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Drugs prices still on rise 5 years after Doha
Newsdesk
HIV/AIDS efforts are stagnating: accountability is key
For more information on UNAIDS data see http://www. unaids.org/en/HIV_data/ 2006GlobalReport/default.asp For more information on the ITPC Missing the Target 3 report see http://www. aidstreatmentaccess.org
Alon Skuy/AP/Empics
For more information on the Millennium Development Goals see PLoS Med 2006; 3: e455; doi:10.1371/journal. pmed.0030455
25 years after the first cases of AIDS, the global HIV/AIDS epidemic continues to grow, and internationally, efforts to prevent infections and provide universal access to treatment are failing in many areas. However, this view, voiced on World AIDS Day, Dec 1, 2006, is countered by the fact that prevention programmes are getting better results when focused on those most at risk and adapted to changing national epidemics. In the most comprehensive report ever on HIV/AIDS, UNAIDS states that despite an annual expenditure of over $8 billion, prevention programmes still reach a minority of those who need them, only about one in five people who need antiretrovirals are receiving them, and mother-to-child transmission has reduced by only 10% between 2001 and 2005. An estimated 39·5 million people are now living
Children form a symbolic ribbon on World AIDS Day in Johannesburg, South Africa
with HIV. 4·3 million new infections occurred in 2006—in eastern Europe and central Asia, infection rates may have risen by more than 50% since 2004. “It is imperative that we continue to increase investment in both HIV prevention and treatment services to reduce unnecessary deaths and illness from this disease”, said WHO acting director-general, Anders Nordström. The International Treatment Preparedness Coalition (ITPC) has released an analysis of six heavily affected countries. Missing the Target 3 suggests that without immediate action, efforts towards universal treatment access will fall 5 million people short by 2010. “We need to be building sustainable health systems that can deliver both HIV treatment and HIV prevention, as well as tuberculosis and other services”, said coauthor Fatima Hassan (AIDS Law Project, South Africa). Gregg Gonzales, report coordinator, emphasised that “prevention will fail without the build up of health care and service infrastructure that treatment will provide. In communities on the ground, treatment and prevention go hand in hand, they’re inextricably tied together”. In particular, available treatment is a key reason why individuals might come forward for HIV testing. HIV/AIDS will make it difficult, if not impossible, for many countries
to reach the 2015 Millennium Development Goals, reported Robert Hecht and colleagues (International AIDS Vaccine Initiative and EASE International). According to UNAIDS, “some countries have made great strides in expanding access to treatment, but have made little progress in bringing HIV prevention programmes to scale, whereas other countries that are now experiencing a reduction in national HIV prevalence are making only slow progress to ensure that treatment is available to those who need it”. In particular, the effects of the epidemic on women and children “need continued and increased attention”, said Peter Piot, UNAIDS director. The issue now is accountability: “If we are to reach the targets that countries have set for themselves then, now more than ever, we need to make the money work”. UN secretary-general Kofi Annan declared: “Accountability—the theme of this World AIDS Day—requires every president and prime minister, every parliamentarian and politician, to decide and declare that ‘AIDS stops with me’. It requires them to strengthen protection for all vulnerable groups”, but he added, accountability “requires every one of us to help bring AIDS out of the shadows, and spread the message that silence is death”.
