug Purchase Facility hosted by the World Health Organisation.  But UNITAID is also well aware of how much more remains to be done for  children already living with the disease.

Philippe Douste-Blazy, of France, is a special advisor who promotes UNITAID and other sources of innovative financing for the achievement of the United Nations Millennium Development Goals (MDGs).

“There was some progress made but there is still a lot to be done by the international community,” Douste-Blazy told IPS regarding the fight against HIV/AIDS. “Unfortunately we do not have enough money to achieve the MDGs by 2015,” he added.

Douste-Blazy spoke to IPS U.N. correspondent Julia Kallas about the progress that has been made in preventing mother-to-child transmission of HIV but also how the international community must continue providing childhood HIV treatments to developing countries. Excerpts from the interview follow.

Q: What is the current funding scenario for treating childhood HIV in developing countries?

A: About 3.3 million children are living with HIV today. Unfortunately we do not have enough money to reach the Millennium Development Goals (MDGs) in general but in particular to reach the health-related MDGs – HIV, tuberculosis and malaria.

We must find funding now because with the current economic crisis, we will see a dramatic decrease in Official Development Aid (ODA). It will be difficult for all countries to help. We cannot ask the Greek government, for example, to donate 3 billion dollars for development countries because they are seeing an increase in poverty themselves. So we are going to see an increase in childhood mortality.

We have to create innovative financing for development. For example, UNITAID has placed a small tax on plane tickets. This funding helps combat childhood HIV.

Children are rarely born with HIV in wealthy countries because mothers living with HIV are treated during pregnancy to ensure that their babies are born HIV-free. Still, more than 1,000 children are born HIV-positive every day – 99 percent of them in Africa. Only 28 percent are treated.

We analysed what companies were interested in producing antiretroviral drugs. Our long-term funding gave suppliers the incentive to manufacture child-friendly formulations so we were able to buy pills for five years. Several generic suppliers that entered the market brought the price of the pills down by 70 percent.

Before, no child was treated by periotic antiretroviral, but with an adult’s syrup, 18 times a day. Now with only two pills a day, children can be treated.

Q: World AIDS Day is on Dec. 1. Should we be celebrating major progress?

A: Yes. We can see that there was some progress made, but there is still a lot to be done by the international community. For the first time more than 50 percent of the 15 million patients who need antiretroviral therapy have access to it.

It is also huge progress that we have 7 million fewer new HIV infections around the world, in particularly in Sub-Saharan Africa. Unfortunately in Eastern Europe, Russia and Indonesia, however, the infection has increased.

Q: Can you talk about the development of the three-in-one fixed-dose combination AIDS medicines for children?

A: Since its creation UNITAID has been working on combating paediatric HIV by creating a market for quality child-friendly antiretroviral treatments. Before, there was no incentive for pharmaceutical companies to invest in child-friendly antiretroviral drugs. HIV treatments for children in low-income countries were syrups designed for adults – up to 18 foul-tasting doses a day.

So the three-in-one fixed-dose combination AIDS medicines for children are a major innovation, from 18 doses a day to a pill twice a day. It is huge progress. Every year UNITAID finances the treatments of more than 100,000. Now is the time to follow up on our work with paediatric HIV.

Q: How should the new post-2015 sustainable development agenda address HIV/AIDS, and what can be done more effectively?

A: We cannot continue if we do not have money. Every head of state, head of government or member of parliament says we are going to reach the MDGs. It is not true.

To combat HIV we need three things. First is prevention. We need to help prevent high-risk people such as prostitutes and homosexuals from becoming infected. Secondly, we must ensure universal access of treatment. Only 54 percent of adults and 28 percent of children are being treated today.

Finally, we need to raise funds to achieve the MDGs – we need more innovative financing. With UNITAID, we proved that this is possible.

Q: Can you talk more about the one-dollar plane tax idea created by you, former Brazilian president Lula and former French president Chirac? What needs to be done to get more countries involved in this project?

A: UNITAID’s funding model is based on an air ticket solidarity levy. Every American who goes to France is going to pay one extra U.S. dollar to support our program. It is the same thing in 15 other countries. In five years we raised 2.5 billion dollars, and it is predictable, sustainable funding.

For the traveller, it is painless – people who can pay for a plane ticket can easily pay an extra dollar. It is not even the price of a coffee. With this funding we help combat childhood HIV. Eight out of 10 children are treated thanks to this system. Now we are working to convince more countries to become involved in this program.

Excerpt:

Condom promotion campaign in Male: Credit: SHE

By Feizal Samath
MALE, Sep 22 2012 (IPS)

For an orthodox Islamic country, the Maldives has made remarkable progress in halting the spread of HIV in the Indian Ocean archipelago through bold awareness programmes and the distribution of condoms.

A few years ago, condoms were available in the Maldives only at drug stores and on production of a doctor’s prescription. Anyone found carrying a condom in the streets  was liable to be arrested by police.

But, a five-year project mounted by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), reports progress in creating awareness of safe sex issues and the use condoms by providing them free. The GFATM is supported by the Bill and Melinda Gates Foundation.

The GFATM programme in the Maldives addressed the sexually active among the 300,000 Maldivians, but focused on the 110,000 foreign workers in the country – mostly Bangladeshis, Indians and Sri Lankans employed in construction and in the country’s famed luxury resorts.

“We did a lot of work in the five years of the programme, which ended in August,” Ivana Lohar, HIV/AIDS project manager at the United Nations Development Programme in the Maldives, told IPS. “We believe that one more round of global funding would help to sustain the momentum.”

The challenge, Lohar said, is to ensure that the Maldives remains a low HIV prevalence country despite the presence of high-risk groups. As of December 2011, only 15 HIV cases were reported among Maldivians, while there were 289 cases among the foreign  labour force.

At the spanking new Voluntary Counselling and Testing Centre set up in the heart of capital by the Society for Health Education (SHE), a local non-government organisation (NGO), both local residents and foreign workers can avail of the free services.

Asna Luthfee, programme associate at SHE, says her work has included training 40 migrant workers as peer educators to promote awareness at hotspots where foreign workers congregate and provide condoms on request.

SHE offers a range of services through a sexual and reproductive health clinic, including screening for thalassaemia, DNA testing, counselling and psychosocial support. “We distribute oral pills, emergency contraceptives and condoms. We don’t ask people whether they are married or not – we distribute on request,” Luthfee said.

“There is also counselling if testing for HIV shows positive, and these cases are referred to the government,” Luthfee said. The programme, in which SHE and UNAIDS are partners, has been successful enough to be seen as a model for the region, she added.

Mohamed Yahiya, an accountant from Bangladesh who also works as HIV peer educator, said a government decision made earlier in the year to allow workers who contract HIV in the country to stay on and get free treatment, has helped immensely.

“Many were scared to talk about their HIV status fearing deportation, but the new government guidelines have eased those concerns,” he said. Foreign workers, however, undergo mandatory testing on arrival and those testing positive are refused entry.

The campaign has had its ups and downs because of pressure from the public and  religious groups that accused organisers of promoting promiscuous sexual behaviour.

“Though religion has its own inhibitions, Maldivian society is open and able to understand the need for awarenesss,” says Lohar. “We are not trying to interfere with religious beliefs, but flagging a serious public health issue. AIDS is a devastating condition that can impact the economy.”

A spokesman (officials may not be named under briefing rules) for the National AIDS Programme (NAP) said stigma and discrimination are still prevalent and public surveys in 2008 and 2009 showed that them to be  barriers to effectively addressing HIV and AIDS.

The UN-funded Biological and Behavioural Survey on HIV/AIDS – 2008 had noted that the potential for HIV transmission is “accelerated by non-use of condoms and the sharing of unsterile needles and syringes among injectors.”

Unprotected sex is high in all the risk groups. Aside from the risk behaviours themselves, a growing concern is the early age at which commercial sex and injecting drug use start in the Maldives, the study found.

The Maldives, warned the report, “is showing signals of a possible future epidemic which need to be closely monitored by the national programme, including injecting drug use in prisons and rehabilitation centres and risk behaviours found among the 18-24 year age group (selling and buying of sex, group sex, male-to-male sex, sex with non-regular partners, and injecting drug use).”

The NAP spokesman said that religious groups and scholars are supportive of public health efforts to prevent diseases and in this context using condoms is advised. “Prevention efforts are well supported by the religious scholars, and recently they have been involved as partners in HIV prevention work,” he added.

A major component of the programme was the conduct of migrant fairs where free testing for HIV/AIDS was provided. The latest of these fairs, which was held in August,  had collaboration from  government agencies, embassies and high commissions.

“Though most workers don’t understand English, these cultural shows break barriers and provide foreigners access to services, overcoming stigma and discrimination,” Luthfee said.

“Workers are provided information in their own language and when they return to their home countries they go back armed with knowledge on health issues,” said Yahiya.

Dengue patients at Cambodia's National Paediatric hospital. Credit: Erika Pineros/IPS

By Vincent MacIsaac
PHNOM PENH, Sep 13 2012 (IPS)

Public health experts in Cambodia are unenthused by reports of trials for a dengue vaccine conducted in neighbouring Thailand, saying it will be too costly for those who need it most – children in the least developed and developing countries.

“Of course, they cannot come out with a vaccine that costs 20 cents,” Dr. Philip Buchy, head of the virology unit at the Pasteur Institute of Cambodia, told IPS.

