[Ip-health] ITPC Report Examing HIV/AIDS Access in 14 Countries...

[Ann-Marie Sevcsik]

MISSING THE TARGET #5:=0D
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Improving AIDS Drug Access and=0D
Advancing Health Care for All=0D
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International Treatment Preparedness Coalition (ITPC)=0D
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Current Report From International Treatment Preparedness Coalition (ITPC)=
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December 2007 -- Missing the Target #5 [PDF]=0D
=0D
Missing the Target #5 Media Release 11-27-07 [PDF]=0D
Media Contacts=0D
Chris Collins: +1 845-701-0158; ChrisCSF@aol.com=0D
Gregg Gonsalves gregg.gonsalves@gmail.com=0D
Kay Marshall: +1-347-249-6375; kaymarshall@mac.com=0D
Previous Reports=0D
July 2007 ---ITPC AIDS Treatment Access materials=0D
November, 2006 ---ITPC AIDS Treatment Access materials=0D
May, 2006 -- ITPC AIDS Treatment Access Update [PDF]=0D
November 2005 -- ITPC AIDS Treatment Access Report [PDF]=0D
May 2006 ITPC Press call transcript [RTF]=0D
May 2006 ITPC Press Release [RTF]=0D
November 2005 Archive=0D
Executive Summary=0D
=0D
At the G8 meeting in Gleneagles in 2005 and again at the United Nations UNG=
ASS session in 2006, world leaders promised to come as close as possible to=
 providing universal access to AIDS treatment and prevention by 2010. Estim=
ates of HIV incidence and prevalence will change, but by any account, today=
 several million people in desperate need of AIDS treatment do not have acc=
ess to it. And at the current pace of growth in treatment delivery, several=
 million will not have access by the end of 2010. Broken promises will mean=
 millions of deaths.=0D
=0D
Scale up of AIDS treatment is driving unprecedented expansion of health del=
ivery and, in the process, identifying critical challenges to health system=
s as well as practical solutions to address them. This report identifies ma=
ny ways in which governments and global agencies must act to correct system=
s essential to delivery of health. In the area of antiretroviral drug acces=
s=C3=A2=E2=82=AC=E2=80=9Da special focus of this report=C3=A2=E2=82=AC=E2=
=80=9D our research found that in many countries drug registration, procure=
ment, and supply management systems are inadequate, drug stock-outs are com=
mon, and most people are not being treated with ARV regimens that are consi=
stent with recent WHO recommendations for improved first-line and standardi=
zed second-line treatment combinations.=0D
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On-the-ground research by civil society advocates from 17 countries also re=
veals the close interconnection of AIDS services with other health and soci=
al supports. The lessons for successful AIDS treatment are true for all hea=
lth services: appropriate delivery includes adequate nutrition, clean water=
, trained health workers, accessible health clinics, integration of prevent=
ion and treatment, and free provision of drugs, diagnostic and monitoring t=
ests, and other commodities. Mobilization around AIDS has raised new resour=
ces, built consumer-engagement in providing health care, marshaled enduring=
 public support, and promoted the development of results-oriented approache=
s to global health. Building on these foundations should be a central strat=
egy in developing comprehensive systems of health care. In Haiti and Rwanda=
, for example, providers are demonstrating how to deliver AIDS treatment as=
 part of a comprehensive program that includes HIV prevention and a wide ra=
nge of health services.1 2 3=0D
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We cannot allow responses to AIDS and other chronic health issues to become=
 bogged down in simplistic dichotomies: prevention vs. treatment; horizonta=
l vs. vertical programming; disease-specific funding vs. strong health syst=
ems. There is only one appropriate approach: We must do everything, better,=
 for more people, and in an increasingly coherent way.=0D
=0D
In this fifth installment of the Missing the Target report series, we are b=
roadening and deepening our approach to monitoring AIDS service delivery in=
 heavily affected countries. Seventeen teams (from Eastern Europe, Africa, =
Asia, and Latin America) participated in the development of this report. An=
d we are beginning the process of expanding the focus of the report series =
to incorporate more of the inextricably interwoven aspects of ending AIDS, =
including HIV prevention, TB services, and support services.=0D
=0D
Scaling up AIDS services=0D
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In the first section of MTT5, nine country teams provide first-hand reports=
 on central issues related to AIDS service scale-up in their countries. Eac=
h demonstrates that increasing access to AIDS treatment brings not only bet=
ter life and new hope, but also shines light on challenges and effective ap=
proaches to a spectrum of health, poverty, and human rights issues.=0D
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    The Missing the Target team in Cambodia found that low salaries, inadeq=
uate training and other issues have led to a serious human resources shortf=
all .=0D
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    Cameroon describes how lack of nutritional resources has emerged as a d=
etermining factor in delivering care=0D
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    In China, a close analysis reveals that multiple charges for AIDS-relat=
ed health services exist, even in the context of a =C3=A2=E2=82=AC=C5=93fre=
