Rapporteur reports
Track B report by Omar Sued
The “Universal access, universal crises and universal prices” started with a louder protest of a Brazilian NGO calling for no patent protection for second line and new HIV drugs. The session was presented by Jaya Shreedhar, from India, one of the main providers of generic drugs.
Kevin De Cook, from WHO, presented the encouraging trends and the current challenges in the universal access to HIV care and treatment. During the last year 1.000.000 of PLWHA initiated ARV, however the coverage persists low (31%). The scaling up has been similar or higher in woman than in males, and 97% of individuals are receiving first line regimen. The big challenges are the price –in particular in second line regimens-, and expand the PTMC coverage. During 2007 in low and middle income countries only 18% of pregnant woman were tested for HIV, and for the HIV positive the ARV coverage was 33%. One important issue is to improve the virologic diagnostic of children, currently few infants are being diagnosed in the early months of live. Other challenges include to increase the HIV in TB patients (10% coverage of testing in HIV), to implement preventive isoniazid and CTX prophylaxis, and develop improve ARV regimens. The “3I” strategy (Intensive case finding, Isoniazid prophylaxis and Infection Control) was proposed to combat the epidemic of XDR/TB. The main challenges continue being how to prevent the HIV transmission, improve ARV regimens, and increase the retention of patients.
Mariangela Simao, from the National STD/Aids Program of Health of Brazil, described the experience of her country in the challenges of scaling up or ARV treatment. In 2006, HIV prevalence was 0.61%, with 32,000 new AIDS cases every year. The State provides ARV therapy for 190,000 (94.8% coverage) with a budget of US$ 640m, where a 25% of patients in second line have a significant impact. Sustainability of the program is related to fair prices of brand drugs. Faire price is based on a equal cost for all developing countries, and should consider the level of use of the drug in the country and the coverage.
Ellen’t Hoen from MSF addressed the experience working on the patent barriers. Effects on generic competition induced a fall down in original prices and now represent a 57% of PEPFAR budget. However, new fixed drug combinations (as Atripla) are 10 times expensive than the generic combination most used in resource limited setting. Price negotiation included differential prices, voluntary licenses, compulsory licensing, demonstrated to be no the best solution in all context. In biotechnology, it was recognized that the use of patent pools could serve the interests of both, the public and private industry and can be proposed as a new mechanism to assure broader availability of drugs at lower prices. When product with patent rights held by different owners are brought together and managed avoid the case by case negotiations.
Agnes Binagwaho, from Rwanda states that the poverty is the first problem to face when manages HIV in the country. Since the civil war in 1994, when the country was almost destroyed, the ARV program increases their coverage to 70% of PLWHA, with more than 90% of survival after one year. This figure was reached through a country lead process, ensuring that the external partners were fitted into the national plan, well coordinated, following a standardized format, determining the cost efficacy to adapt interventions according these results. The health program should be not vertical, but sectorial, focused in the prevention, and community involvement and transparency. These actions will, in addition, strengthen the overall health system.
Richard Elliot presented the Canadian example of implementing flexibilities in the TRIPS agreement, and gave same examples of how overcome the difficult process to negotiate the production of generic drugs.
Leadership report by Rebecca Hodes
This session examined the impact of intellectual property protection on public health, looking at the specific examples of Brazil and Canada to explore the ways in which two nations (one developing, one affluent) have used the global pricings regime to the advantage of people with HIV in spite of obstacles including opposition from governments and the pharmaceuticals industry.
K. de Cock presented data about the uptake of HIV-testing among TB patients in African countries. He emphasised the dangers in increasing prevalence of MDR and XDR TB, calling for greater access to diagnostics and drugs, and arguing for the importance of the ‘Three I’s’ (intensified case studies, isoniazid preventative therapy and infection control). These remarks squared with the requests by a protesting group of treatment activists from South Africa, the US and Latin America just prior to this session. De Kock closed by highlighting the dramatic price differentials between first and second-line ART, and by emphasising the imperative of greater and cheaper access to the latter.
M. Simão described Brazil as ‘as close as possible to universal ART access’ at 95% coverage, and stated that 25% of all patients are using 2nd line drugs. Simão detailed Brazil’s successes in negotiating lower prices on ART, and attributed these to robust political leadership. She explained the difficulties in establishing the real costs of drug R & D due to the secrecy of the pharmaceutical industry, and the enormous savings to Brazil’s health budget resulting from price negotiations on generic Efavirenz.
E. T’Hoen spoke of the centrality of generics access and fixed dose responses if treatment is to be rolled out as rapidly and effectively as possible, and argued for the enormous future benefits of a ‘patent pool’ and for the need to dissolve intellectual property in order to eradicate barriers to the development of new products.
R. Elliott offered a trenchant summary of the ways in which intellectual property laws prevent access to treatments, and emphasised that these laws must be interpreted and implemented in ways that promote public health and access to care.
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