Buchy was referring to the Paris-based pharmaceutical company Sanofi SA’s dengue vaccine efficacy trials, the results of which were published in the British medical journal Lancet, this month.

Dr. Stephen Bjorges, leader of the vector-borne disease team at the World Health Organisation (WHO) in Cambodia, agrees. Even if Sanofi succeeds “funds would need to be mobilised” to cover the cost of inoculating children in Cambodia, he said.

A dengue epidemic that raged through Cambodia during the first eight months of the year landed more than 30,000 people in hospital, the majority of them children.

According to the Lancet report, Sanofi’s vaccine offers some protection against three of the four serotypes of the dengue virus – about 30 percent against serotype one and from 80 to 90 percent against serotypes three and four.

However, Sanofi’s vaccine does not protect against serotype two, which was circulating in the study area during the trial, giving the vaccine an overall efficacy rate of 30.2 percent, the report said.

Large-scale phase-3 trials are underway on 31,000 children and adolescents in Latin America and Southeast Asia, Sanofi said in a press statement timed with the release of the Lancet report.

According to the Reuters news agency, the company has already invested more than 430 million dollars in a new factory in France to produce the vaccine.

WHO’s Bjorges said that if the phase 3 trials proved the vaccine was effective, its initial market likley would be tourists from wealthy nations and the military, a view Buchy agrees with.

Buchy doubted, however, that an effective vaccine was around the corner. “The vaccine is not for tomorrow,” he said. “Dengue epidemics still have good days ahead of them.”

Still, both doctors expect increasing investment in vaccines and vaccine-related research as global warming expands the range of the mosquito that transmits dengue into southern Europe and the United States.

Developed countries are beginning to factor the costs of dengue treatment into their long-range healthcare budgets, while pharmaceutical companies have identified a potentially lucrative, emerging market, Buchy said. “Global warming is providing a shortcut for vaccine research.”

“Interest in vaccines is going to grow exponentially now that there is some success with a vaccine,” Bjorges said.

The European Union provided more than 10 million dollars for three dengue-related research projects in Southeast Asia earlier this year, including one in Cambodia to investigate the role that asymptomatic carriers play in transmission, Buchy said.

“If we can identify a gene that is protective this may allow us to develop drugs for treatment and vaccination,” he added.

Funding for prevention and control of epidemics in poor countries remains scant, however. The budget for Cambodia’s national dengue control programme is about 500,000 dollars, most of it provided by the Asian Development Bank.

Bjorges says one reason for the lack of funding for prevention and control is that it has shown little success. “Dengue control is 50 years old and everything that has been thought of has been tried.”

Breeding sites have to be eradicated weekly in order to prevent the mosquito that transmits the virus from emerging from its larvae, and this requires changes in human behaviour that have proven difficult to sustain on a weekly basis, Bjorges explained.

Another problem may be that those who allocate global health funds rely on short-term cost-benefit models, Bjorges said. They are under pressure to produce quick, quantifiable results for the funds they allocate, and dengue prevention and control projects do not fit these models, he explained.

Buchy was less pessimistic about the possibility of changing human behaviour. “Behaviour change is possible, but it requires more investment in education.”

Buchy’s view is echoed by Prof. Duch Moniboth of Cambodia’s National Pediatric Hospital that treated 1,673 children for dengue in the first seven months of this year. “There is not enough education about dengue – how to prevent infection and how to eradicate breeding sites.”

New research, however, suggests that dengue is far more prevalent in Cambodia than previously calculated, underscoring the need for increased investment in prevention.

The disease is underreported partly because Cambodia’s dengue surveillance system relies on data from state-run hospitals and charitable children’s hospitals. Cases treated at private hospitals and clinics are not reported to the health ministry.

Charitable hospitals treating dengue patients in Cambodia have been pleading for donations after being inundated with patients in May. The National Paediatric Hospital has been relying on nursing students to treat children who spill into the hallways and the foyer around the main stairwell.

The hospital receives a mere 20 dollars per patient, regardless of how long the child stays, Moniboth said. On average, doctors receive monthly salaries of about 125 dollars, while nurses are paid about 75 dollars, he said.

With such meager funding for healthcare what is needed is a cheap vaccine, Moniboth said.

Pakistan needs affordable solutions to reducing maternal deaths. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Sep 12 2012 (IPS)

“I can’t imagine life without misoprostol,” says Dr. Azra Ahsan, a gynaecologist and obstetrician who has, for more than a decade, been using the controversial drug to stop women from bleeding to death after delivery.

Originally intended for treating gastric ulcers misoprostol has since 2000 been gaining in popularity for its ability to induce labour and stop post partum haemorrhage (PPH).

“I knew that it can save women from dying long before 2009 when it was registered for use in Pakistan,” said Ahsan, a member of the government’s National Commission on Maternal and Neonatal Health.

WHO guidelines advocate the use of misoprostol against PPH, while the International Federation of Gynaecology and Obstetrics (FIGO) suggests using the drug in situations where regular ‘uterotonic’ drugs like oxytocin and ergometrine are not available.

Doctors like Ahsan are dismayed at moves to get WHO to reverse its listing in April 2011 of misoprostol among essential medicines that “satisfy the healthcare needs of the majority of the population” and are  “available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford.”

Findings of scientific studies published in the August issue of the Journal of the Royal Society of Medicine are being cited in suggesting that WHO should “rethink its recent decision to include misoprostol on the essential medicines list.”

Allyson Pollock, who led the study, stated that there is insufficient evidence to suggest that misoprostol works in preventing PPH. Instead, she urges poor countries to improve primary care and prevent anaemia to lower the risk of haemorrhage following delivery.

Ahsan, however, says that in Pakistan some 80 percent of pregnancy cases end up with the mother’s uterus failing to contract naturally after delivery, calling for the use of uterotonic medicines to reduce bleeding.

“Nearly 27 percent of maternal deaths in Pakistan are caused by excessive blood loss after childbirth,” Ahsan explained to IPS.

According to the latest Pakistan Demographic and Health Survey (2006), Pakistan’s maternal mortality ratio stands at 276 for every 100,000 live births, and is among the highest in South Asia.

Bleeding, the leading cause of maternal deaths worldwide, is defined by the WHO as blood loss greater than 500 ml following a delivery.

The fact that misoprostol is also misused in Pakistan – and other developing countries like Brazil – to induce abortion cheaply, has added to controversies over the drug.

“I don’t care if people think it is used, misused or even abused…I know it saves mothers from dying,” says Ahsan.

Unlike other uterotonics, misoprostol has the advantage that it does not need refrigeration for storage and can be easily administered orally by trained birth attendants, Ahsan said.

A joint statement by FIGO and the International Confederation of Midwives states: “… in home births without a skilled attendant, misoprostol may be the only technology available to control PPH.”

Zulfiqar Bhutta, head of women and child health at the Aga Khan University, Karachi, and member of the independent expert review group for maternal and child health to the United Nations secretary-general, agrees with Pollock that misoprostol needs to be evaluated more robustly.

“But I wouldn’t throw out the baby with the bath water yet,” Bhutta told IPS. “There is a need to increase its use in the right circumstances and also carefully monitor misuse. It is no magic bullet and should not lead to complacency in provision of essential maternal services,” he said.

“I think the point of the paper published recently is to try and separate  science from messianic zeal,” says Bhutta who is also co-chair of ‘Countdown to 2015’, a global scientific and advocacy group tracking progress towards the U.N. Millennium Development Goal Five pertaining to maternal health.

“Misoprostol is promising and we should do our best to evaluate its safe use,” said Bhutta. “But, there are people in Pakistan who are recommending large scale distribution to families for use in all births. Will this be cost-effective or indeed safe?”

Pollock’s study has stirred international concern. International Planned Parenthood Federation’s Upeka de Silva told IPS in an e-mail that if WHO withdraws misoprostol, it would mean “countless women will be denied life-saving care and forced to suffer pregnancy-related complications which are entirely preventable.”

“We are fully aware that all studies have limitations and that continued research on best practices for maternal care is needed,” de Silva said.

“However, for the purposes of meeting the urgent needs of women, particularly in rural, underserved communities, we are confident about being guided by the abundant literature and expert evidence supporting the safety and effectiveness of misoprostol for multiple reproductive health indications,” de Silva said.

Further, she said: “The increasing number of clients provided with safe abortion services, treatment for incomplete abortion and PPH through clinics run by our member associations is further evidence that misoprostol should remain available and accessible.”

“It’s alright to stir confusion sitting in cushy offices, but the ground reality in Pakistan is quite different,” said Ahsan. “The conditions we work under are very, very constrained…let’s not forget the hot temperatures and long power outages (causing refrigeration failure).”

Patients attending Opiate Substitution Therapy at a clinic in the eastern Ukrainian region of Dnipropetrovsk. Credit: International HIV/AIDS Alliance in Ukraine.

By Pavol Stracansky
KIEV, Sep 3 2012 (IPS)

Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS – one of the eight Millennium Development Goals – the region has the world’s fastest-growing HIV epidemic.

Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease.

Daniel Wolfe, director of the International Harm Reduction Development Programme at the Open Society Foundations, told IPS: “In most post-Soviet countries, where HIV remains concentrated among injecting drug users, harsh policies and discrimination in healthcare settings continue to cripple the AIDS response.”