e=C3=A2=E2=82=AC=C2=9D ARV program=0D
=0D
    In the Dominican Republic, there is an increasing level of ARV coverage=
 but the government must now address poorly supported public hospitals and =
limited access to specialized care=0D
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    In India, the national AIDS authority has just announced a long awaited=
 second-line therapy plan; much greater attention is needed to marginalized=
 populations=0D
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    In Kenya, the report team documents the devastating impact of stigma an=
d discrimination on health service delivery=0D
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    The Russia team reviews the deadly combination of poverty, powerlessnes=
s and social discrimination among marginalized groups=0D
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    In Zambia, a district-by-district survey identifies multiple and variab=
le barriers to care, including limited access to diagnostic tests, poor nut=
rition, and long travel times to clinics=0D
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    The Zimbabwe team documents advances in service delivery that have been=
 accomplished in the midst of national political and economic turmoil but f=
inds continuing challenges such as fake ARVs and lack of access to clean wa=
ter=0D
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Focus on drug access=0D
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In part two of this report, =C3=A2=E2=82=AC=C5=93ARV Procurement, Registrat=
ion, and Stock-Outs=C3=A2=E2=82=AC=C2=9D, 14 national teams review drug acc=
ess issues, and find that global and national processes for AIDS drug regis=
tration are burdened by inefficiencies, duplications, delay, and, in some i=
nstances, corruption. In many cases key ARVs, particularly newer and second=
-line therapies, are not yet registered in high impact countries =C3=A2=E2=
=82=AC=E2=80=9C an administrative roadblock that puts lifesaving care out o=
f reach for hundreds of thousands of people.=0D
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While specifics vary by country, our research reveals that high prices, pat=
ent barriers, registration barriers, and misinformation among policy makers=
 and clinicians mean that many countries are using AIDS treatment combinati=
ons that are not preferred according to WHO guidelines, such as fixed-dose =
combinations of stavudine (d4T)+lamivudine (3TC)+nevirapine (NVP). In China=
 there is still wide use of didanosine (ddI)+stavudine (d4T)+ nevirapine (N=
VP), another combination not recommended by WHO. Drug stock-outs in governm=
ent-run treatment centers are common in several countries, and they often p=
rompt drug sharing, and with it the potential for the development of resist=
ance, as well as impoverishment as people who are forced to pay out of pock=
et for medicines in the private sector.=0D
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    In Argentina, high cost and restrictions on some drugs impede access to=
 some second-line and other medicines=0D
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    In Belize, human resources shortfalls, price increases and inadequate q=
uality assurance plague drug delivery=0D
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    In Cambodia, expanded access to drug resistance and viral load testing =
is needed, as is increased attention to drug quality=0D
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    In China, access to second-line therapy is extremely limited, new WHO t=
reatment guidelines on improved first-line treatment have not been widely i=
mplemented and patents on key medicines are preventing cost-cutting generic=
 competition=0D
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    In the Dominican Republic, new intellectual property laws and patent en=
forcement by Merck are leading to higher prices and limited access to some =
key drugs=0D
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    In India, drug stock-outs are reported across the country, particularly=
 where IDUs require treatment regimens that are not hepatotoxic=0D
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    In Malawi, a chronic shortage of health care workers is a major impedim=
ent to drug access; while there are no ARV stock-outs, other important drug=
s are often unavailable=0D
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    In Morocco, new intellectual property laws threaten the provision of AI=
DS treatment=0D
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    In Nigeria, despite a rapid scale up of ARV treatment and a free treatm=
ent policy, treatment sites are not easily accessible in many parts of the =
country, and CD4 and other tests are still being offered at a fee in severa=
l locations=0D
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    In the Philippines, treatment is not yet accessible to all, there is a =
healthcare worker shortage and diagnostic testing access is limited=0D
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    In Russia, ARV stock-outs are a severe and ongoing problem=0D
=0D
    In Uganda, stock-outs are commonplace, and limited support and care ser=
vices undermine drug access=0D
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    In Zambia, there is concern that AIDS drug access depends on the work o=
f NGOs and the government is not sufficiently engaged=0D
=0D
    In Zimbabwe, stock-outs are frequent and the increasingly unfriendly ge=
neral policy environment remains a cause for concern=0D