Kelly Morris
Drugs prices still on rise 5 years after Doha International groups campaigning for access to medicines have complained that the 2001 Doha Declaration has failed to protect public health and reduce prices of medicines as promised. “5 years after the Doha Declaration, drug prices are on the rise again. If developed countries do not grant compulsory licences for production 10
and export, we are going to be back to where we started from in no time and all progress to date will be lost”, Ellen ‘t Hoen, of charity Médecins Sans Frontières, explained. The Doha Declaration on the TRIPS Agreement and Public Health, adopted by a ministerial conference in Doha, Qatar, on Nov 14, 2001, says
that poor countries must be able to use public-health safeguards included in the World Trade Oragnization’s intellectual property rules called Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). The Declaration also ensures that governments may issue compulsory licences on patents for medicines, http://infection.thelancet.com Vol 7 January 2007
Newsdesk
or take other steps to protect public health. A report entitled Patents versus patients: five years after the Doha Declaration, released by international charity Oxfam to mark the fifth anniversary of the Declaration, says that rich countries have taken little or no steps to fulfil their obligations and have actually undermined the declaration. “Generic competition, which is the most sustainable way to keep the prices of medicines down, has been further restricted. As a result, people are still suffering or dying needlessly”, Rohit Malpani of Oxfam told TLID. Brook Baker (Northeastern University School of Law, Boston, MA,
USA) believes that 5 years after signing the Doha Declaration, the US government and major pharmaceutical companies continue to use all means possible to subvert developing countries’ use of TRIPScompliant measures to access more affordable medicines. “We should be far past the stage where worrying about drug prices and patent/registration status inhibits treatment scale-up, but regrettably public health remains subservient to corporate interests and US trade policy”, he noted. According to Michael Davis (Cleveland State University College of Law, Cleveland, OH, USA), “TRIPS is only designed to colonise, via
intellectual property instead of physical occupation, the third world. It is [unwise] to think that Doha could change that central goal. The pre and post-Doha forms of TRIPS are hardly different”. It is hard to believe that countries that were ill-informed or apathetic about TRIPS would suddenly become illuminated by the Doha amendments. Before Doha, for example, the less developed countries never took any of the steps they might have taken to avoid the harshness of TRIPS. “And, sure enough, nothing good happened, nor can it happen”, Davis concluded.
For more information on the Oxfam report see http://www. oxfam.org.uk/what_we_do/ issues/health/bp95_patents.htm
Khabir Ahmad
12 years after chloroquine was withdrawn as a treatment for Plasmodium falciparum malaria in Malawi because of high rates of treatment failure, chloroquine is once again an effective antimalarial drug in this country, researchers report. But, warned senior researcher Christopher Plowe (University of Maryland School of Medicine, Baltimore, MD, USA), “Malawi is a small fragile island of chloroquine-sensitive malaria in a sea of resistance and we don’t know how quickly resistance to chloroquine would come back if it were reintroduced [here] as an antimalarial”. Within decades of its discovery as an effective antimalarial, resistance to chloroquine had developed and spread around the world. In 1993, Malawi became the first African country to replace chloroquine with sulfadoxine-pyrimethamine for the treatment of malaria. Chloroquine resistance is associated with a single point mutation in the malarial parasite and Plowe’s team recently reported that the prevalence of this resistance marker in blood smears in Malawi dropped from 85% in 1992 http://infection.thelancet.com Vol 7 January 2007
to 0% in 2001. There are also hints that clinical chloroquine sensitivity is returning in several countries where the drug is no longer used, said Plowe. In their randomised clinical trial, the researchers treated 210 children with uncomplicated P falciparum malaria living in Blantyre, Malawi, with either chloroquine or sulfadoxinepyrimethamine for 28 days. They reported that the cumulative efficacy of chloroquine was 99% (95% CI 93–100); the efficacy of sulfadoxinepyrimethamine was 21% (95% CI 13– 20). However, Plowe warned that: “a 28-day study is not long enough to know if there are low levels of parasite resistance to chloroquine in this population so we are now planning a year-long study in which children will be given chloroquine alone or in combination with other drugs each time they develop malaria”. “This is the first trial to show definitively that clinical chloroquine sensitivity can return in countries where chloroquine has not been used for some time”, commented Peter Kremsner (Institute for Tropical Medicine, University of Tübingen,
Sean Sprague/Still Pictures
Malarial sensitivity to chloroquine returns to Malawi
Couple sleeping in a mosquito net to reduce the risk of malaria
Germany), “and that is very good news”. Nevertheless, he noted, for now the best therapies for malaria are combination treatments, in particular artemisinin-based ones. Plowe added, “it is important that we flood Africa with effective combination therapy as quickly as possible so that chloroquine and sulfadoxinepyrimethamine can be withdrawn. Then, maybe, at some time in the future, we can reintroduce these older drugs in carefully controlled settings”.