Figures showing the extent of the region’s problems with the disease make grim reading. According to the World Health Organisation (WHO), while HIV infection rates are actually falling globally, Eastern Europe and Central Asia (EECA) is seeing the reverse.

The WHO says that there were 170,000 new HIV infections in the region in 2011. New infections have risen 22 percent in the EECA since 2005, and there is no sign of a slowdown.

Injection drug use has been identified as fuelling the epidemic – accounting for up to 70 percent of new infections, according to the WHO.

Activists say the key to tackling the epidemic lies first and foremost in combating the injecting drug use problem, but that official and unofficial stances towards drugs and their users are stopping the problem being effectively tackled, or are even making it worse.

Dasha Ocheret of the Eurasian Harm Reduction Network, told IPS: “Punitive drug policies have to be stopped. People are afraid to get treatment for fear of criminal prosecution or problems with the police in other forms and there are situations where people would rather risk getting HIV than go somewhere like a needle exchange centre.”

Russia and the Ukraine are widely seen as facing the greatest problems, with official policies in the former being blamed for hindering the fight against HIV/AIDS in other countries in the region too.

Opiate-substitution therapy (OST), a treatment for drug users in which methadone or buprenorphine are provided to heroin users, which is standard practice in much of the rest of the world, is banned by law in Russia. Public promotion of its use is punishable by jail.

Critics of methadone treatment in Russia argue that it keeps patients in addiction, while others claim western countries want the treatment offered in Russia for commercial gain. They also warn that methadone would probably end up being sold on the black market, sparking another drug problem.

But with Russia emerging in recent years as a major donor in the EECA region, it is also exporting its policies, including on OST, along with its money, and there are fears this could lead to OST programmes being shelved or restricted in other states.

“Russia is a serious regional player and its policy on drugs, like its policies on other drugs, influence policies in other countries in the region,” said Ocheret.

UNAIDS officials have publicly said that the spread of HIV among injecting drug users could be largely stopped if OST, combined with needle exchange programmes, were offered.

This is a view backed up by groups such as Harm Reduction International, which told IPS that huge differences – up to 30 percent – in prevalence rates of HIV among injecting drug users in western countries and Russia is down to the provision of OST and needle exchange programmes.

But even in EECA countries where needle exchange and OST schemes are on offer, there are often serious problems with access to them.

In many EECA countries government officials continue to question their effectiveness and refuse to support them financially, leaving programmes relying on donor support.

This can limit the coverage, scale and subsequent effectiveness of such programmes, and, because such funding is rarely indefinite, creates fear among those on them that their access to OST could be suddenly cut off if a programme closes.

But a greater problem is the active persecution of those trying to access schemes.

Many drug users across the region, where lengthy jail sentences for possession of even the tiniest amounts of drugs – for instance the residue in a used syringe handed in at a needle exchange centre – are the norm, have reported being beaten, tortured, blackmailed or even falsely imprisoned by police.

A spokesman for the International HIV/AIDS Alliance in Ukraine, where OST and needle exchange schemes ostensibly have government backing, told IPS: “Physical and other intimidation towards drug users is routine police practice.

“Drug users, sex workers, and service providers have spoken of how police have extorted money and information from drug users through severe beatings, electric shocks, partial suffocation with gas masks, and threats of rape.

“They have also reported that police planted drugs in their homes or on their persons, and used this as evidence to arrest or abuse them.”

Discrimination of drug users also extends to the provision of antiretroviral (ARV) drugs.

The International HIV/AIDS Alliance in Ukraine told IPS that denying drug users ARV drugs was a “common problem”, although there is no way of officially proving it.

The Eurasian Harm Reduction Network also told IPS similar incidents had been reported in Russia.

The WHO estimates that only 23 percent of people who are eligible for HIV drugs in the EECA actually receive them. The figure in sub-Saharan Africa is more than double that.

Local groups working to combat the disease say until Western healthcare approaches to HIV/AIDS treatment and prevention are adopted, the region is unlikely to get the epidemic under control.

Ocheret told IPS: “Countries like Poland, for instance, introduced western healthcare practices on HIV/AIDS, including OST, in the 1990s when it had a difficult problem with HIV/AIDS and by doing so managed to get the problem under control.

“In many EECA countries these programmes remain in perpetual ‘pilot’ stages and have never developed further.”

A child gets a measles shot at the Jalozai refugee camp. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Aug 14 2012 (IPS)

Measles outbreaks, which have killed at least 100 children in Pakistan’s militancy-hit border areas since May, have prompted calls by experts for better cooperation in territories adjacent to Afghanistan with international immunisation campaigns.

“The latest victims of this paediatric disease are children in the Mohmand Agency of the Federally Administered Tribal Areas (FATA) where nine deaths have been confirmed as a result of non-vaccination,” Dr. Anwar Shah, top health officer in the agency, told IPS.

Measles, a highly infectious disease, produces cough, high fever and distinctive rashes as symptoms.

Shah blamed unsettled conditions caused by Taliban militancy as well as poor public awareness of the value of vaccination for the outbreak of measles in the seven agencies and six border regions that make up the FATA and in adjacent Khyber Pakhtunkhwa province.   

“My eight-year-old son died of measles last month. He hadn’t been immunised,” Amir Rehman, a farmer in the Lakaro area of Mohmand Agency, told IPS over telephone.

Rehman said he had to take his three surviving children to Charsadda, one of the 25 districts of Khyber Pakhtunkhwa, to have them vaccinated against measles.   

In FATA’s North Waziristan, where the outlawed Tehreek Taliban Pakistan group banned oral polio vaccination (OPV) in June, an estimated 163,000 children are said to be exposed to poliomyelitis.

The result of the ban on OPV is that the FATA is now the only polio-endemic region in the world that harbours two strains of poliovirus, posing a threat to countries certified polio-free, according to the World Health Organisation (WHO) officials.

According to Asghar Ali, a WHO doctor, most of the FATA’s seven agencies have less than 45 percent vaccination coverage against the national target of 95 percent set by the ‘Prime Minister’s Emergency Polio Eradication Plan 2012’.

The situation is worst in the South Waziristan agency where the Taliban has ordered a ban on all vaccinations, leaving the children vulnerable not only to polio but also to measles and other infectious diseases.  

On Jul. 31, South Waziristan’s chief surgeon Azmat Hayat Khan issued a warning that the Taliban’s blanket ban could result in a measles outbreak and more deaths. “The problem is complex because apart from the ban on vaccination there is a shortage of vaccines,” Khan told IPS.

“Measles-affected children need to be admitted to hospital within 24 hours and this is not possible in the tribal areas where people lack transport or resources to move their children to facilities in KP,” Khan said.

Khan said that besides the 100-odd children known to have died of measles since May about 3,000 have been treated in hospitals.

“When unvaccinated children get measles, they need to be rushed to hospitals if they are to survive,” Muhammad Aman, a pediatrician at the Khyber Teaching Hospital in Peshawar, told IPS.

Dr. Jan Baz Afridi, top immunisation officer in KP, told IPS that additional vaccinators were being deployed in KP districts. “Our staff now visits villages and makes announcements from mosques over loudspeakers to encourage people to get all children up to 15 years of age immunised,” he said.  

Fawad Khan, FATA’s chief health director, said: “Law and order is another problem hampering the government’s effort to promote vaccination. We are looking to the government to ensure security of the health workers to carry out immunisation activities.”  

“Vaccine-preventable ailments do not discriminate between cultures, religions, borders or language,” Michael Coleman, communications specialist with the United Nations Children’s Fund (UNICEF), told IPS. “A small number of unvaccinated children could put at the razor’s edge the lives of thousands of children.”

In April, UNICEF joined WHO and the Centres for Disease Control and Prevention of the United States in launching a global strategy to reduce measles deaths to zero by 2015.

But the new strategy relies on high vaccination coverage and close monitoring of the spread of measles as well as rubella, using laboratory-backed surveillance and effective communication – grossly lacking in the FATA. 

Studies by the WHO, published in April, showed that accelerated efforts to reduce measles deaths had resulted in a 74 percent reduction in global measles mortality, from an estimated 535,300 deaths in 2000 to 139,300 in 2010.

The WHO study estimated that during the 2000-2010 period, measles vaccine had saved over 9.6 million children.

“Since April, we have immunised 8,000 children against measles in the Jalozai refugee camp (outside Peshawar), where people displaced by military action against the Taliban in FATA are lodged,” WHO’s Dr. Junaid Shah told IPS. “It is much harder to immunise children in the FATA.”  

Shah said that propaganda by the Taliban against oral polio vaccine had not only harmed the immunisation efforts in the FATA but was now proving to be a setback to global efforts to reduce deaths from measles.  

Girls’ and women’s access to contraceptives is both a right and a transformational health and development priority. Credit: Patrick Burnett/IPS

By Julio Godoy
PARIS, Jul 18 2012 (IPS)

Improving family planning to avoid unwanted pregnancies in developing countries, as well as assuring girls’ access to education, and women’s participation in the economy, are essential components of a sound development policy, according to Western experts and African activists.

During a summit on family planning in London last week numerous economic development experts, government delegates from industrialised and developing countries, and private donors agreed to raise some 4.3 billion dollars by 2020 to allow 120 million women and girls in the world’s poorest countries, particularly in the continent of Africa, to access contraceptives and other family planning materials.