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Recommendations=0D
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The report makes a number of concrete recommendations to the key players wh=
o are responsible for making near universal access to AIDS treatment a real=
ity by 2010:=0D
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WHO, UNAIDS and other UN technical agencies:=0D
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=C3=A2=E2=82=AC=C2=A2 WHO needs to take the lead to educate countries about=
 changes to standard first- and second-line treatment regimens. This will i=
ncrease country demand and help contribute to price reductions.=0D
=0D
=C3=A2=E2=82=AC=C2=A2 UN technical agencies must clearly and publicly commu=
nicate changes in WHO ARV drug guidelines and provide technical support and=
 guidance to countries to help implement the changes.=0D
=0D
=C3=A2=E2=82=AC=C2=A2 WHO must be much more active and visible as the arbit=
er in setting norms on the use and availability of life-saving medicines, f=
or example through reinvigorating the AIDS Medicine and Diagnostic Service =
(AMDS) and through eliminating bottlenecks and increasing support for the W=
HO prequalification program.=0D
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=C3=A2=E2=82=AC=C2=A2 WHO must reinvigorate the operational urgency of the =
=C3=A2=E2=82=AC=C5=933 by 5 Initiative.=C3=A2=E2=82=AC=C2=9D Given its focu=
s on building primary care services, WHO should lead global efforts to simu=
ltaneously expand AIDS services while strengthening broader care systems.=
=0D
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=C3=A2=E2=82=AC=C2=A2 UN agencies should provide increased technical and po=
litical support to help create political and policy space for governments t=
o overcome patent barriers through use of public health flexibilities in in=
ternational trade law.=0D
=0D
=C3=A2=E2=82=AC=C2=A2 WHO=C3=A2=E2=82=AC=E2=84=A2s Intergovernmental Workin=
g Group on Public Health, Innovation and Intellectual Property (IGWG) provi=
des a critical opportunity for much-needed leadership from UN agencies, as =
well as national governments, to increase access to affordable medicines th=
rough a clear international strategy and plan of action.=0D
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The Global Fund:=0D
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=C3=A2=E2=82=AC=C2=A2 The Global Fund should encourage countries to switch =
from outdated and non-optimal AIDS treatment regimens to improved treatment=
 combinations, and develop a plan to support countries making the switch.=
=0D
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=C3=A2=E2=82=AC=C2=A2 The Global Fund should ensure its grantees are procur=
ing medicines at preferential prices, such as those secured through UNITAID=
=C3=A2=E2=82=AC=E2=84=A2s partnership with the Clinton Foundation (announce=
d May 2007).=0D
=0D
=C3=A2=E2=82=AC=C2=A2 The Global Fund should act in cases where countries a=
re reporting paying high prices for medicines through the Price Reporting M=
echanism by diagnosing the problem and working with partners such as UNITAI=
D to ensure procurement at lowest cost.=0D
=0D
=C3=A2=E2=82=AC=C2=A2 The Fund should proactively support grantees in ident=
ifying and correcting procurement bottlenecks and strengthening national pr=
ocurement systems for ARVs and other medicines.=0D
=0D
Bilateral donors including PEPFAR:=0D
=0D
=C3=A2=E2=82=AC=C2=A2 Bilateral programs should work with national treatmen=
t programs, community organizations, PLWHA and other partners to support na=
tional efforts to switch to optimized first-line treatment. Budgetary alloc=
ations should reflect at least the initial increases in costs for optimized=
 first-line treatment.=0D
=0D
=C3=A2=E2=82=AC=C2=A2 PEPFAR and other bilateral donors should work with co=
untries to achieve agreed benchmarks for increasing the national capacity o=
f countries in procurement and supply management.=0D
=0D
UNITAID: The international drug purchase facility should work aggressively =
to support initiatives to increase competition and further reduce the price=
 of new standardized treatment regimens, such as fixed dose combinations of=
 tenofovir (TDF) + lamivudine (3TC) +efavirenz (EFV), as well as generic ve=
rsions of heat-stable lopinavir+ritonavir (LPV/r) and other ritonavir-boost=
ed protease inhibitors such as atazanavir (ATV).=0D
=0D
Drug companies: Pharmaceutical companies must act with enlightened self-int=
erest to expand access to their products by ceasing to intimidate countries=
 that use flexibilities in trade law and, where appropriate, by establishin=
g voluntary licensing arrangements to encourage local production. Both inno=
vator and generic drug companies must work to register their products much =
more expeditiously where people are in urgent need of treatment.=0D
=0D
National governments:=0D
=0D
Governments must build local and regional regulatory capacity to assure the=
 quality, safety, and efficacy of medicines and make use of options to acce=
lerate access to drugs, including reliance on the WHO drug prequalification=
 process. National governments must show political will to increase access =
to affordable medicines by using flexibilities in international trade rules=
 established by the Doha Declaration on TRIPS and Public Health.=0D
=0D
The Missing the Target reports illustrate many connections between access t=
o AIDS treatment and wider health and social support issues. In countries s=
uch as the Dominican Republic, which we=C3=A2=E2=82=AC=E2=84=A2ve followed =
