[Ip-health] Lancet on G8, WHA, and DNDi

[Rachel Cohen]

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Thanks to Nathan Ford for forwarding these.

Rachel

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Lancet Infectious Diseases 01 July 2003

Damp spirits among G8 fresh pledges

Kelly Morris

The significance of the setting for the G8 summit was not lost on its audie=
nce. The meeting of leaders from the richest nations convened at the health=
 spa of Evian-les-Bains, consuming vast amounts of the local mineral water =
between June 1-3, while worldwide more than 15000 children died due to lack=
 of clean water and inestimable millions of days' work were lost through di=
arrhoeal disease. UK charity WaterAid called the summit "a washout", while =
Oxfam, among many others, suggested that the optimistic agenda for health a=
nd related sectors had been watered down before the meeting.

The water sector received little more than a reaffirmation of previous G8 p=
ledges to halve the number of people without access to clean water and sani=
tation by 2015. An ambitious agenda that included doubling aid spent on wat=
er and sanitation had been proposed by French President Jacques Chirac, but=
 "washed down the drain" by the G8, reckons WaterAid. Now, asks the charity=
's Stephen Turner, where is the further US$30 billion-the annual European s=
pending on ice-cream-needed to reach the proposed target? "The most the G8 =
can promise is to redouble their efforts", says Turner. "They are continuin=
g to condemn a child to die every 15 seconds from water-related diseases."

Bernard Pecoul from Me?dicins Sans Frontie`res (MSF) notes that the French =
draft of what he now calls "an inaction plan on health", included "concrete=
 objectives to increase access to affordable generic drugs". But, behind cl=
osed doors, he suggests, "the G8 are deliberately blocking access to afford=
able drugs in trade negotiations". Nathan Ford of MSF describes how the rew=
ritten agenda was defended at the summit by the USA and Germany largely, he=
 believes, to reflect the interests of their pharmaceutical industries. Giv=
en the lack of opportunity for interested groups to influence the limited d=
ebate, this agenda was effectively adopted as the G8 communique? on health,=
 says Ford. "It was all quite depressing, actually", he adds.

Meanwhile, the Global Fund to Fight Aids, TB, and Malaria praised renewed c=
ommitments to support its work, plus an additional $1=B72 billion in fundin=
g pledges. But the Fund, which has already approved $1=B75 billion to 93 co=
untries, projects that $3 billion will be required to fulfil half of the pr=
ojected grant requests until end 2004-current pledges account for 23% of th=
at sum. Pe?coul is concerned how that money will be used, pointing out that=
 poor countries could treat up to five times as many people with locally pr=
oduced generic drugs rather than branded western treatments.

In a summit preoccupied with economic growth, concerns arose that the large=
 bilateral aid contributions proposed between individual nations could have=
 a divisive effect on global health. And although political will was demons=
trated for sustainable devel opment in Africa, doubts were expressed about =
the emphasis of some of the declared policy. The G8 Action Plan for Africa =
proposes as a key priority, "pressing ahead with current work with the inte=
rnational pharmaceutical industry" to promote availability of life-saving m=
edicines, rather than exploiting flexibility in current trade and intellect=
ual property laws. The plan also would include "relevant public-private par=
tnerships" for childhood immunisations and elimination of micronutrient def=
iciencies.

--------------------------------


Drugs for neglected diseases

Samuel Siringi

Sleeping sickness, leishmaniasis, and elephantiasis are some of the disease=
s that will be addressed by a new US$20 million African initiative. The Dru=
gs for Neglected Diseases Initiative would conduct research into the diseas=
es, which also include hydatid, kala azar, schistosomiasis, and Buruli ulce=
r. They are diseases that mainly attack the poor people in Africa and are c=
onsidered neglected since treatment options are inadequate or simply do not=
 exist.

Behind the initiative are the WHO, France's Medicins Sans Frontie`res (MSF)=
 and Institut Pasteur, Brazil's Oswaldo Cruz Foundation, India's Council of=
 Medical Research, and Malaysia's Ministry of Health. The Kenya Medical Res=
earch Institute (KEMRI) is the lead research and joint centre in Africa. Ac=
cording to MSF's director of campaign for access to essential medicines, Be=
rnard Pecoul, the initiative plans to raise US$250 million from governments=
, private foundations, individuals, and founding partners in the next 10 ye=
ars.

The initiative comes amid accusations that the west has ignored the plight =
of poor patients by either minimising funding or failing to do research on =
new drugs for diseases that affect them.

KEMRI director Davy Koech says most Kenyans are at risk of contracting the =
neglected diseases. "It is unfortunate that no new drugs for treating sleep=
ing sickness have been developed in the last 50 years, whereas the number o=
f people suffering from the disease continues to rise", he says.