The summit underscored the importance of girls’ and women’s access to contraceptives as both a right and a transformational health and development priority.

Simultaneously, gender activists attending the second African Women’s Economic Summit, which concluded on Jul. 14 in Lagos, Nigeria, urged policy makers, corporate organisations and political leaders to step up measures to promote women’s empowerment and remove barriers impeding their economic development.

“I don’t want my daughters … in the coming years discussing these same issues (of women’s education and economic empowerment),” Cecilia Akintomide, vice president of the African Development Bank (AfDB), co-organiser of the African summit, told the audience in Lagos. “I want to see a change in my lifetime.”

During the meeting in Lagos, Nigeria’s finance minister, Ngozi Okonjo-Iweala, emphasised that women’s economic empowerment is no longer simply an option “because investing in women, who constitute half of the continent’s population, is the only way to sustain the growth” recently recorded across the African continent.

“Women are the third largest emerging market in the globe.  Women are the third largest source of growth. One of the fastest ways to sustain current growth is to invest in women,” Okonjo-Iweala said.

Participants at the London summit echoed these views, with an emphasis on the health risks associated with unwanted pregnancies.

“Enabling an additional 120 million women in the world’s poorest countries to access and use contraception, something women in the developed world take for granted, will save millions of lives and enable girls and women to determine their own futures,” said Andrew Mitchell, British secretary of state for international development.

Mitchell called the commitments of the summit a “breakthrough for the world’s poorest girls and women, which will transform lives now and for generations to come.”

By 2020, the collective efforts announced in London will allegedly result in 200,000 fewer women dying during pregnancy and childbirth, more than 110 million fewer unintended pregnancies, over 50 million fewer abortions, and nearly three million fewer babies dying in their first year of life.

Avoiding unwanted pregnancies also allows girls and women pursue their own education and improve their professional opportunities.

Numerous studies show that the investment of a single dollar in family planning leads to savings of up to six dollars in health, housing, water, and other public services.

Contraceptive use also leads to more education and greater opportunities for girls, helping to end the cycles of poverty that millions of women and their families are trapped in. Up to a quarter of girls in sub-Saharan Africa drop out of school due to unintended pregnancies.

Based on such evidence, the United Nations Millennium Development Goals (MDGs) call for gender equality, universal education, and improving maternal and child health, setting specific objectives to be met by 2015.

According to the U.N. 2012 MDG report, released Jul. 2, meeting these goals by 2015, while challenging, is possible, “but only if governments do not waiver from their commitments made over a decade ago.”

In the foreword of the report, U.N. secretary-general Ban Ki-moon, warned that the current economic crises battering much of the developed world “must not be allowed to decelerate or reverse the progress that has been made.”

“Let us build on the successes we have achieved so far, and let us not relent until all the MDGs have been attained,” he urged.

The U.N. report points out that the world has achieved parity in primary education between girls and boys. Driven by national and international efforts, many more of the world’s children are enrolled in school at the primary level, especially since 2000.

Girls have benefited the most. There were 97 girls enrolled per 100 boys in 2010 – up from 91 girls per 100 boys in 1999.

Such improvements, as well as improving maternal health and reducing unwanted pregnancies, coincide with women’s demands across the world.

Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, told participants at the London summit that women she meets on her travels tell her that “access to contraceptives can often be the difference between life and death”.

“Today is about listening to their voices, about meeting their aspirations, and giving them the power to create a better life for themselves and their families,” Gates added.

In Lagos, in a video message addressed to the Second African Women’s Economic Summit, AfDB President, Donald Kaberuka said that women have always played a pivotal role in the socio-economic development of Africa.

As farmers, entrepreneurs, traders and innovators, they are key economic actors in the continent, he added. “I believe, strongly believe, investing in women…is essential to revitalising our economies,” Kaberuka pointed out.

(END)

From a wooden, weather-beaten building on the edge of this border town, Mahn Mahn charts dangerous missions deep Myanmar (also Burma) for the 2,000-odd health workers under his wing.

These tours, through the mine-infested stretches of eastern Myanmar, include supplying basic maternity kits for pregnant women from the country’s ethnic minorities.

Beneficiaries of these humanitarian forays by the Back Pack Health Worker Team (BPHWT), the non-profit group that Mahn Mahn is secretary of, include the Karen, Karenni, Mon and Shan communities.

In staying its course, this group, which began its mission over a decade ago, implies that little has changed on the ground despite ceasefire agreements signed over the past 10 months between the reformist government of President Thein Sein and armed ethnic groups.

The communities affected by the decades-long conflict on the mountainous, jungle terrain of the Thai-Myanmar border are highly vulnerable. Human rights groups estimate that the fighting has rendered 500,000 villagers as internally displaced persons (IDPs).

“If you want to know about the impact of the conflicts, start with maternal mortality (MM) along eastern Burma – the worst in the country,” says Mahn Mahn, the 48-year-old medic from the Karen ethnic minority. “One in 12 pregnant women risks dying because of complications.”

His words are echoed by other international and local public health organisations working along the Thai-Myanmar border. In eastern Myanmar, MM rates have hovered between 721 and 1,200 per 100,000 live births compared to Myanmar’s national average of 240 per 100,000 live births.

These MM rates “dwarf the rates in Thailand (44 deaths for 100,000 live births), leaving women in eastern Burma with the worst pregnancy outcomes anywhere in Asia,” noted a report released this February by the Global Health Access Programme (GHAP), a U.S. non-governmental organisation.

The report, ‘Separated by Borders, United by Need’, describes the reproductive health crisis as a “public health emergency.” The absence of skilled birth attendants, lack of access to contraception, limited health information and absence of health clinics within easy reach have fuelled such deaths at childbirth, it said.

Too many women dying of complications arising from unsafe abortions and post-partum haemorrhage also expose the level of human rights violations perpetrated by Myanmar’s military during its armed campaigns against ethnic rebel groups.

The government’s official policies in the conflict zones work to deny healthcare to the ethnic minorities and prevent international humanitarian organisations from stepping in.

“We have documented that the experience of human rights violations is correlated with negative health outcomes,” says Jen Leigh, field director for GHAP. “Households that have experienced forced displacement have higher odds of infant and child death, child malnutrition and failure to use contraception.”

In a region where, according to surveys, some 18 percent of women of reproductive age are malnourished, stories of MM cases come as no surprise.

“From the information I gathered, attending trainings with midwives or health workers from our partner organisations, it appears like everybody knows somebody who died of pregnancy-related complications,” Leigh said in an IPS interview.

Little wonder why the Mae Tao clinic in Mae Sot, run by the legendary Dr. Cynthia Maung, has become a magnet for pregnant women along the border. Its reproductive health team delivers between 3 -15 babies daily as part of a free service.

Last year saw the clinic assisting a record 3,033 live births, up from the previous year’s 2,758 live births.

Close to half of the women who gave birth at the clinic came from across the border, following antenatal care they had received from Dr. Cynthia, an ethnic Karen who has won six international awards for her humanitarian work at the clinic since 1989.

But deep in the conflict zones, where the guns have gone silent, women have no choice, no hope for clinical care when giving birth. “Between 80 to 90 percent deliveries are at home with untrained midwives,” says Dr. Cynthia, as she is known here. “Only four percent have access to emergency care in a clinic.”

“There is a need for more trained birth attendants in those areas,” she told IPS. “They could save lives if they know safe birth techniques and be supplied with birth-kits. Even cutting an umbilical cord properly is a matter of life and death.”

Dr. Cynthia’s clinic has helped the BPHWT train women from remote areas about safe birthing practices. Over 800 local women have been given training trained and supplied with sterilisation equipment, gloves and razor blades to cut umbilical cords.

“The communities have begun to depend on our trained birth attendants,” says Mahn Mahn. “We are helping women who are unable to make it to the Mae Tao clinic or the few other clinics in the ethnic areas.”

He expects this local variant of a mobile health service to continue. After all, the BPHWT, which has 95 teams that fan out across the rugged terrain with health supplies slung behind their back, handles other health emergencies too, such as aiding landmine victims.

“It is going to be a long time before the ceasefires become meaningful for communities along the border,” Mahn Mahn notes. “Let’s say it will be so when the MM rates come down.”

Outside a Srinagar hospital

By Athar Parvaiz
SRINAGAR, India , Jun 19 2012 (IPS)

A year after the Indian government began paying pregnant women to deliver their babies in state-run facilities, the pressure is showing on the country’s understaffed and poorly equipped  hospitals.

Between February and May, 397 newborns died at the G.B. Pant hospital in this city, summer capital of northern Jammu and Kashmir state, underlining deficiencies typical of government-run health facilities across the country.

“My baby turned pale soon after a nurse administered an injection and he died moments after that,” Haleema Akhtar, a grieving mother, told IPS.

“I saw over a dozen infants dying before my eyes in a matter of hours. The conditions at the hospital can only be described as inhuman. We could not afford to go to a private hospital,” a tearful Akhtar told IPS.

An official inquiry into the deaths, conducted by Dr. Showkat Zargar, eminent physician and ex-officio secretary to the state government, blamed inadequate staff and equipment.

“There is total apathy and mismanagement by the hospital administration,” Zargar said in his report.