across five reports, problems get solved, new problems emerge and, over tim=
e, the number of people getting ARVs (and staying alive) increases. Continu=
ing monitoring and civil society pressuring plays a major role in this impr=
ovement.=0D
=0D
Natural disaster and political and economic upheavals (for example, in Zimb=
abwe) can set-back but do not have to stop the momentum of increasing acces=
s to treatment. The goal of getting AIDS treatment to more and more people =
is working, saving millions of lives, and transforming people=C3=A2=E2=82=
=AC=E2=84=A2s relationship to health services around the world.=0D
=0D
=0D
*****************************************=0D
Ann-Marie Sevcsik=0D
Scientific Communications Manager=0D
Drugs for Neglected Diseases initiative (DNDi)=0D
Place St Gervais 1 / 1201 Geneva / Switzerland=0D
+41 (0)22 906 9230/50 (office/direct); + 41(0)22 906 9231 (fax)=0D
+41 (0)79 814 9147 (mobile)=0D
amsevcsik@dndi.org=0D
=0D
DNDi has just launched its first product: read more at www.actwithasaq.org=
=0D
Learn more about 'Best sciences for the most neglected' at www.dndi.org=0D
*****************************************=0D
=0D
-----Original Message-----=0D
From: ip-health-admin@lists.essential.org [mailto:ip-health-admin@lists.ess=
ential.org] On Behalf Of ip-health-request@lists.essential.org=0D
Sent: Tuesday, November 27, 2007 6:00 PM=0D
To: ip-health@lists.essential.org=0D
Subject: Ip-health digest, Vol 1 #2488 - 5 msgs=0D
=0D
Send Ip-health mailing list submissions to=0D
=09ip-health@lists.essential.org=0D
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To subscribe or unsubscribe via the World Wide Web, visit=0D
=09http://lists.essential.org/mailman/listinfo/ip-health=0D
or, via email, send a message with subject or body 'help' to=0D
=09ip-health-request@lists.essential.org=0D
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You can reach the person managing the list at=0D
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When replying, please edit your Subject line so it is more specific=0D
than "Re: Contents of Ip-health digest..."=0D
=0D
=0D
Today's Topics:=0D
=0D
   1. Postponed: Nov 27 KEI brownbag lunch to discuss WHO-IGWG II negotiati=
ons (Malini Aisola)=0D
   2. Committee on ESC Rights Advises Costa Rica government to assess impac=
t of CAFTA-DR (Caroline Dommen)=0D
   3. WIPO (Press Release): WIPO Contributes Expertise in International Dia=
logue on Avian Flu (Thiru Balasubramaniam)=0D
   4. Oxfam briefing paper - Investing for Life: Meeting poor people's need=
s through responsible business practices (Rohit Malpani)=0D
   5. BBC: Oxfam calls for drug firm action (Johanna von Braun)=0D
=0D
--__--__--=0D
=0D
Message: 1=0D
Date: Mon, 26 Nov 2007 12:20:39 -0500=0D
From: Malini Aisola <malini.aisola@keionline.org>=0D
Reply-To: malini.aisola@keionline.org=0D
Organization: Knowledge Ecology International=0D
To: Ip-health@lists.essential.org,=0D
=09"# Iplusa (E-Mail)" <iplusa@lists.keionline.org>,=0D
=09a2k discuss list <a2k@lists.essential.org>=0D
Subject: [Ip-health] Postponed: Nov 27 KEI brownbag lunch to discuss WHO-IG=
WG II negotiations=0D
=0D
Due to scheduling problems, we are postponing the brown bag lunch to=0D
discuss IGWG-II negotiations earlier scheduled for tomorrow. We will=0D
send out a message soon about the new date. Our apologies for any=0D
inconvenience caused.=0D
=0D
Regards,=0D
Malini=0D
=0D
=0D
--=0D
=0D
Malini Aisola=0D
=0D
malini.aisola@keionline.org=0D
=0D
www.keionline.org=0D
=0D
=0D
Knowledge Ecology International=0D
=0D
1621 Connecticut Ave., NW, Washington, DC 20009 USA=0D
=0D
Tel.:  +1.202.332.2670 Fax: +1.202.332.2673=0D
=0D
=0D
--__--__--=0D
=0D
Message: 2=0D
From: "Caroline Dommen" <cdommen@3dthree.org>=0D
To: <ip-health@lists.essential.org>=0D
Date: Mon, 26 Nov 2007 18:52:23 +0100=0D
Subject: [Ip-health] Committee on ESC Rights Advises Costa Rica government =
to assess impact of CAFTA-DR=0D
=0D
This is a multi-part message in MIME format.=0D
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[ Picked text/plain from multipart/alternative ]=0D
Este correo electr=3DC3=3DB3nico tambi=3DC3=3DA9n est=3DC3=3DA1 disponible =
en espa=3DC3=3D=0D
=3DB1ol; para recibirlo, dir=3DC3=3DADjase a:  <mailto:cdommen@3dthree.org>=
 cdomm=3D=0D
en@3dthree.org=0D
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Apologies for cross-postings=0D
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UN Human Rights Body Gives Credence to Costa Rica=3DE2=3D80=3D99s =3DE2=3D8=
0=3D9CNo=3DE2=3D=0D
=3D80=3D9D Coalition:=0D
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Government Advised to Assess the Impact of CAFTA-DR on the Enjoyment of Eco=
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nomic, Social and Cultural Rights=0D
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Geneva, 26 November 2007 =3DE2=3D80=3D93-Worried about the impact of CAFTA-=
DR on =3D=0D
human rights?  So are the guardians of the International Covenant on Econom=
=3D=0D
ic, Social and Cultural Rights.=0D
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During the recent appearance of Costa Rica before the Committee on Economic=
=3D=0D
, Social and Cultural Rights, Committee members raised concerns about the e=
=3D=0D
ffects of the Dominican Republic-Central America-United States Free Trade A=
=3D=0D
greement (CAFTA-DR) on various economic, social and cultural rights in Cost=
=3D=0D
a Rica, including the rights to health, social security, food and water.=0D
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In its final recommendations to the Costa Rican government, made public tod=
=3D=0D
