The Big Bad Wolf as the friendly next-door neighbor
(A mixture of the Wolf in Little Red Riding Hood, and the Wolf in The Three Little Pigs, he is a friendly misunderstood crossdresser whom the Fairy Godmother unaffectionately refers to as “some gender confused wolf.” He appears to still be wearing Lil Red’s grandmother’s clothes and is apparently on good terms with the three little pigs. In Far Far Away Idol, he sings “Hungry Like the Wolf”. In recent “Shrek The Halls,” he shows off a sarcastic attitude. Available at http://spanengrish.blogspot.com/2007/12/transgendered-characters-in-children.html)
This post examines Andrew Witty’s proposal to introduce patent pools to fight diseases in underdeveloped/poor countries. The interesting fact about his proposal is that he offers to introduce such pools for ‘neglected’ diseases. However, HIV/AIDS that causes maximum number of deaths in these regions (especially Africa) is not covered, and as per Mr. Witty it doesn’t fall within the ambit of a neglected disease. Really now?
PROBLEM: PHARMA SECTOR AND PROFIT MARGINS
The pharmaceutical sector, traditionally controlled by companies situated in developed countries has resulted in market power being concentrated and often serving the profit margins of these companies. The point being that the companies have often used their profitability to lobby with the governments and the governments in turn have used their economic and political strength to further the cause of these companies, product patents being one such example.
One could say that given the concentration of power, these companies often behave like the big bad wolf placing profits over patients. It should be noted that developing and underdeveloped countries alone don’t face this problem of expensive medicines. In the European Commission’s press release IP/09/1098 dated July 8, 2009, EU’s Competition Commissioner, Neelie Kroes stated that, “We must have more competition and less red tape in pharmaceuticals. The sector is too important to the health and finances of Europe’s citizens and governments to accept anything less than the best… When it comes to generic entry, every week and month of delay costs money to patients and taxpayers.” In a related report it was further stated that, “citizens waited more than seven months after patent expiry for cheaper generic medicines, which resulted in costs of over 20 per cent in terms of extra spending…” Given this background the Commission stated that, “the first antitrust investigations are already under way, and regulatory adjustments are expected to follow dealing with a range of problems in the sector.”
ATTITUDES
So there is this problem, the other problem is that the companies producing the branded drugs are more interested in preserving margins as opposed to solving the problem of access to medicines or reducing red tapeism in the pharma sector. It follows from this attitude and the statement of the Commissioner that, the production of cheaper medicines by generic drug manufacturers situated in countries like India and Brazil comes as a severe blow.
More importantly, the reduced margins also provide evidence of the minor but important shift in market power in favour of generic manufacturers. For instance, in present times, in order to receive any support for their claims of intellectual property rights violation, apart from a pure rights based argument, branded drug manufacturers put forth arguments like generic versions aren’t the best quality and so on (again as regards quality while such a general statement as such in relation to generic manufacturers is wrong, there have been quality problems with generic versions in the past as often counterfeit drugs are passed off as generic drugs.)
Moreover, similar to Microsoft’s efforts to beat the popularity of the FLOSS movement, branded drug manufacturers have stepped up their attempts to ensure access to medicines (their branded drugs), especially in the poor and underdeveloped countries where expensive drugs are simply unaffordable and result is high mortality rates in the absence of other options.
FAIRYTALE ENDING??
Like any fairytale, we now see the entry of the good guy who tries to reform the mojo jojos such that the big bad wolf and red riding hood to serve the sick/ill old grandmother together
The good guy here is Andrew Witty, CEO, GSK. Earlier this year Sumathi had written a post on Mr. Witty’s proposal (on behalf of GSK) for promoting and offering to be part of voluntary patent pools to develop treatments for neglected diseases. As stated in the post, this claim was made in an article published by the Guardian. Obviously, the concern shown by Mr. Witty resulted in widespread admiration for a man standing up to flex rules for social welfare. The Guardian dedicated an editorial in his praise. An expert from the editorial reads as follows:
There isn’t a shred of doubt that this step or attempt needs to be acknowledged. However, the question is whether the step is constructive in reality. This aspect will be examined in this post.