“Just one junior post-graduate student and a qualified nurse were looking after critically sick babies. I counted 27 (newborns) in a nursery, with no senior resident doctor posted in the neonatal intensive care unit,” Zargar reported.

Citing the hospital’s records, the report said the facility had witnessed 981 infant deaths in 2010 and 985 in 2011, averaging a high 20 percent mortality – twice the accepted rate for state-run hospitals in India.

Another committee comprising legislators from the Jammu and Kashmir   assembly corroborated Zargar’s findings. Mustafa Kamal, a member of the state legislators’ committee, told IPS “the deaths occurred due to a lack of equipment, shortage of manpower and a pathetic sanitation system in the hospital.”

The spate of infant deaths at the G.B. Pant hospital mirrored a similar episode at the district hospital in Malda, in West Bengal state, in November 2011. No fewer than 26 babies had died in a space of two weeks because of infection.

On Mar. 20, India’s health minister Ghulam Nabi Azad, called to account in Parliament, admitted that India’s infant (under one year of age) mortality rate (IMR) of 47 per 1,000 live births was worse than in the neighbouring countries of Nepal, Sri Lanka and Bangladesh.

“In India, the IMR is 47 per 1,000 live births, which translates into 1.25 million infant deaths per year,” Azad said. Only Pakistan had a worse IMR rate in South Asia, he said.

A report released Jun. 13 by the United Nations Children’s Fund (UNICEF) as part of the ‘Countdown to 2015’ initiative placed India’s IMR rate slightly higher at 48 per 1,000 live births.  The initiative tracks country-level progress in reducing maternal, newborn and child mortality and involves various partners.

According to the UNICEF report, Pakistan has an IMR of 70  per 1,000 live births, followed by India with 47, Nepal with 41, Bangladesh with 38 and Sri Lanka with 26.

The UNICEF report said most of these deaths are preventable through access to health services before, during and immediately after childbirth.

In the case of Jammu and Kashmir, according to official data accessed by IPS, there are only 24 pediatricians available to take care of over a million children below the age of six years.

The Doctors’ Association of Kashmir (DAK) says that many of the hospitals not only lack child specialists but also basic life-saving equipment such as ventilators. “No doctor can work without the support of basic health infrastructure,” DAK president Nissar-ul-Hassan told IPS.

In a bid to lower the IMR, the government launched in June 2011 the Janani–Shishu Suraksha Karyakram (JSSK), a programme to protect mothers and newborns, by providing a range of services free to pregnant women in government hospitals across the country.

Cashless and free services under the JSSK include normal and caesarian section deliveries, care and proper diet for up to 30 days after delivery plus free transport from home to hospital and back.

A sample registration system (SRS) survey carried out in 2010 by the Registrar General of India showed that initiatives to get pregnant women to avail of professional services were working with three-fourths of deliveries  already happening in institutional settings.

But there are vast differences in how programmes aimed at lowering the IMR were being implemented across this country of 1.2 billion people living in 27 states in a wide variety of settings.

While states like Kerala, Tamil Nadu and Andhra Pradesh recorded less than one percent of births conducted by untrained midwives, Jharkhand state in central India still has 46.5 percent of births attended to by  untrained traditional birth attendants.

Prominent health activists welcome programmes like the JSSK but say the government needs to spend much more if it is to meet the millennium development goal (MDG) of reducing child mortality rate by two-thirds, between 1990 and 2015.

Dr. Mira Shiva, coordinator of the non-government Initiative for Health, Equity and Society, points to the fact that where India’s public outlay on health was six percent of GDP in 1991, it had been whittled down to a little over one percent of GDP by 2011.

“Naturally, such a drastic reduction in GDP spending has taken a toll on the public health delivery system – so it is not enough to get pregnant women to the hospitals and hand out doles,” said Shiva who is on several health committees.

In February, the government had announced that by the end of India’s 12^th five-year plan, due to be rolled out this year, spending on health would be increased to 2.5 percent of GDP – nominally placed at 1.67 trillion dollars in 2011.

But Shiva said that would still work out to less than half of what many countries in situations comparable to that of India, such as Brazil, are spending on the health sector.

According to a World Bank report published in 2010, public health expenditure in Brazil was 3.72 percent of GDP in 2008 but moved up to 4.13 percent of GDP in 2009.

(END)

Pakistan’s efforts to contain polio in areas bordering Afghanistan may have received a setback following the conviction of a doctor who allegedly ran a fake vaccine programme to locate Al-Qaeda chief Osama bin Laden.

Dr. Shakil Afridi, who was sentenced to 30 years in prison on May 23 on charges of treason, is said to have helped the Central Intelligence Agency (CIA) of the United States track down bin Laden by collecting DNA samples from selected residents in the cantonment town of Abbottabad.

Bin Laden was killed in a U.S. raid on his secret residence in Abbottabad in May 2011. Afridi was arrested by Pakistani authorities three weeks later, leading to friction between Islamabad and Washington.

Médecins Sans Frontières, the international medical aid charity, had then warned that the CIA’s alleged use of a vaccination programme as cover to spy on bin Laden threatened immunisation work around the world.

Afridi’s role appears to have exacerbated suspicions among people in the Federally Administered Tribal Areas (FATA) that polio vaccinations are part of a U.S. conspiracy to render their children infertile.

“The problem of refusing vaccination is not new but Afridi’s fake vaccination campaign has proved to be a setback to our efforts to popularise immunisation,” Dr. Rekhanullah Khan, a polio officer in the FATA, told IPS.

This year, Pakistan has already recorded 22 cases of polio with 10 of them from the FATA, a territory consisting of seven tribal agencies.

“In the FATA, authorities are facing difficulties reaching children of immunisable age,” said Dr. Javid Khan of the World Health Organisation (WHO).

“In the Khyber Agency of the FATA, which recorded its eighth case last week, oral polio vaccines have not been administered since October 2009, leaving some 150,000 children vulnerable,” Javid Khan told IPS. “This is a programme by the U.S. to cut the population of the Muslims and weaken them to a point that they become incapacitated to defend Islam,” Qari Mohammad Akram, a resident of FATA’s Bajaur agency, told IPS over telephone.

“People here don’t want any treatment for a disease that has not affected them. We need to follow teachings of Islam and heed the Prophet,” he argued.

Refusal to cooperate with health authorities is also because FATA residents are demanding a better deal from the central government.

“Last week, parents refused to allow vaccination in South Waziristan agency, saying they would prefer to have electricity, paved roads and clean drinking water first,” Dr. Muhammad Khalid of the expanded programme on immunisation (EPI) in the FATA, told IPS.

The ‘Dawn’ English language daily, published from Karachi, quoted Dr. Elia Curry, leader of the WHO’s polio eradication section in Pakistan, as saying on Jun. 9 that the virus will continue to circulate as long as anti-polio drives miss significant numbers of children.

Curry told Dawn that environmental surveillance, covering sewer systems, had proved persistent circulation of wild poliovirus in cities like Lahore and Rawalpindi with children in the provinces of Punjab and Khyber Pakhtunkhwa particularly vulnerable.

According to WHO’s website, the Khyber Agency is the only area in Asia having both the wild poliovirus-1 and wild poliovirus-3 types and this poses a threat to efforts at polio eradication in the country as well as globally.

WHO officials said there was added risk of the virus spreading from the FATA to other parts of the country because of the ongoing large-scale population migration to other parts of the country.

An immunisation drive begun in selected areas of Pakistan on Jun. 4 is expected to reach at least 17 million children, but would still miss children in the FATA because of military operations against the Taliban in several areas, particularly the Khyber Agency.

Some parents are convinced that unsettled conditions in the FATA are mainly responsible for polio continuing to threaten their children.

“Both the army and Taliban are responsible for making my daughter crippled,” says Allah Noor, whose 21-month-old daughter, Salma, was diagnosed with polio on Jun. 1.

“Obviously vaccinations cannot be carried out when fighting is in progress and the health facilities are closed,” Noor, a resident of Usai Khula village of the Khyber Agency, said. “I want to tell all parents to cooperate and save their children from vaccine-preventable ailments,” he told IPS.

In early April, the WHO had requested Khyber Pakhtunkhwa’s provincial government to carry out mass immunisations in the Jalozai refugee camp, home to 40,000 children uprooted by military operations in the FATA.

On WHO’s request, Dost Muhammad Khan, chief justice of the Peshawar High Court, ordered the setting up of transit points to vaccinate children fleeing military operations in the FATA’s Khyber Agency and reaching the Jalozai camp.

“We established 48 vaccination points where children coming in from the Khyber Agency are being vaccinated,” Dr. Jan Baz Afridi, who heads the EPI in Khyber Pakhtunkhwa, said.

In 2011, Pakistan emerged as the worst polio-infected country in the world with 198 cases and this year will be no different if urgent measures for mass immunisation are not taken, according to WHO officials.

(END)

A knock on her front door throws Beenish, a 28-year-old housewife from Lahore, into a fix: should she allow the female volunteer vaccinators to administer the oral polio vaccine (OPV) to her two-year-old son, or not?

The decision has not always been this hard. Last year, Beenish had no qualms about hosting the service providers in her home to perform the simple procedure.

But now she is gripped with anxiety about the potentially harmful nature of the vaccine.

Her fears are not unfounded.