For more information on chloroquine antimalarial efficacy in Malawi see N Engl J Med 2006; 355: 1959–66; DOI: 10.1056/NEJMoa062032 and N Eng J Med 2006; 355: 1956–57; DOI: 10.1056/NEJMp068214
Jane Bradbury 11
HIV/AIDS efforts are stagnating: accountability is key
For more information on UNAIDS data see http://www. unaids.org/en/HIV_data/ 2006GlobalReport/default.asp For more information on the ITPC Missing the Target 3 report see http://www. aidstreatmentaccess.org
Alon Skuy/AP/Empics
For more information on the Millennium Development Goals see PLoS Med 2006; 3: e455; doi:10.1371/journal. pmed.0030455
25 years after the first cases of AIDS, the global HIV/AIDS epidemic continues to grow, and internationally, efforts to prevent infections and provide universal access to treatment are failing in many areas. However, this view, voiced on World AIDS Day, Dec 1, 2006, is countered by the fact that prevention programmes are getting better results when focused on those most at risk and adapted to changing national epidemics. In the most comprehensive report ever on HIV/AIDS, UNAIDS states that despite an annual expenditure of over $8 billion, prevention programmes still reach a minority of those who need them, only about one in five people who need antiretrovirals are receiving them, and mother-to-child transmission has reduced by only 10% between 2001 and 2005. An estimated 39·5 million people are now living
Children form a symbolic ribbon on World AIDS Day in Johannesburg, South Africa
with HIV. 4·3 million new infections occurred in 2006—in eastern Europe and central Asia, infection rates may have risen by more than 50% since 2004. “It is imperative that we continue to increase investment in both HIV prevention and treatment services to reduce unnecessary deaths and illness from this disease”, said WHO acting director-general, Anders Nordström. The International Treatment Preparedness Coalition (ITPC) has released an analysis of six heavily affected countries. Missing the Target 3 suggests that without immediate action, efforts towards universal treatment access will fall 5 million people short by 2010. “We need to be building sustainable health systems that can deliver both HIV treatment and HIV prevention, as well as tuberculosis and other services”, said coauthor Fatima Hassan (AIDS Law Project, South Africa). Gregg Gonzales, report coordinator, emphasised that “prevention will fail without the build up of health care and service infrastructure that treatment will provide. In communities on the ground, treatment and prevention go hand in hand, they’re inextricably tied together”. In particular, available treatment is a key reason why individuals might come forward for HIV testing. HIV/AIDS will make it difficult, if not impossible, for many countries
to reach the 2015 Millennium Development Goals, reported Robert Hecht and colleagues (International AIDS Vaccine Initiative and EASE International). According to UNAIDS, “some countries have made great strides in expanding access to treatment, but have made little progress in bringing HIV prevention programmes to scale, whereas other countries that are now experiencing a reduction in national HIV prevalence are making only slow progress to ensure that treatment is available to those who need it”. In particular, the effects of the epidemic on women and children “need continued and increased attention”, said Peter Piot, UNAIDS director. The issue now is accountability: “If we are to reach the targets that countries have set for themselves then, now more than ever, we need to make the money work”. UN secretary-general Kofi Annan declared: “Accountability—the theme of this World AIDS Day—requires every president and prime minister, every parliamentarian and politician, to decide and declare that ‘AIDS stops with me’. It requires them to strengthen protection for all vulnerable groups”, but he added, accountability “requires every one of us to help bring AIDS out of the shadows, and spread the message that silence is death”.
