"You can tell the people that if they succeed in killing me, that I forgive and bless those who do it. Hopefully, they will realize they are wasting their time. A bishop will die, but the church of God, which is the people will never perish” "A church that suffers no persecution - PowerPoint PPT Presentation
can tell the people that if they succeed in killing I forgive and bless those who do it. ully, they will realize they are wasting their time hop will die, but the church of God, is the people will never perish” urch that suffers no persecution njoys the privileges and support of hings of the earth - beware! - t the true church of Jesus Christ." a letter to President Carter: say that you are Christian. u are really Christian, e stop sending military aid e military here, se they use it only to kill my people." Archbishop Oscar Rome
Transcript
"You can tell the people that if they succeed in killing me, that I forgive and bless those who do it. Hopefully, they will realize they are wasting their time. A bishop will die, but the church of God, which is the people will never perish”
"A church that suffers no persecution but enjoys the privileges and support of the things of the earth - beware! - is not the true church of Jesus Christ."
From a letter to President Carter: "You say that you are Christian. If you are really Christian, please stop sending military aid to the military here, because they use it only to kill my people."
Archbishop Oscar Romero
Combination therapy (HAART) revolutionzedthe fight against AIDS in the USWith deaths dropping 84% in the developed world
However, in the late 1990’sthese drugs cost $10,000-15,000 per year!
Why so expensive?
Companies seek to recoup research costsAnd make profits while medicines are
under patent
Companies seek to recoup research costsAnd make profits while medicines are
under patent
US drug patents give 20 years of protection, but they are applied for before clinical trials, so the effective life of a drug patent tends to be 7-12 years.
$10,000 to $15,000 per year is not very affordable if you are
one of the 2.6 billion—40% of the world’s population—living on less than US$2 a day.
2007 Human Development Report (HDR) United Nations Development Program
Five years after HAART therapy was introduced in the West,
<8,000 people in all of sub-Saharan Africawere receiving the life-saving drugs
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A few nations (not the poorest)Took leadership roles in dealing
With this crisis
A few nations (not the poorest)Took leadership roles in dealing
With this crisis
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
In 1996 the government of Brazil pledged provide free combination antiretroviral treatment by the end of the year. It said it would spend up to $45 million/yearon protease inhibitors .
This made a big difference!
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
By 2000 the number of people living with HIV in Brazilwas less than half that once predictedand the number of AIDS deaths plummeted 50%
This made a big difference!
Miami Herald (1996) 'Brazil to Offer Patients AIDS 'Cocktail' for Free Promising Drug Mix too Costly for Most', October 28
By 2000 the number of people living with HIV in Brazilwas less than half that once predictedand the number of AIDS deaths plummeted 50%
"It makes a lot of sense to look at what Brazil is doing... Something they're doing is working." - Mbulelo Rakwena, South Africa's ambassador to Brazil
Big Pharma also made some concessions
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5
In 1996 Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it was safe and effective at preventing mother-to-child transmission
This was still much too expensive For patients in the developing world!
CNN (1998) 'Company to offer AZT at steep discount to third world', March 5
In 1996 Glaxo Wellcome cut the price of AZT by 75% after a trial in Thailand showed it was safe and effective at preventing mother-to-child transmission
Big changes required two things
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Get Cheaper drugs by avoiding patent protectionRound 1, 1999
South Africa passed legislation that enabled local companies to manufacture or import HIV/AIDS drugs at a fraction of the price of patented drugs. The US argued that this undermined patent rights.
BBC News (1999) ' Africa AIDS drug trade dispute ends', September 18
The Pharma Empire strikes back
39 major pharmaceutical companies prosecuted the South African government for this legislation.