ay, the UN Committee advised the Costa Rican government to seriously assess=
=3D=0D
 the potential adverse impacts of its commitments under CAFTA-DR =3DE2=3D80=
=3D9Cp=3D=0D
articularly on traditional agriculture, labour rights, access to health, so=
=3D=0D
cial security, and the intellectual property regimes protecting, inter alia=
=3D=0D
, access to medicines, biodiversity, water and the right of indigenous comm=
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unities to these resources.=3DE2=3D80=3D9D[1]=0D
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These recommendations add the Committee=3DE2=3D80=3D99s authoritative weigh=
t to c=3D=0D
oncerns long posed by human rights activists and the large percentage of th=
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e Costa Rican population who oppose the agreement.=0D
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CAFTA-DR was narrowly ratified through a referendum in Costa Rica on 7 Octo=
=3D=0D
ber 2007 amidst accusations of electoral fraud, and to the dismay of the ma=
=3D=0D
ny experts who are concerned about the likely negative social and economic =
=3D=0D
impacts of CAFTA-DR.  The Agreement will only enter into force when the Nat=
=3D=0D
ional Assembly has approved eleven laws relating to its implementation.=0D
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The =3DE2=3D80=3D9CNo=3DE2=3D80=3D9D coalition, which represents the wishes=
 of almost h=3D=0D
alf of the country=3DE2=3D80=3D99s population, have repeatedly pointed, int=
er ali=3D=0D
a, to the dangers of the new intellectual property regime CAFTA-DR imposes,=
=3D=0D
 which will require changes in patent law that the National Pharmaceutical =
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Industry estimates will cause medicine prices to rise by at least 800%.[2]=
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At present, access to health services is virtually universal in Costa Rica,=
=3D=0D
 in large part due to existing patent legislation which enables the product=
=3D=0D
ion of generic medicines and thus ensures that even the poorest sections of=
=3D=0D
 the population are able to afford necessary drugs.  CAFTA-DR will change a=
=3D=0D
ll this, through intellectual property provisions that will dramatically li=
=3D=0D
mit Costa Rica=3DE2=3D80=3D99s ability to manufacture, sell or import gener=
ic med=3D=0D
icines.=0D
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In response to questions posed by the Committee during the review on 6 and =
=3D=0D
7 November 2007, the delegation stressed that the Costa Rican government ha=
=3D=0D
d undertaken a human rights impact assessment of CAFTA-DR and was aware of =
=3D=0D
the potential negative effects of the agreement on certain sectors of the p=
=3D=0D
opulation.  The State confirmed that implementation would be carefully moni=
=3D=0D
tored, and social compensation distributed where necessary.  Despite these =
=3D=0D
vague assurances, the delegation failed to respond concretely to the majori=
=3D=0D
ty of the Committee=3DE2=3D80=3D99s questions regarding CAFTA-DR, suggestin=
g that=3D=0D
 the government has not fully taken into account the effect of the free tra=
=3D=0D
de agreement on its human rights obligations.=0D
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As State party to the International Covenant on Economic, Social and Cultur=
=3D=0D
al Rights, the Costa Rican government is legally bound to ensure that it do=
=3D=0D
es not regress on any of its human rights obligations.  Following this sess=
=3D=0D
ion before the UN Committee, the government must be held to account and pro=
=3D=0D
vide its citizens with proof of the human rights impact assessment it claim=
=3D=0D
s to have carried out, as well as policy and budgetary evidence of measures=
=3D=0D
 it is implementing to ensure that CAFTA-DR will not lead to a regression o=
=3D=0D
n the enjoyment of economic, social and cultural rights in the country.=0D
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For more information contact=0D
=0D
=0D
=0D
Caroline Dommen, Director, 3D =3DE2=3D86=3D92 T HR EE,  <mailto:cdommen@3dt=
hree.o=3D=0D
rg> cdommen@3dthree.org, tel +41 22 320 2121,=0D
=0D
cell +41 79 412 7207=0D
=0D
=0D
=0D
Zoe Goodman, Programme Assistant, 3D =3DE2=3D86=3D92 T HR EE, zgoodman@3dth=
ree. <=3D=0D
mailto:zgoodman@3dthree.org> org,=0D
=0D
tel +41 22 320 2121, cell +41 76 257 4543=0D
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See also=0D
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3D =3DE2=3D86=3D92 T HR EE background document : Costa Rica: Strengthening =
Patent=3D=0D
 Laws, Weakening Human Rights, November 2007,=0D
=0D
available at www.3dthree.org/en/page.php?IDpage=3D3D23&IDcat=3D3D5=0D
=0D
=0D
=0D
Committee on Economic, Social and Cultural Rights, Concluding Observations =
=3D=0D
: Costa Rica, E/C.12/CRI.CO.4.doc, 26 November 2007, available at www.ohchr=
=3D=0D
.org/ <http://www.ohchr.org/english/bodies/cescr/cescrs39.htm> english/bodi=
=3D=0D
es/cescr/cescrs39.htm and attached to this email=0D
=0D
=0D
=0D
=0D
  _____=0D
=0D
[1] Committee on Economic, Social and Cultural Rights, Concluding Observati=
=3D=0D
ons : Costa Rica, 26 November 2007, available at www.ohchr.org/english/bodi=
=3D=0D
es/cescr/cescrs39.htm=0D
=0D
[2] Mora Jim=3DC3=3DA9nez, H. 101 Razones para Oponerse al Tratado del Libr=
e Co=3D=0D
mercio entre Centroam=3DC3=3DA9rica y Estados Unidos, San Jos=3DC3=3DA9: Es=
cuela de=3D=0D
 Econom=3DC3=3DADa Universidad Nacional, 2004.=0D
=0D
__._,_.___=0D
=0D
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--=0D
