Through its Campaign for Access to Essential Medicines, Médecins Sans Frontières (MSF) has been closely following the developments in the world of access to medicines, vaccines and diagnostics.
Below are the final five stories that mattered in acces to medicines in 2010.
Read the first five here.
6) Europe threatens to shut down India’s role as the ‘pharmacy of the developing world’
Hundreds of Kenyans rallied outside the European Mission in Nairobi against the EU-India Free Trade Agreement which may block access to life-saving generics medicines from India. December, 2010. Photo by Paul Davis/Health GAP
"A decade ago, people wouldn’t even bother getting tested for AIDS because they knew the drugs to treat them were too expensive anyway. I refuse to go back ten years. We cannot let the Europeans shut down the supply of affordable medicines we and others rely on to treat patients around the world.”
Dr. Peter Saranchuk, HIV doctor for MSF in South Africa
The European Union is pursuing a free trade agreement with India which will restrict Indian drug producers from making affordable generic medicines used to treat people across the developing world. In October 2010, MSF launched a campaign called ‘Europe! Hands Off Our Medicines,’ with the goal of getting the EU to back down.
More than 80% of the AIDS medicines MSF uses to treat 160,000 people across the world are generics from India, and the treatment programmes paid for by international donors rely on affordable Indian medicines just as much.
But this is now under threat, as the EU pushes policies that will dry up the flow of affordable medicines. Europe is trying to undermine India’s patent law, which in the interest of public health only grants patents for medicines that show significant innovation – a fact that has long upset the pharmaceutical industry in wealthy countries. Drug companies have actively – but so far unsuccessfully – sought to challenge the law in Indian courts. Having lost in the courts, the companies are now using the EU’s trade policies to try to stamp out the competition from India.
MSF cannot stand by as its crucial source of affordable medicines is under attack. People have taken to the streets in India, Nepal, Thailand, Indonesia, Kenya and Europe in support of this campaign. The negotiations for the free trade agreement are ongoing and MSF will continue to speak out against these harmful policies.
Take action by sending a letter to the EU’s Trade Commissioner Karel De Gucht, telling him to take his hands off our medicines! Click here
7) Fatal confusion: The fight against fake medicines veers off-course
A nurse prepares daily medications for TB patients undergoing treatment in a hospital in Nukus, Uzbekistan,for MDRTB - Multi Drug Resistant Tuberculosis. March, 2007. Photo by Donald Weber/Atlas Press
“Relying on measures that only enforce intellectual property is a poor framework for protecting public health. This approach has skewed the response to the fake medicines, and has led to inappropriate and harmful solutions being promoted that fail to ensure patients have access to safe, quality and effective medicines and create barriers to access to medicines.”
Michelle Childs, Director of Policy/Advocacy, MSF Campaign for Access to Essential Medicines
Fake medicines, which make false claims about what they contain or where they are from, represent a genuine problem. But in 2010, a number of initiatives that claim to deal with this problem have gone off course, by taking a trade approach to what is first and foremost a public health problem. So instead of actually dealing with the danger of fake and substandard drugs, they end up preventing access to quality generic medicines.
When Kenya, for example, adopted a law to fight fakes, it chose a definition of the word ‘counterfeit’ so broad that the law risks including legally-produced, quality generic medicines. The net is being cast far too wide: the law could seriously endanger people’s health, as MSF and other treatment providers depend on a reliable flow of generic medicines to treat people in their programmes. In April 2010, Kenyan public health activists won a first legal battle to challenge the constitutionality of the law, which is now under judicial review. But similar legislation is proceeding in Uganda and other East African countries.
Further, a group of rich countries finalised in 2010 the Anti-Counterfeiting Trade Agreement (ACTA) which they want developing countries to sign on to. But hiding behind an agreement that claims to be about protecting the public from fakes is in fact a treaty that seeks to enforce intellectual property: ACTA will inhibit the production and distribution of affordable generic medicines by excessively punishing intellectual property violations, strengthening monopolies on medicines and enhancing the rights of brand-name pharmaceutical companies.
The problem of substandard and fake drugs must be addressed, but not by harming access to generic medicines. What is needed is a clear definition of what fake medicines are so that the problem is not confused with trade issues, as well as measures that address the actual public health problem. And the far larger problem of substandard medicines must get greater attention.
8) Improved treatment for severe malaria saves more lives
The MSF teams have been cooperating with Burundi's authorities to fight the spread of malaria by treating patients and distributing mosquito nets to prevent new infections in the province of Karuzi. September, 2010. Photo by Gwenola Francois / MSF
“We now have the proof that fewer children will die from severe malaria when we use artesunate injections instead of quinine. And high-quality artesunate is now available from reliable sources that have been validated by the World Health Organization. So we have the evidence and we have the tools, but the challenge now is a quick roll-out of this treatment in Africa.”