Lahore, the capital of Pakistan’s populous Punjab province, is still reeling from the deaths of over 125 people who suffered an adverse reaction to Isotab, distributed by the government-run Punjab Institute of Cardiology (PIC) to a large number of cardiac patients.

Subsequent laboratory tests revealed that each tablet contained the antimalarial substance Pyrimethamine in quantities over 14 times the recommended weekly dose for malaria patients.

“I can’t afford to trust these people (with) my child’s life. The government’s inefficiency and the harms associated with free medicine are (dangerous) to us all,” Beenish told IPS.

The tragedy over the cardiac patients ignited severe criticism of the government from various corners of society.

The absence of a sufficient drug regulatory mechanism at the provincial level has also been dragged into the spotlight as a major health concern.

Obstacles to the eradication campaign

Outright distrust in the public health system has taken a crippling toll on the anti-polio initiative, especially in Punjab.

The United Nations Children’s Fund (UNICEF) estimates that roughly 700,000 children in the province already miss immunisation drives for various reasons. With fears of contamination now proliferating, and scores of households resisting the vaccination, medical experts fear this number will now rise.

Pakistan is one of just four countries in the world where the wild poliovirus is still circulating freely; the other three are India, Nigeria and Afghanistan.

Of the 326 polio cases reported in these countries in 2011, only one was detected in India, 52 in Nigeria, 76 in Afghanistan, and an alarming 197 in Pakistan.

According to UNICEF, “The annual incidence of polio in Pakistan, which was estimated to be more than 20,000 cases annually in the early 1990s, had decreased to around thirty cases in 2005. Just a few years ago Pakistan was on the verge of polio eradication. It seemed that we had made it.”

But a resurgence of infection rates has turned the country into a site of global concern, as it is now responsible for well over 60 percent of polio cases worldwide.

Global polio watchdogs recently found that the particular strain of poliovirus endemic to Pakistan has traveled to other countries and caused outbreaks in China and Afghanistan.

While UNICEF, the World Health Organisation (WHO) and federal and provincial governments have been urging mass media to minimise negative coverage of anti-polio drives, a recent political scandal involving the United States’ Central Intelligence Agency (CIA) appears to have undone several years’ worth of efforts in that regard.

Towards the end of Jan. 2011, U.S. defence secretary Leon Panetta urged Pakistan to release a doctor named Shakil Afridi who was under arrest on charges of treason.

At the behest of CIA officials, Afridi reportedly launched a fake polio vaccination campaign in Abbottabad last year, using it as a front to gather DNA samples from people thought to be relatives of the elusive Osama Bin Laden. This elaborate scheme would later contribute to the frenetic manhunt for and subsequent assassination of the Al Qaeda leader.

“(Before this) happened, one could brush aside negative perceptions about the polio vaccine, terming them baseless and ‘agenda-driven’, but not this time,” Fazal Shah, a development sector professional based in the northern district of Mardan, told IPS.

“How can anybody deny something confirmed by the U.S. itself, including in its own media?” he asked.

Religious leaders and tribal elders who had hitherto been highly successful in generating public support for the polio vaccine – by breaking myths about the vaccine being life-threatening, made of haram (forbidden) ingredients or causing infertility among both male and female recipients – found their efforts seriously hampered by Afridi’s hoax vaccination drive.

In fact, as news of the CIA’s scheme filtered into thousands of households across Pakistan via sensational newspaper and TV reports, Pakistan’s entire polio eradication campaign began to suffer a major setback.

In an effort to form a joint front against the barrage of negative media coverage, individuals and groups working to exterminate the poliovirus have identified key partners in the fight and are approaching the media together, hoping for strength in numbers.

The timing of such a united front is crucial as the polio vaccine is currently being distributed in the Federally Administered Tribal Areas (FATA) and, for the first time in the past three years, in the lower part of Orakzai Agency – areas that had, for years, been inaccessible due to rampant militancy and military confrontations between rebels and state armed forces.

In a statement drafted exclusively for IPS, UNICEF claimed, “Pakistani journalists, being the major pillar of (this) nation, have both a moral and professional responsibility to ensure that polio eradication is set on top of the public agenda.”

“Balanced coverage, accurate reporting, due verification of facts, critical analysis of rumors, segregation of individual opinion from expert knowledge (and) avoiding unnecessary sensationalism are of the utmost importance in reporting about polio,” it added. “Recently, the media has contributed to numerous unwarranted speculations about the alleged side effects of the polio vaccine. The oral polio vaccine used in Pakistan is potent, safe, and efficacious; it is exactly the same vaccine that brought the number of polio cases down to just over 30 in 2007,” the statement concluded.

Mueen Ahmed, a Lahore-based investigative reporter with Pakistan’s premier Geo TV, agrees headlines like “Polio Vaccine Claims Child’s Life” should be carried only if autopsy reports confirm the claim.

However, he says the media cannot be stopped from calling a spade a spade.

“If the government engages untrained vaccinators for less than five dollars a day and stores vaccines out in the open, how can the media remain silent?” he asked.

Mueen believes the disease cannot be treated without simultaneously bringing about a complete paradigm shift.

“The day people all over the country start chasing vaccinators, rather than (vice versa), we will achieve our goal,” he said, adding the media could be instrumental in bringing about such a fundamental change in public thinking. Azhar Mahmood Bhatti, director of the Punjab’s Expanded Programme on Immunisation (EPI), went a step further to suggest that legislation be implemented along with responsible media coverage.

“Laws should be (on the books) to make immunisation mandatory, and birth certificates should be issued to children only on verification of their polio vaccination cards,” he told IPS.

Behind closed doors, a trade deal affecting a fifth of the world’s population has been quietly in the works for years.

The EU-India FTA could kill the generic drug market despite the fact that generic competition lowers medicine prices by 90-99 percent. Credit: Erich Ferdinand/CC-BY-2.0

But while details of the free trade agreement (FTA) between the European Union and India remain ambiguous to the general public, concerns continue to mount over the effects such a deal could have on an unsuspecting third party: the affordable drug market of the developing world.

Negotiations have been underway for five years, with details on issues such as India’s generic drug market sending delegates from both the EU and India through multiple rounds of deliberations in the hopes of settling on an FTA that would be “mutually beneficial and sustainable”, especially given Europe’s current economic climate.

Finally, the five-year ordeal seems to be moving toward a conclusion, according to the European External Action service.

The latest EU-India summit took place on Feb. 10 and was hailed by José Manuel Durão Barroso, president of the European Commission, as a “significant step forward.”

The European Union is already India’s primary trade partner and largest source of foreign direct investment (FDI), according to Barroso.

EU-India trade doubled from 28.6 billion euros in 2003 to more than 67.9 billion euros in 2010, while EU investment has tripled to three billion euros since 2003.

Barroso says the final agreement will be reached in the fall of 2012 and, if passed, would signal the implementation of the largest trade agreement in the world, opening the doors for research and innovation, job creation, and countless business opportunities.

But experts and activists are fiercely opposed to the deal, which they say will stunt the availability of affordable medicine in the developing world.

“Hands off our medicine”

These concerns aren’t new; the issue has been on the radars of several organisations for years, with growing concerns over how the trade agreement is being reached and what it means for organisations who work to supply low-cost medicines to those in need.

As the FTA has evolved, certain measures such as data exclusivity have been taken off the table, though other potentially harmful provisions remain.

Initial opposition to the trade deal centered on issues of intellectual property rights and market access for large European businesses, with the not-for-profit group Corporate Europe Observatory (CEO) at the helm with a petition to halt the trade agreement altogether.

The petition had the signatures of over 100 organisations as of December 2010, just prior to the 11th EU-India summit.

One of CEO’s biggest concerns is that new trade rules could stall the distribution of generic drugs, thus keeping patented medicine prices high and increasing the overall cost of healthcare for households. According to Oxfam International, generic competition lowers medicine prices by 90-99 percent.

Most significantly, generic competition in India has lowered prices for first line antiretroviral drugs to 100 dollars per year for a single patient, down from 10,000 dollars just 10 years ago for the same treatment.

Doctors Without Borders (known by its French acronym MSF), an independent international medical humanitarian organisation that delivers emergency aid, has also been steering opposition to the FTA’s impact on generic drugs.

The organisation’s campaign called for Europe to keep their “hands off our medicine” and issued a statement outlining risks associated with the widening net of enforcement provisions, which have serious implications for the availability of medicines.

If certain enforcement provisions related to intellectual property are included in the FTA, they could give large pharmaceutical companies the right to sue not only generic drug manufacturers but also generic drug supplies and customers, MSF said.

Such measures could deter treatment providers from buying or supplying generic drugs, leaving the far more expensive brand drugs as the only option for people in desperate need.

The organisation rallied in New Delhi on Feb. 10 along with HIV-positive community members to call attention to the remaining provisions in the FTA that put the generic drug market in serious jeopardy.

Nearly 2,000 people strong, the protests included remarks from Unni Karunakara, the president of MSF, who proclaimed, “We have watched too many people die in places where we work because the medicines they need are too expensive. We cannot allow this trade deal to shut down the pharmacy of the developing world.”

Given that Europe posits itself as a world leader in development aid, the potential hypocrisy of the situation isn’t lost: if these provisions are, in fact, included in the FTA, the EU stands to undermine its own large-scale aid efforts by limiting access to life-saving medications.