Until recently, sleeping sickness patients had to undergo painful treatment=
 with arsenic-based medicine because of unavailability of more effective tr=
eatment. In Africa alone, the disease affects up to 500 000 people and thre=
atens another 60 million.

Neglected diseases often affect the poor in developing countries. As a resu=
lt, pharmaceutical companies have little interest in these diseases. The ne=
w project thus advocates increased public responsibility and involvement in=
 neglected diseases. Infectious diseases could be reduced if more funds wer=
e put into health research and drugs manufacture, according to experts.

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WHA acts on health regulations and intellectual property

Clare Kapp

WHO has been granted increased authority to deal with outbreaks of communic=
able diseases. The move was part of World Health Assembly (WHA) resolutions=
 that urge greater collaboration on severe acute respiratory syndrome (SARS=
) and more intense efforts to conclude the revised International Health Reg=
ulations (IHRs).

WHO's annual assembly (May 19-28) declared that the organisation was "deepl=
y concerned that SARS-as the first severe infectious disease to emerge in t=
he 21st century-poses a serious threat to global health security, the livel=
ihood of populations, the functioning of health systems, and the stability =
and growth of economies".

WHO voiced concern that the rapid spread of the virus had drawn attention t=
o the inadequacy of the current health regulations.

Most importantly, the WHA called on WHO Director-General Gro Harlem Brundtl=
and "to take into account reports from sources other than official notifica=
tions" in assessing potential international public-health threats.

WHA said WHO should collaborate with national authorities to assess the ser=
iousness of any threat and "when necessary and after informing the governme=
nt concerned, to conduct on-the-spot studies by a WHO team with the purpose=
 of ensuring that appropriate control measures are being employed".

Brundtland said the resolution would give the agency a much firmer platform=
 for action on potential global public-health risks. In particular, officia=
ls said it would help WHO to circumvent governments that are reluctant to r=
eport outbreaks and unwilling to grant speedy access to independent experts=
, as was initially the case with Chinese authorities and SARS.

The WHA also urged governments to establish national task forces and design=
ate responsible officials who would be accessible at all times to ensure th=
at emergencies would be speedily reported to WHO.

Director-General elect Jong-Wook Lee, whose appointment was confirmed by th=
e assembly, said WHO would launch a US$200 million fund to reinforce its Gl=
obal Outbreak and Alert Response Network.

The IHRs and SARS resolutions were unanimously approved on the final day of=
 the assembly. During the debate top health officials from all SARS-affecte=
d countries-including China, Canada and Vietnam-spoke out for more effectiv=
e international controls.

"The IHRs are outdated and belong to another time and age where infectious =
diseases which were dangerous to international health were a limited few", =
said Brundtland. "Here we have SARS illustrating that a public-health threa=
t can come out of nowhere."

The IHRs are the only legally binding set of rules on global alert and resp=
onse for infectious diseases. Last updated in 1981, they have serious short=
comings, not least because they class only cholera, plague, and yellow feve=
r as notifiable diseases and do not reflect contemporary threats such as bi=
oterrorism.

The revision is laborious because of the scope and complexity of the proces=
s, coupled with sensitivities over national sovereignty.

The USA, in particular, is watching carefully to ensure that the revised re=
gulations do not conflict with its federal structure or constrain the actio=
n of the Centers for Didease Control and Prevention (CDC).

"If the acceleration in rules does not infringe upon our authority and lead=
ership, then we will have no problem", said US Health and Human Services Se=
cretary Tommy Thompson, when asked about the US position on the IHRs.

At a press conference on the eve of the WHA, Thompson repeatedly made it cl=
ear that he believed the CDC had a more important role on the global health=
 stage than WHO. "The CDC is really the diamond", according to Thompson.

Thompson infuriated developing countries by submitting a resolution stressi=
ng the prime importance of intellectual property rights (IPRs) in innovatio=
n and public health. Brazil tabled a counter-resolution that health should =
have priority over trade.

After prolonged and bitter debate on IPRs, the WHA reached a compromise res=
olution. The resolution voiced concern that, of 1400 new products developed=
 between 1975 and 1999, only 13 were for tropical disease and just three fo=
r tuberculosis. It pointed out that, although industrialised countries acco=
unted for 90% of global pharmaceutical sales, 90% of the 14 million deaths =
due to infectious diseases happened in developing countries.

WHA urged WHO to support governments in the transfer of technology, giving =
high priority to antiretroviral drugs against HIV/AIDS, and to help monitor=
 the public-health implications of trade agreements.

Most significantly, it said WHO should establish the terms of reference for=
 an "appropriate time-limited body" to produce an analysis of IPRs, includi=
ng the question of incentives for the creation of medicines that mainly aff=
ect the poor. Brazil, which has been pushing for WHO to exercise such a rol=
e, described this as a victory for developing countries.

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