[ E.C.12.CRI.CO.4.doc of type application/msword deleted ]=0D
--=0D
[ Press Release_Costa Rica ESCR CAFTA 26 Nov.pdf of type application/pdf de=
=3D=0D
leted ]=0D
--=0D
=0D
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--__--__--=0D
=0D
Message: 3=0D
From: Thiru Balasubramaniam <thiru@keionline.org>=0D
To: ip-health@lists.essential.org=0D
Date: Tue, 27 Nov 2007 11:40:39 +0100=0D
Subject: [Ip-health] WIPO (Press Release): WIPO Contributes Expertise in In=
ternational Dialogue on Avian Flu=0D
=0D
=0D
=0D
=0D
http://www.wipo.int/pressroom/en/articles/2007/article_0083.html=0D
=0D
http://www.wipo.int/patentscope/en/lifesciences/ip_health.html=0D
=0D
---------------=0D
=0D
WIPO Contributes Expertise in International Dialogue on Avian Flu=0D
=0D
Geneva, November 16, 2007=0D
PR/2007/529=0D
=0D
At the request of the World Health Organization (WHO), the World=0D
Intellectual Property Organization (WIPO) has offered its expertise=0D
and technical input on patent issues as they relate to influenza=0D
viruses and their genes. A technical WIPO report on this question=0D
will serve as one input to WHO=3D92s Intergovernmental Meeting on Pandemic=
=0D
Influenza Preparedness: Sharing of Influenza Viruses and Access to=0D
Vaccines and other Benefits, which will meet in Geneva from 20-23=0D
November 2007.=0D
=0D
WHO, as the lead international agency for public health matters, deals=0D
with a host of international issues relating to flu virus surveillance=0D
and the preparation and distribution of flu vaccines, and is=0D
coordinating the international response to the threat of a flu=0D
pandemic. Earlier this year, the World Health Assembly (WHA) adopted a=0D
key resolution on =3D93Pandemic influenza preparedness: sharing of=0D
influenza viruses and access to vaccines and other benefits=3D94 (WHA=0D
60.28). This resolution called for a study on =3D93the patent issues=0D
related to influenza viruses and their genes=3D94 in the context of a=0D
broad set of actions for influenza pandemic preparedness, the sharing=0D
of influenza viruses, access to vaccines and other benefits.=0D
=0D
The WIPO secretariat is assisting the WHO secretariat to help clarify=0D
relevant technical patent-related issues raised by the debate. This is=0D
in line with WIPO=3D92s cooperation responsibilities within the UN system,=
=0D
and the Organization being the UN specialized agency on intellectual=0D
property. This work is undertaken by the program on life sciences=0D
established within WIPO to provide this kind of technical and=0D
practical support, including when it is sought by policymakers in=0D
other international bodies and processes. WIPO=3D92s technical work in=0D
this area is intended to be supportive of and responsive to the=0D
essential work undertaken by the WHO as the key agency on matters=0D
relating to public health.=0D
=0D
WIPO=3D92s ongoing technical-level contributions to the international=0D
dialogue on avian flu issues are progressively unfolding on three=0D
fronts:=0D
=0D
(i)         a technical study on a number of  specific patent issues=0D
prepared in response to the WHO=3D92s request. This study seeks to=0D
explain, in a way that is accessible and relevant to health=0D
policymakers, the technical side of the patent system as it relates to=0D
the flu virus;=0D
(ii)        work on illuminating the =3D93patent landscape=3D94. This invol=
ves=0D
the search for practical answers to guide health policymakers in=0D
identifying what is actually being patented, where and by whom, and=0D
with what implications for virus sharing and vaccine development and=0D
production. This further aims to bridge the gap between a complex and=0D
rapidly evolving body of patent data and the needs of international=0D
health policymakers;=0D
(iii)       a more general practical review of the issues which seeks=0D
to put all of these elements into a broader context and to provide=0D
health policymakers with a comprehensive factual resource on IP=0D
matters as they relate to public health.=0D
=0D
This technical-level work does not advocate any specific=0D
recommendations or policy options. The responsibility to determine the=0D
appropriate responses and mechanisms to safeguard public health rests=0D
with public health policymakers. WIPO=3D92s technical contribution is=0D
designed to provide useful background information to buttress the=0D
efforts of health policymakers as they set future directions for a=0D
global response that may help pre-empt and contain a potential public=0D
health crisis. It further aims to provide a neutral technical=0D
background for the important international discussion of these broader=0D
public policy issues.=0D
=0D
In addition, WIPO is hosting the third in a series of public symposia=0D
on the life sciences and intellectual property on Friday, November 16,=0D
2007 on the theme "Intellectual Property and Life Sciences=0D
Regulation."  WIPO=3D92s Symposia on Life Sciences and Intellectual=0D
Property Policy provide an opportunity to examine intellectual=0D
property as it relates to the life sciences. They are designed to=0D
build understanding among a wide range of stakeholders (including=0D
international policy-makers, government agencies, legislators,=0D
delegates, civil society and the private sector) both of the practical=0D
use of the intellectual property system in the life sciences area and=0D
its impact on this rapidly evolving field by providing a forum for=0D
exchanging information and ideas. The program of the forthcoming event=0D
and information on the full series of WIPO Life Sciences Symposia are=0D
available at http://www.wipo.int/patentscope/en/lifesciences/.=0D