Kelly Morris
Drugs prices still on rise 5 years after Doha International groups campaigning for access to medicines have complained that the 2001 Doha Declaration has failed to protect public health and reduce prices of medicines as promised. “5 years after the Doha Declaration, drug prices are on the rise again. If developed countries do not grant compulsory licences for production 10
and export, we are going to be back to where we started from in no time and all progress to date will be lost”, Ellen ‘t Hoen, of charity Médecins Sans Frontières, explained. The Doha Declaration on the TRIPS Agreement and Public Health, adopted by a ministerial conference in Doha, Qatar, on Nov 14, 2001, says
that poor countries must be able to use public-health safeguards included in the World Trade Oragnization’s intellectual property rules called Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS). The Declaration also ensures that governments may issue compulsory licences on patents for medicines, http://infection.thelancet.com Vol 7 January 2007
Newsdesk
or take other steps to protect public health. A report entitled Patents versus patients: five years after the Doha Declaration, released by international charity Oxfam to mark the fifth anniversary of the Declaration, says that rich countries have taken little or no steps to fulfil their obligations and have actually undermined the declaration. “Generic competition, which is the most sustainable way to keep the prices of medicines down, has been further restricted. As a result, people are still suffering or dying needlessly”, Rohit Malpani of Oxfam told TLID. Brook Baker (Northeastern University School of Law, Boston, MA,
USA) believes that 5 years after signing the Doha Declaration, the US government and major pharmaceutical companies continue to use all means possible to subvert developing countries’ use of TRIPScompliant measures to access more affordable medicines. “We should be far past the stage where worrying about drug prices and patent/registration status inhibits treatment scale-up, but regrettably public health remains subservient to corporate interests and US trade policy”, he noted. According to Michael Davis (Cleveland State University College of Law, Cleveland, OH, USA), “TRIPS is only designed to colonise, via
intellectual property instead of physical occupation, the third world. It is [unwise] to think that Doha could change that central goal. The pre and post-Doha forms of TRIPS are hardly different”. It is hard to believe that countries that were ill-informed or apathetic about TRIPS would suddenly become illuminated by the Doha amendments. Before Doha, for example, the less developed countries never took any of the steps they might have taken to avoid the harshness of TRIPS. “And, sure enough, nothing good happened, nor can it happen”, Davis concluded.
For more information on the Oxfam report see http://www. oxfam.org.uk/what_we_do/ issues/health/bp95_patents.htm
Khabir Ahmad
12 years after chloroquine was withdrawn as a treatment for Plasmodium falciparum malaria in Malawi because of high rates of treatment failure, chloroquine is once again an effective antimalarial drug in this country, researchers report. But, warned senior researcher Christopher Plowe (University of Maryland School of Medicine, Baltimore, MD, USA), “Malawi is a small fragile island of chloroquine-sensitive malaria in a sea of resistance and we don’t know how quickly resistance to chloroquine would come back if it were reintroduced [here] as an antimalarial”. Within decades of its discovery as an effective antimalarial, resistance to chloroquine had developed and spread around the world. In 1993, Malawi became the first African country to replace chloroquine with sulfadoxine-pyrimethamine for the treatment of malaria. Chloroquine resistance is associated with a single point mutation in the malarial parasite and Plowe’s team recently reported that the prevalence of this resistance marker in blood smears in Malawi dropped from 85% in 1992 http://infection.thelancet.com Vol 7 January 2007
to 0% in 2001. There are also hints that clinical chloroquine sensitivity is returning in several countries where the drug is no longer used, said Plowe. In their randomised clinical trial, the researchers treated 210 children with uncomplicated P falciparum malaria living in Blantyre, Malawi, with either chloroquine or sulfadoxinepyrimethamine for 28 days. They reported that the cumulative efficacy of chloroquine was 99% (95% CI 93–100); the efficacy of sulfadoxinepyrimethamine was 21% (95% CI 13– 20). However, Plowe warned that: “a 28-day study is not long enough to know if there are low levels of parasite resistance to chloroquine in this population so we are now planning a year-long study in which children will be given chloroquine alone or in combination with other drugs each time they develop malaria”. “This is the first trial to show definitively that clinical chloroquine sensitivity can return in countries where chloroquine has not been used for some time”, commented Peter Kremsner (Institute for Tropical Medicine, University of Tübingen,
Sean Sprague/Still Pictures
Malarial sensitivity to chloroquine returns to Malawi
Couple sleeping in a mosquito net to reduce the risk of malaria
Germany), “and that is very good news”. Nevertheless, he noted, for now the best therapies for malaria are combination treatments, in particular artemisinin-based ones. Plowe added, “it is important that we flood Africa with effective combination therapy as quickly as possible so that chloroquine and sulfadoxinepyrimethamine can be withdrawn. Then, maybe, at some time in the future, we can reintroduce these older drugs in carefully controlled settings”.
For more information on chloroquine antimalarial efficacy in Malawi see N Engl J Med 2006; 355: 1959–66; DOI: 10.1056/NEJMoa062032 and N Eng J Med 2006; 355: 1956–57; DOI: 10.1056/NEJMp068214
Jane Bradbury 11