International pressure eventually affected thisPatent litigation in 2001
International pressure eventually affected thisPatent litigation in 2001
Major pharmaceutical companies withdrew theirchallenge of South African legislation after protestsby the European Parliament and a petition against the action was signed by 300,000 people from over 130 countries
Get Cheaper drugs by avoiding patent protectionRound 2, 2001
The Indian drug company Cipla offered to make AIDS drugs available at sharply reduced prices (<$1 per day!) to Doctors without Borders (Medecins Sans Frontieres)
Kumar S. (2001) 'Indian company offers low cost AIDS drugs', the Lancet, 357:616 February 24
This spurred changes in pricingBy Big Pharma
In essence it was a price warand patients won
Not everyone was impressed by Pharma’s offer
''…a victory, but a small one, much like an elephant giving birth to a mouse'’
Doctors without Borders (Medecins Sans Frontieres )
Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector", WHO, 2008
Generics mean the price of antiretroviral medication in resource-poor countries continues to plummet
A year’s first-line drugs can now be bought for as little as $92.2
Drug prices are calculated using formulas based on average income per head
Prices of antiretroviral medication in the developed world remain high due to “Tiered pricing”
Drug prices are calculated using formulas based on average income per head
"Preferential pricing is the only way we can meet both conflicting needs in the fight against AIDS. We can refinance our high research and development costs for innovative, new treatments by the established price system in industrialised countries and can offer affordable medicines to patients in poor countries who otherwise cannot afford antiretroviral medication"
- Alessandro Banchi, chairman of Boehringer
Prices of antiretroviral medication in the developed world remain high due to “Tiered pricing”
In 1995 TRIPS - The Agreement on Trade Related Aspects of Intellectual Property Rights was accepted by all members of the World Trade Organization
Because its implementation will have a huge impact on generic drug production, most developing countries (e.g. India) were given a 10-year transition period.Least developed countries have until 2016.
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Patent issues continue to linger over the process
Since 2003 TRIPS has contained a waiver thatallows ''compulsory licenses'' to be issued to override specific patent restrictions. With these, countries that suffer a serious health crisis but are unable to produce drugs at home can import generics from other nations
Patent issues continue to linger over the process
In 2002 WHO created a list of preferred AIDS drugsAs part of its list of ESSENTIAL medicines
WHO also issued guidelines for when to start treatment:
Stage 1 asymptomaticStage II moderate weight loss and mild infectionsStage III severe weight loss, chromic diarrhea or fever, TB, etcStage IV wasting syndrome or severe opportunistic infections
Would you be happy with this if you were the patient?
Stage 1 asymptomaticStage II moderate weight loss and mild infectionsStage III severe weight loss, chromic diarrhea or fever, TB, etcStage IV wasting syndrome or severe opportunistic infections
Big changes required two things
Cheaper drugs by avoiding patent protection
More global investment in providing these free or at low cost
Public pressure grew to findFunds to help poor patients
"If we can get cold Coca Cola and beer to ever y remote corner of Africa, it should not be impossible to do the same with drugs." - J oep Lange, the President of the I nternational AIDS Society
Many players came togetherTo push for more money
The World Health Organisation created the first global target for ARV treatment access in 2003. It called for 3 million people in developing countries to have access to treatment by the end of 2005, meeting 50% of estimated need.
President George W. Bush signs the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 =up to $15 billion over 5 years
Congress and the PresidentPut US dollars behind the effort
As of September 2007,PEPFAR estimates that it helped provide ART to approximately 1,445,500 people
Public health experts and nonprofit organizations have questioned some aspects of PEPFAR programs, including requirements mandating that one-third of prevention spending be directed towards abstinence-only programs.
Progress began well, but failed to accelerate. At the end of 2005 only 1.3 million people in low- and middle-income countries were receiving drugs, 40% of the target.
Not surprisingly, progress was uneven in differentparts of the world. Only three African nations - Botswana, Namibia and Uganda - met their 50% targets.
If at first you don’t succeed….
July 2005The Group of Eight (G8)(Canada, France, Germany, Italy, Japan, Russia, the UK and the US) pledged to work towarduniversal access to antiretroviral (ARV) treatment worldwide by 2010.
July 2005The Group of Eight (G8)(Canada, France, Germany, Italy, Japan, Russia, the UK and the US) pledged to work towarduniversal access to antiretroviral (ARV) treatment worldwide by 2010.
Two months later, all United Nations Member States endorsed this goal by committing themselves to: "Developing and implementing a package for HIV prevention, treatment and care with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it"
In 2006, UNITAID an international drug purchase facilitywas established to ensure a stable source of funding for drugs to fight HIV/AIDS, malaria and tuberculosis.
"3 by 5 has helped to mobilize political and financial commitment to achieving much broader access to treatment. This fundamental change in expectations is transforming our hopes of tackling not just HIV/AIDS, but other diseases as well." - Dr Lee Jong-wook, WHO Director-General
This IS making a difference
This IS making a difference
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The trend is good but there is a long way to go
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The trend is good but there is a long way to go
WHO
The trend is good but there is a long way to go
WHO
The trend is good but there is a long way to go
WHO
97% of those treated are receiving 1st line drugs
WHO
What about those resistant to this combination?
WHO
Second line drugs are much more expensive
The US must continue to lead in this effort
On July 30, 2008, President Bush signed into law H.R. 5501, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act.=up to $48 billion to combat the three diseases, including:$39 billion for: • PEPFAR bilateral HIV/AIDS programs