=0D
For more information please contact the Media Relations and Public=0D
Affairs Section at WIPO:=0D
=0D
=0D
     *             Tel.:                  +4122-3388161 or +4122-3389547=0D
     *             Fax:                  +4122-3388280=0D
     *             Email:              publicinf@wipo.int=0D
=0D
=0D
------------------------------------------------------------=0D
=0D
=0D
Thiru Balasubramaniam=0D
Geneva Representative=0D
Knowledge Ecology International (KEI)=0D
thiru@keionline.org=0D
=0D
=0D
Tel: +41 22 791 6727=0D
Mobile: +41 76 508 0997=0D
=0D
=0D
=0D
=0D
=0D
--__--__--=0D
=0D
Message: 4=0D
Date: Tue, 27 Nov 2007 06:32:55 -0500=0D
From: "Rohit Malpani" <rmalpani@OxfamAmerica.org>=0D
To: <ip-health@lists.essential.org>=0D
Subject: [Ip-health] Oxfam briefing paper - Investing for Life: Meeting poo=
r people's needs through responsible business practices=0D
=0D
This is a multi-part message in MIME format.=0D
--=0D
[ Picked text/plain from multipart/alternative ]=0D
http://www.oxfam.org/en/policy/briefingpapers/bp109_investing_for_life_0=0D
711=0D
<http://www.oxfam.org/en/policy/briefingpapers/bp109_investing_for_life_=0D
0711>=0D
=0D
Pharmaceutical industry is undermining its own future as millions of=0D
poor people denied access to medicines=0D
=0D
=0D
=0D
=0D
=0D
The pharmaceutical industry is denying medicines to millions of poor=0D
people and undermining its own future because companies are refusing to=0D
change the way they do business in developing country markets, according=0D
to a new report by international agency Oxfam.=0D
=0D
The report "Investing for Life=0D
<http://www.oxfam.org/en/policy/briefingpapers/bp109_investing_for_life_=0D
0711> " looks at the world's top 12 pharmaceutical companies, including=0D
their drug pricing policies, their record in developing medicines=0D
relevant to poorer countries and their stance on protecting intellectual=0D
property rights.=0D
=0D
Oxfam says the industry is failing to ensure universal access to=0D
medicines because it refuses to put the issue at the heart of its=0D
business model. As a result, it is failing to capture the full potential=0D
of emerging markets touted as the "new frontier" for its business=0D
success.=0D
=0D
According to a major consultancy firm, a loss of faith in the industry=0D
on the part of its investors has so far cost pharmaceutical's=0D
shareholders $1 trillion dollars.=0D
=0D
"The industry is burying its head in the sand. More than 85% of world=0D
consumers are underserved or have no access to its medicines. The=0D
industry must recognize that charging high prices, quashing generic=0D
competition, developing medicines only for those rich enough to pay and=0D
fighting for harsher patent laws is an ineffective business strategy for=0D
new markets, as much as it is a moral outrage," said Jeremy Hobbs, Oxfam=0D
International Executive Director.=0D
=0D
"Investors are worried about the industry's performance. They know that=0D
emerging markets are key for the industry's future growth but companies=0D
have been responding to the challenge of breaking into emerging markets=0D
in an ad-hoc and inconsistent way. This is bad for the industry and bad=0D
for poor people who are still facing devastating diseases like malaria,=0D
tuberculosis, asthma, cancer, and HIV/AIDS without affordable=0D
medicines," Hobbs said.   The report reveals shortcomings where the=0D
industry:=0D
=0D
*=09Has failed to implement a systematic and transparent=0D
tiered-pricing policy, where prices for all essential medicines are set=0D
according to people's ability to pay;=0D
*=09Continues largely to neglect research and development into=0D
diseases that predominantly affect poor people in developing countries;=0D
*=09Continues to be inflexible in protecting intellectual property,=0D
including challenging poor countries in court to stop them using legal=0D
public health safeguards;=0D
*=09Continues to rely too heavily on donations to get affordable=0D
medicines to people, even though this is unsustainable and sometimes=0D
counter-productive.=0D
=0D
Oxfam notes that some companies are offering differentiated prices but=0D
this is extremely limited and mainly for high-profile diseases such as=0D
HIV and AIDS. However, these offers are not systematic worldwide and are=0D
often still priced well above the means of people living in developing=0D
countries. Oxfam says that drug companies often adapt pricing in=0D
developing countries solely as a reflection of the publicity that=0D
surrounds the disease or the country.=0D
=0D
For instance, Abbott Laboratories was selling Kaletra - a second line=0D
anti-retroviral medicine - at $2,200 per patient per year in low=0D
middle-income countries like Guatemala, where a person's average wage is=0D
$2,400 a year. Only until Thailand, in response to the needs of poor HIV=0D
patients, issued a compulsory license to reduce the price of Kaletra to=0D
$1,000, did Abbott reduce the price of Kaletra worldwide to $1,000 per=0D
patient per year. Also in Thailand, French giant Sanofi-Aventis offered=0D
its cardiovascular disease medicine Plavix at a price that was 60 times=0D
more expensive than Emcure, the Indian generic version. In March 2007,=0D
it responded to Thailand's use of compulsory licensing by offering a 70%=0D
cut.=0D
=0D
Oxfam's report says that companies are still not investing enough into=0D
researching and developing medicines for diseases that predominantly=0D
affect poor people in developing countries. Between 1999 and 2004, there=0D
were only three new innovative drugs targeted at diseases affecting the=0D