Besides the petition, CEO also launched legal action against the European Commission early last year, claiming that corporate lobby groups were given privileged access to information on the EU-India trade talks.

The organisation alleged that 17 documents were released to industrial players but withheld from CEO because it would “undermine the EU’s international relations.”

CEO requested the documents in order to monitor the trade deal, which the organisation believes leans much heavily towards the interests of large corporations at the expense of trade unions, NGOs and small enterprises.

CEO’s Pia Eberhardt said that she expects a hearing within the first half of this year, though no formal date has been set. From that point, it will take roughly six additional months to reach a conclusion.

But while the case circles the justice system, the FTA could slip through the cracks.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

By Henrietta Abayie and Paul Carlucci
GREATAER ACCRA WEST DISTRICT, Ghana, Nov 24 2011 (IPS)

For the past 10 years, Buruli ulcer has been eating Benjamin Essel’s leg. The skin above his ankle is totally gone, and a swollen, pulpy and reddish wound rises almost up to his knee and wraps around his calf. Even still, this is an improvement over recent years.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Medical professionals say it is little known in afflicted communities and among staff at local hospitals, even though its early stages are easy to treat. It occurs in wet, rustic areas, and, consequently, its victims tend to be the rural poor.

Researchers know that it is caused by mycobacterium ulcerans, the same thing that causes leprosy and tuberculosis, but they are not sure how it is transmitted, which makes prevention very difficult.

Catching and curbing the disease in its early stages inevitably leads to full recovery with medication like antibiotics, but poverty, ignorance, spiritual beliefs, and underfunded health facilities conspire to stall treatment.

About 50 to 60 percent of this West African country’s victims end up with lesions like Essel’s or larger.

Disfiguration, disability, and amputation are common outcomes. Doctors and nurses are calling for more resources to educate endemic communities and train local health care providers.

“This disease affects rural poor, whose voices are not heard anywhere,” says Dr. Edwin Ampadu, the country’s national Buruli ulcer chief. “The public has very little knowledge about this. When we had opportunities to bring this to the media or TV, people shied away. That is very sad, because when you talk to people, they think the disease is far away. But it is very close to this place.”

According to the World Health Organization (WHO), Buruli first surfaced in Uganda in 1897. Fifty years later, Australian researchers provided the first full description of the disease, and, in 1960, a rash of cases broke out in Buruli County, Uganda, giving the disease its modern handle.

Since 1980, it has spread across West Africa, and, in 1998, WHO began addressing it on a global scale. The disease is present in 30 African countries, as well as the Americas, Asia, and the Western Pacific. In Ghana, there have been 11,000 cases recorded since 1993.

Buruli comes in four progressive stages: nodule, plaque, oedema, and ulcer. The first stage is just a lump in the skin, while the fourth phase can produce wounds several times as dramatic as Essel’s.

While prevention remains a puzzle – some researchers in Australia think the disease may be transmitted by mosquitoes – early treatment could not be easier. According to a 2003 survey, all it takes is 20 to 50 dollars worth of antibiotics. On the other end of the treatment spectrum is a price tag of nearly 1,000 dollars, not to mention the social fallout from that degree of illness.

“Education is ongoing,” says Martin Oppong, the Buruli ulcer programme coordinator for the Ga West District, where Amasaman Hospital is located. “But it’s a disease that no one can pinpoint as to the mode of transmission, so people’s perception as to the cause determines where they seek help.”

Some, like 50-year-old Ama Foa, think they have been cursed. Others, like 50-year-old Victoria Oppong, think it is a boil. Like Essel, both women let the disease progress before getting treatment. Now none of the three can work, and Essel and Victoria Oppong live in the ward.

Ghana’s National Buruli Ulcer Control Programme was struck in 2002, almost 30 years after the disease was first detected in the coastal province of Greater Accra Region. But doctors complain that it is grossly underfunded.

Amasaman Hospital’s ward exists mostly with the help of World Vision, the Christian relief, development and advocacy non-governmental organisation. In 2005, World Vision introduced a three-year programme to help with dressings, surgery, drugs, and general care, all of which are allocated from the government, but only every four months, and not in sufficient quantities.

World Vision also helps feed patients, who would otherwise have to fend for themselves, as the hospital does not pay for food. In 2008, the NGO renewed the programme. This September, it expired.

“Maybe they will renew,” says Oppong. “Maybe they won’t.”

Meanwhile, Ampadu is trying to build capacity in other endemic jurisdictions. He wants to train more local health care providers on detection, so the disease can be caught and stopped in its early stages. He also wants to build surgical capacity, so doctors can perform skin grafts and other surgeries with minimal damage to the patient.

So far, capacity is spotty. While Amasaman has one doctor who can assist in operations with the guidance of a surgeon from Korle Bu Teaching Hospital, one of the country’s central medical facilities, larger places like Nsawam in Eastern Region have no one. Ampadu chalks this up to professional interest.

“The gaps are many in terms of capacity building,” he says. “We have very few doctors who have shown serious interest. The cases are not many if you compare to tropical diseases.”

And then there are the financial limitations. Ampadu frames the whole thing as an issue of corporate responsibility. As it happens, many of the afflicted rural areas are also hotspots for Ghanaian industries like farming and mining. He’s calling on more companies to provide funds for education and outreach so the disease can increasingly be stopped in its early stages, which is currently the closest thing to prevention available. It should be an easy fix.

“If we invest seriously in early prevention,” he says, “maybe in three years time I can assume that we will not see this ugly lesion.”

Excerpt:

By Kristin Palitza
CAPE TOWN , Nov 16 2011 (IPS)

South African health experts are calling on governments to use legally available mechanisms to promote the production or import of generic drugs in their countries.

Patented drugs limit patients access to public health care. Credit: Kristin Palitza/IPS

Pharmaceutical patents continue to drive up drug prices, making it expensive to treat patients. This often leads to limited access to health care, especially in developing countries where the disease burden is high, but public health budgets remain low, experts said.

Governments can revert to the Doha Declaration – a declaration on the Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS) and Public Health, which was signed 10 years ago by member countries of the World Trade Organisation in Doha, Qatar – which exits to ensure that patents do not undermine the ability of countries to achieve the right to health.

“Countries, like South Africa, may interpret TRIPS as they see fit. They can enact national legislation to allow fewer patents and promote generic production of drugs to promote access to medicine for all,” explained Médecins Sans Frontières (MSF) South Africa access and innovation officer Mara Kardas-Nelson.

The availability of generic medications can have drastic consequences for public health. “When generics were produced for antiretroviral (ARV) treatment for HIV-patients, costs rapidly decreased from over 10,000 dollars per patient per year to about 600 dollars,” said Kardas-Nelson. “It allowed increased access to medicines for millions of people.”

But when the TRIPS agreement was signed in 1995, pharmaceuticals were allowed to apply for 20-year patents for their drugs, which meant that during that period, no generic versions of those medicines could be produced. This drastically reduced the global availability of generics. Only six years later, when the Doha Declaration was signed, were governments allowed to circumvent the strict patenting regulations in the interest of protecting their citizens access to health care.

Surprisingly, very few developing countries, including South Africa, have amended their Patent Acts to make use of the possibilities the Doha Declaration provided – mainly due to international pressure from the pharmaceutical industry, the United States and European Union, where many of the world’s patented drugs are manufactured, health experts argue.

“Countries must not bow to this pressure,” warned Treatment Action Campaign (TAC) senior researcher Catherine Tomlinson. South Africa currently provided patent protection beyond what is required by the TRIPS agreement, she said.

“Unlike South Africa, India, Brazil and Thailand have used flexibilities allowed under TRIPS to curb excessive patenting of pharmaceuticals and promote public health. While South Africa granted 2,442 pharmaceutical patents in 2008 alone, Brazil only granted 278 pharmaceutical patents between 2003 and 2008,” Tomlinson explained.

Publicly, the South Africa government repeatedly confirmed the need for generics. In a joint declaration with India and Brazil, South African President Jacob Zuma officially acknowledged earlier this year that the impact of intellectual property on health, access to drugs and prices can best be tackled by scaling up production of generic medicines. But up until now, such declarations have remained lip service.

“We demand Zuma lives up to his commitment. We have not yet seen any concrete indications that government will take steps to change the Patent Act law,” said Tomlinson. “There is lack of political will.”

TAC and MSF also demand stricter and independent review of patent applications, as well as for third parties to be able to oppose patents pending approval and the first year after they have been granted.

Moreover, South Africa should make use of its right to issue compulsory licenses under the Doha Declaration that would allow it to access generic versions of otherwise patented medicines in cases where prices are prohibitively expensive, the organisations say. In contrast to other developing nations, such as Thailand, South Africa has not once made use of this option.

The consequences of South Africa’s strict patent protection are high medicine costs and the delayed availability of affordable generic medicines. South African pharmaceutical benefit management company Mediscor reported in its 2010 medicines review that drug expenditure increased by 25.2 percent between 2008 and 2010, while medicine use only increased 5.8 percent.

For patients receiving chronic, life-saving medication, such as ARVs, availability of generic medication can mean the difference between life and death.

Nokwanda Pani, an HIV-positive woman who lives in South Africa’s third-largest township, Khayelitsha, near Cape Town, has been receiving ARV treatment since 2005. Four years later, when she developed resistance to the drugs, she was put onto a second line of medication.