WHO defines neglected diseases as follows, “those diseases that affect almost exclusively poor and powerless people living in rural parts of low-income countries.”
Thus, as per this definition the lack of the following points makes a disease ‘neglected’:
Lack of Availability, i.e., availability of drugs in sufficient numbers,
Lack of Accessibility, i.e., those diseases that “affect almost exclusively poor and powerless people living in rural parts of low-income countries.”
Lack of Quality, those diseases that “affect almost exclusively poor and powerless people living in rural parts of low-income countries.”
Further, the WHO website lists AIDS as the leading cause of death in Africa. The details are produced below:
* The African Region has 11% of the world’s population, but an estimated 60% of people with HIV/AIDS.
* HIV/AIDS is the leading cause of death for adults in the Region.
* The number of HIV-positive people on antiretroviral treatment increased eight-fold between December 2003 and December 2005: from 100 000 to 810 000.
Moreover, the drugs for HIV/AIDS, which help cure/treat the disease are way too expensive for the general junta of these countries and are also unavailable. As per statistics, in Africa AntiRetroviral Therapy (ART) is only reaching 23% of those who need it; another 3.6 million people need ART.
Hence, we see that given the statistics, HIV/AIDS would be a neglected disease as per WHO’s standard, i.e., neglected from the point of the victim/patient. Given this scenario, one can legitimately ask, (a) Can Mr. Witty define neglected and (b) how is the voluntary patent pool helping? The answer, regrettably, is that Mr. Witty cannot define neglected from the patient’s perspective and consequently the patent pool does not cover HIV.
Michelle Childs argues against such exclusion and states that, “He [Mr.Witty] is saying there is no need for a patent pool for HIV. Our position is that there is an urgent need for a patent pool for HIV because of the rising prices of new first and second line drugs for patients who develop resistance.”
The problem is that given the statistics and WHO’s definition of neglected diseases, Mr. Witty’s claim falls through.
This lacuna is addressed by the efforts of UNITAID, an international drug purchase facility, who attempts to put together patent pool related to AIDS treatments. UnitAid welcomed GSK’s announcement of a patent pool to tackle neglected diseases and place its patents for necessary medicines into a pool.
Also, possibly looking at this step as a building block, Guardian reported that, leading UK and international organizations wrote to GSK urging it to pool its patents on HIV medicines to help save millions of lives in developing countries. As per the report, the letter is from 15 organisations, including the Stop Aids Campaign, Médecins Sans Frontières, Unicef and Christian Aid, calls on GlaxoSmithKline to join a patent pool being put together by Unitaid, which aims to improve access to drugs for HIV/Aids and other diseases in poor countries.
Interestingly, as per reports by the Guardian and Local Tech Wire, this letter was sent to Mr. Witty post his claims that enough was being done by GSK to address the problem of HIV/AIDS in developing countries and that it wasn’t a neglected disease. He also stated that he did not know enough about UnitAid and had only read about them in the papers. [It was after this statement that the letter was sent to him by UnitAid asking him to join the patent pool. However, by saying that Aids is not a neglected disease methinks that he has already rejected the idea of joining this pool.]
Thus, we see that the sheen is already wearing off Mr.Witty’s proposal of the voluntary patent pool to help fight diseases at an affordable cost in poorer countries. To be fair, he had said this at the very beginning, that the proposal will not cover AIDS/HIV. However, given the statistics one fails to understand how his reasoning would work. If 60% of the population is dying of a disease, their treatment is neglected and shouldn’t that be the focus of patent pools aiming to solve health problems in developing countries. So, the problem is, I fail to understand how, for Mr Witty, malaria is a neglected disease and AIDS isn’t!! Then again not everyone can define ‘neglected’.
Like you rightly said, cost will directly co-relate with success against diseases in developing countries, cost of medicines that is.
Like you rightly said, cost will directly co-relate with success against diseases in developing countries, cost of medicines that is.