Dr. Martin De Smet, Coordinator of MSF’s Malaria Working Group
Promising news from the field of malaria research in 2010 shows that treating children suffering from severe malaria with injections of artesunate could save many more lives
Malaria kills around one million people every year, with nine in ten deaths being in young African children. Severe malaria – which is marked by serious symptoms such as coma, convulsions, or difficulty breathing – progresses rapidly and is particularly deadly. Those who manage to survive are often left with life-long neurological damage.
Severe malaria is still mostly treated with the drug quinine, while uncomplicated malaria is treated with drugs containing derivates of artemisinin, an extract from a Chinese plant. In early 2010, the World Health Organization (WHO) strongly recommended that adults with severe malaria be treated with artesunate, a derivate of artemisinin, because it is more effective and has fewer side effects than quinine.
Now, the results from a large trial in nine African countries provide the strong evidence that children would also benefit from the newer drug. MSF is already treating severe malaria in children with a drug derived from artemisinin and will now widely introduce artesunate. Artesunate should be used to treat both adults and children with severe malaria so that many more lives can be saved.
But wider obstacles remain: WHO treatment recommendations have yet to be revised in light of the latest evidence in children, and most countries have yet to recommend artesunate in place of quinine for either adults or children. And international donors have yet to put their full weight behind the latest evidence.
9) Measles makes an unnecessary comeback
In South Kivu, DRC, MSF ran a mass immunisation campaign in Fizi health zone that aimed to vaccinate 120,000 children between the ages of 6 months and 15 years against measles over a period of six weeks. November, 2010. Photo by Haavar Karlsen
“It’s frustrating to see measles outbreaks that could and should have been avoided. Measles and improvement of basic vaccination must get back into the political spotlight.”
Dr. Tido von Schoen-Angerer, Executive Director, MSF’s Campaign for Access to Essential Medicines
For the past few decades, measles has been in retreat, prompting some to campaign for its global elimination. But events in 2010 showed the ambitious slogans have come too early. An often lacklustre response to a surge of outbreaks in sub-Saharan Africa and insufficient funding means the disease is far from being under control. In 2008, more than 160,000 people died of measles, most of whom were children under five years.
Measles is a highly-contagious disease that can emerge as soon as the vaccination coverage in a population drops below a certain level. Children in poor countries are at particular risk of complications and death. For years now, MSF has been at the forefront of responses, working with health ministries in many countries.
Outbreaks in 2010 struck many sub-Saharan African countries, including Chad, Malawi, Zimbabwe, South Africa, Nigeria and the Democratic Republic of Congo. What’s particularly surprising about the recent resurgence of measles is that epidemics are occurring not just in war-torn countries where health systems are weak and unable to cope, but also in stable countries where vaccination programmes have been in place for a number of years already. This shows that something is wrong with the current effort to fight measles.
To make sure the progress achieved in recent decades is not lost, the disease must return to the spotlight. Controlling measles epidemics needs political and financial support for both routine services and outbreak responses. But these have been declining at a time when the price tag of US$1 to vaccinate a child makes measles control one of the most cost-effective health interventions available.
10) The neglect of tropical diseases like kala azar continues
A patient is treated for kala azar in the MSF health centre in Pibor, Jonglei State, Sudan. July, 2010. Photo by Cédric Gerbehaye / Magnum Foundation Emergency Fund / VU'
“Groups at risk of kala azar infection often include hard-to-reach populations such as poor rural communities and people displaced by conflict. This makes the need for simple, effective treatment all the more important."
Nathan Ford, Medical Coordinator, MSF’s Campaign for Access to Essential Medicines
In 2010, southern Sudan battled to contain its biggest kala azar outbreak in eight years, highlighting the urgent need for newer better tools to treat neglected tropical diseases in developing countries.
Kala azar, or visceral leishmaniasis, is contracted through the bite of a parasite-carrying sandfly. Symptoms include an enlarged spleen, fever, weakness, and wasting. It thrives in poor, remote and unstable areas with extremely limited healthcare. About 500,000 new cases of kala azar are seen each year, and it is increasing as an opportunistic infection for people living with HIV/AIDS.
By the end of November 2010, MSF had treated 2,355 people for the disease in southern Sudan - eight times more than for the same period in the previous year. Untreated, kala azar is fatal in almost all cases within four months, but timely treatment has a very high rate of success (up to 95%).
Although there are a number of treatment options, each carries significant limitations. Liposomal amphotericin B (AmBisome) is a highly effective treatment but its high cost restricts its wider use. The mainstay of treatment for most patients (except where there is high resistance) is 30 days of extremely painful intramuscular injections of antimony-based treatments with sodium stibogluconate (SSG), a highly toxic drug developed in the 1930s. Individuals infected with both kala azar and HIV experience higher toxicity and less effectiveness with existing drugs.
The results of studies using combinations of existing drugs to optimise treatment and reduce cost and the development of resistance are expected shortly and could bring some short-term improvement. But what is really needed are new drugs that are less toxic, given orally over shorter periods and safe for pregnant women and women of child-bearing age.