She now worries about what will happen to her if her body stops responding to the medication again. Because, in South Africa, third-line treatment is only available in the private health care sector, at a high cost of 4,200 dollars per patient per year – an amount that Pani cannot afford.

Without generic competition, the cost of second- and third-line ARVs can be up to 20 times more expensive than first-line ARVs, confirmed MSF. Such price differences do not only apply to HIV treatment but to all drugs, including those needed to treat cancer, tuberculosis, diabetes or high-blood pressure.

“Because I rely on the public health sector, third-line treatment is not available to me. If I build up resistance again, it’s the end of the road for me,” Pani says. For her, it all comes down to one central question: “Why is our government putting the profits of pharmaceutical companies before our lives?”

Excerpt:

Doctors in Mogadishu are warning that famine victims in internally displaced camps have become vulnerable to contagious diseases like cholera and measles, as conditions here are ripe for an outbreak. This comes as internally displaced persons complain that relief aid to some camps has dwindled or stopped.

A four-year-old girl with meningitis sleeps in a makeshift tent in Sigale camp. Her parents left her to go beg for aid. Credit: Shafi'i Mohyaddin Abokar/IPS

The leader of a group of Somali volunteer doctors aiding the famine victims living in camps outside of Mogadishu, Dr. Abdi Ibrahim Ahmed, told IPS that sanitation in the camps was of concern and that many did not have access to clean drinking water.

“Conditions in the camps are very ripe for killer diseases. Doctors are ready to contribute their time, knowledge and energy, but we call on the Somali government to take our warnings seriously,” Ahmed told IPS.

He said people at IDP camps have contracted various diseases including upper and lower respiratory infections, measles, malaria and meningitis.

Ahmed said that standby medical units need to be established in the camps, adding that improved sanitation was needed to help prevent the spread of disease.

“If torrential rains fall and there are no mobile teams operating at the camps, I am afraid that contagious diseases will kill many,” the doctor told IPS.

While international aid continues to be delivered to Somalia, relief efforts at some camps have dwindled or stopped.

The Sigale camp on the outskirts of Mogadishu holds more than 3,000 people, according to the camp chairman Mohamed Hassan Sheik Abdi. However, they have not received relief aid since early August.

“We received our last food assistance from Qatar in the early days of Ramadan. Since then no one has come to us. We only heard on the radio that assistance from the international community is coming daily and that food distribution is continuing at some IDP camps,” Abdi told IPS.

He said that every morning mothers and fathers from the camp go to the city where they beg for food and charity.

“They return with what they get in the evening and feed their children who don’t eat all day,” he added.

The living conditions here are deteriorating rapidly.

While the United Nations Children’s Fund built a few toilets in Sigale and other IDP camps, they are not sufficient to meet the needs of the increasing population of these camps. While adults form long queues to use the few toilets at Sigale, children opt to defecate outside.

Also, there is a severe lack of water and women are forced to walk vast distances to find water.

It is no wonder that the drinking water is contaminated and has led to a number of watery diarrhoea cases, now one of the main causes of death at the camps.

According to Abdi, 10 persons, mostly children under the age of five, died from watery diarrhoea, whooping cough and diphtheria at Sigale since late September.

Since August, at least 38 people from Sigale and four other surrounding IDP camps have died from watery diarrhoea and other diseases.

The non-governmental relief organisation Qatar Charity was one of the first agencies to arrive in Somalia with aid for famine and drought victims. The drought has been described as the worst in the East African region in over 60 years.

Duran Ahmed Farah, Qatar Charity country director for Somalia, told IPS said that his agency has provided food aid to thousands of Somalis and now intends to tackle sanitation and health issues at the camps.

“We first tried to do a life-saving campaign because people were dying of hunger and wanted something to eat. Now we are going to establish mobile medical teams that will be responsible for health care at IDP camps,” Farah told IPS.

He added that aid agencies had not stopped their relief efforts but were feeding the new arrivals to Mogadishu.

“The huge need here cannot be met within a short time,” he said.

Meanwhile, the relief organisation Usmani Community Centre has started digging wells at some camps.

“We dug the wells at two camps in Hamar-Weyne and Abdel Aziz districts. In January we intend to dig wells at the seven camps that have the highest number of IDPs in Mogadishu,” Abdulaahi Mohamed Saneey, the Somali representative of the charity, told IPS.

The Somali government’s Mogadishu spokesman Mohamed Abdullahi Arig told IPS that the government needed help to prevent a possible cholera outbreak and to prevent other communicable diseases from spreading in the camps.

“The government is more vigilant, but our capacity is too little. We need the international community’s assistance in this sector,” Arig said.

Malawi is experiencing a drug shortage as the country’s international donors remain reluctant to release aid meant for the health sector.

Malawi is experiencing a drug shortage. Credit: Claire Ngozo/IPS

About 60 million dollars in funding has been withheld amid allegations of pilfering and corruption in the procurement of drugs at the government’s Central Medical Stores. The Central Medical Stores procures and distributes drugs to government health facilities.

The lack of aid has had a significant impact on the country’s health sector as international donors fund up to 90 percent of Malawi’s medical budget.

While some donors are supplying key medical facilities with life-saving drugs, this is not sufficient to meet the widespread demand as the supplies are mainly for the country’s three main referral hospitals located in Blantyre, Lilongwe and Mzuzu.

Throughout the country, patients seeking medical treatment at government-run medical facilities are unable to access medication such as anti-retrovirals (ARVs), anti-malarial drugs and even painkillers.

Health facilities are also experiencing a shortage of medical equipment such as gloves, and malaria and HIV/AIDS testing kits.

Agnes Makwasa, a 45-year-old HIV-positive patient from the country’s commercial capital, Blantyre, is struggling to obtain free ARVs. For five years, she received a free one-month supply from her local government clinic, until recently.

“They told me that they could not give me my whole dosage because the clinic had limited stock. I had to return for more drugs after a week, but by then the clinic had run out,” Makwasa told IPS. She said she ended up paying 50 dollars for the medication at a private pharmacy.

“I am a widow with five young children, and I am not employed. I make a living selling doughnuts and only make about 90 dollars a month. This means that my family is living on a very tight budget. This is also a threat to my health now that I cannot afford a balanced diet, which HIV patients are advised to be on while on treatment,” said Makwasa. Up to 60 percent of Malawi’s 13.1 million people live below the poverty line.

The situation has also caused concern in rural Malawi as some health facilities have run out of basic painkillers like aspirin.

Malita Nalikata from Mulanje, southern Malawi, told IPS that medical staff at her local hospital told her that they and the other medical facilities in her district did not have anti-malarial drugs to treat her malaria. They advised her to buy painkillers for treatment, as they did not even have that in stock.

“I don’t have money, so I ended up going to see a traditional healer who gave me some herbs to eat with porridge,” said Nalikata. She gave the medicine man a chicken as payment.

“That is all I could afford and traditional healers accept such kind of payment,” Nalikata said. ? It is common practice in rural areas for poor people to patronise traditional healers when they cannot access medical care from government health centres.

About 80 percent of Malawians use public health facilities, according to the Malawi Health Equity Network, a group of civil society organisations in the health sector.

The Malawi Health Donor Group, a network of international donors including Britain, the United States, Germany and United Nations agencies, have refused to release assistance until the government cleans up the health sector.

Chairperson of the Health Donor Group Athanase Nzokirishaka told IPS that the international donors want the government to work on the shortcomings facing the health sector, especially the way medical drugs and supplies are managed by the Central Medical Stores.

The donors, according to Nzokirishaka, are also concerned with poor record management for the country’s drugs and delays in auditing the process of drug procurement.

“Government has a long way to go towards restoring the trust of the international community, and of Malawians, in the national drug system,” said Nzokirishaka.

“Malawi will need to demonstrate that it can fully resolve issues to do with inefficiency, leakage and corruption at all levels of the system. Indeed weaknesses in the supply chain have already been a major factor in reduced or delayed funding for some donors in the past,” said Nzokirishaka.

For the past year, the donors have left the government to procure drugs for the country’s health facilities, a situation which has led to the critical drug shortage.

For many years, up to 40 percent of Malawi’s national budget has been dependent on donors and 80 percent of the country’s development budget was provided under the Common Approach to Budget Support.

This included contributions from Britain, Germany, the African Development Bank, Norway, the European Union and the World Bank. However, the British and German governments have refused to release up to 400 million dollars this year accusing the Malawian government of bad governance.

The government of Malawi has acknowledged the shortcomings in the health system.

Responding to the concerns by the Health Donor Group, Minister of Health Jean Kalirani admitted to IPS that the lingering weaknesses in the Central Medical Stores and the supply chain of drugs have affected the supply of medicines in health centres and hospitals across the country.

“Government is addressing the drug crisis by strengthening the capacity of the Central Medical Stores as a long term solution. In the short term, we are procuring drugs through an emergency tender while resolving issues that have been raised by the donors,” said Kalirani.

She explained that the government is working on establishing a viable financial model, which will be used to track the flow of drugs efficiently.

By Brian Moonga
Oct 8 2011 (IPS)

A lack of access to medicines due to prohibitive costs is driving some Zambians to use the cheapest remedies they can find and, as Brian Moonga reports, this has some serious health implications:

[podcast]http://traffic.libsyn.com/ipsaudio/20111008_fakemedicines_moonga.mp3[/podcast]