developing world out of 163 medicines brought to the market.=0D
=0D
"Even people suffering from tuberculosis - which kills nearly two=0D
million people a year - need six months of treatment and the most recent=0D
medicine is 30 years old," said Helena Vines-Fiestas, author of the=0D
report.=0D
=0D
On the industry's approach to intellectual property rights,=0D
Vines-Fiestas continued: "High levels of intellectual property=0D
protection have not resulted in new cures for diseases that affect poor=0D
people." Despite this, the report notes that the industry continues to=0D
insist that the global intellectual property regime does not prevent=0D
poor people from accessing affordable medicines. Oxfam says not only is=0D
the industry's view narrow-minded and wrong, but that the evidence is=0D
overwhelming that generic competition is the most effective and proven=0D
method to reduce drug prices.=0D
=0D
In recent years companies have mounted legal challenges or exerted=0D
direct pressure to protect their patents against the legitimate use of=0D
safeguards in Thailand, Brazil and India. "These challenges are made at=0D
the direct expense of poor people," Oxfam said.=0D
=0D
Pfizer even challenged the Philippines government over their use of=0D
public health safeguards in relation to the drug Norvasc.=0D
=0D
"The industry is failing to make the systematic changes needed to serve=0D
developing country markets and meet its responsibility to make medicines=0D
universally available. Public pressure will intensify if companies=0D
continue to offer only patchy concessions, for example around high=0D
profile diseases such as HIV/AIDS and malaria," said Vines-Fiestas.=0D
=0D
The report concludes by arguing that companies will need to revamp their=0D
approaches on pricing structures, R&D investment and patent policies in=0D
order to serve these markets and make its medicines more accessible to=0D
poor people. Companies should adapt to the realities of developing=0D
country markets because up to 80 per cent of people in developing=0D
countries are vulnerable to falling or staying below the poverty line if=0D
they have to bear the cost of expensive medicines, particularly where=0D
treatment is long-term.=0D
=0D
"The industry is operating in a short-sighted way because it could gain=0D
enormous benefits from emerging markets, including lower research and=0D
development costs and cheaper manufacturing. Yet instead it continues to=0D
blindly use its same strategies in poor countries.  Even today, the=0D
richest 15% of the world consumes over 90% of its pharmaceuticals. At=0D
this rate, both the industry and millions of sick patients are losing=0D
out," concluded Jeremy Hobbs.=0D
=0D
=0D
=0D
=0D
=0D
=0D
=0D
=0D
--__--__--=0D
=0D
Message: 5=0D
Date: Tue, 27 Nov 2007 11:47:55 +0000=0D
From: "Johanna von Braun" <jvonbraun@gmail.com>=0D
To: ip-health@lists.essential.org=0D
Subject: [Ip-health] BBC: Oxfam calls for drug firm action=0D
=0D
http://news.bbc.co.uk/2/hi/business/7113584.stm=0D
=0D
=0D
=0D
Oxfam calls for drug firm action=0D
=0D
=0D
=0D
Drug firms are missing out on a huge potential market by failing to=0D
make drugs affordable for the world's poor, a report by charity Oxfam=0D
suggests.=0D
=0D
Drug firms have made "halting progress" in increasing access to=0D
medicine, but much more needs to be done, Oxfam said.=0D
=0D
The world's biggest drug firms have done little research into diseases=0D
that affect poor people, the report said.=0D
=0D
And their overzealous protection of patents means many poor people=0D
cannot afford the drugs they need.=0D
=0D
Priced out=0D
=0D
Currently 85% of the world's population is priced out of the=0D
industry's market, the report said.=0D
=0D
Those who cannot afford drugs often pay with their lives.=0D
=0D
Malaria claims the lives of one million people every year, while two=0D
million people die annually from TB.=0D
=0D
Anti-poverty charity Oxfam says prices for essential medicines need to=0D
be tiered, in line with people's ability to pay.=0D
=0D
Some companies do offer different prices but often "solely as a=0D
reflection of the publicity that surrounds the disease or the=0D
country", the report said.=0D
=0D
Drug firms rely over heavily on donations to deliver affordable drugs=0D
and do little research into the drugs developing countries need, it=0D
added.=0D
=0D
Between 1999 and 2004, there were only three new drugs targeted at=0D
diseases affecting the developing world out of 163 drugs brought to=0D
market, the report said.=0D
=0D
Justify the cost=0D
=0D
Leading pharmaceutical companies argue that they need to charge higher=0D
prices to justify the billions of dollars they spend on research and=0D
development.=0D
=0D
High taxes and mark-ups by pharmacists and dispensing doctors also=0D
push medicine prices higher, they point out.=0D
=0D
In addition, their drugs and brands are often ripped off in countries=0D
with poor copyright protection.=0D
=0D
But, by refusing to offer prices that suit the pocket of its poorer=0D
consumers, drug firms are losing out, Oxfam argues.=0D
=0D
These economies offer huge market potential but industry needs a=0D
"vastly different approach: one which reflects the significance of=0D
massive income disparities", the report said.=0D
=0D
"The industry is operating in a short-sighted way because it could=0D
gain enormous benefits from emerging markets, including lower=0D
development costs and cheaper manufacturing. Yet instead it continues=0D
to blindly use the same strategies in poor countries," Oxfam's head of=0D
research Sumi Dhanarajan said.=0D
=0D
=0D
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