A Bitter Pill For the World's Poor

Drug companies Do Care for the Suffering—If They Have Some Cash

Magazine article

By: Isabel Hilton

Date: January 5, 2000

Source: Hilotn, Isabel. "A Bitter Pill For the World's Poor." The Guardian. January 5, 2005.

About the Author: Isabel Hilton is a reporter, journalist, writer, and radio broadcaster born in Aberdeen, Scotland. She is a lecturer on international relations and a member of the Royal Institute of International Affairs. She is also a regular contributor to distinguished publications such as the New Yorker, The Guardian, The Observer, and New York Times Magazine.

INTRODUCTION

According to the World Health Organization (WHO), more than fourteen million people die in developing countries each year due to curable diseases (such as diarrheal diseases, tuberculosis, and malaria). The HIV/ AIDS epidemic is one example of how access to affordable drugs in impoverished nations, a key component in disease intervention, is complicated by trade restrictions, policy, and the interests of the pharmaceutical industry.

Brazil's National AIDS Program (NAP) is regarded as a successful model of combating the HIV/AIDS epidemic. Since its inception, HIV death rates in Brazil have dropped fifty percent. Despite spending $232 million by 2001 to implement this national health initiative, Brazil has estimated a savings of more than $1.1 billion in healthcare costs. Many researchers urge immediate action using this model of intervention in other developing nations in Asia and Sub-Saharan Africa. However, others are more cautious and argue that a methodical approach (slower to enact) is necessary to implement a system that is sustainable and effective for the long term. Often, developing countries lack the resources and infrastructure to assure adequate delivery of the drugs to the population targeted for prevention and treatment. To further cloud the issue, are factors such as intellectual property rights and trade policy. With a market worth more than $65 billion per year, some human rights organizations ask why drug companies aren't investing more research and development dollars where it's needed most, on diseases that primarily affect poor nations.

PRIMARY SOURCE

In a tiny village in Bihar, in northern India, a young man of 17 was sitting outside his house. He was shaking and sweating profusely, the whites of his eyes were yellow, and his spleen was found to be enlarged. He was suffering from leishmaniasis, known once to the British as dum dum fever and today in India as kalaazar. Untreated, the illness attacks the immune system until the victim succumbs to some opportunistic infection—most likely tuberculosis— and dies.

The young man had tried to get treatment, despite his family's poverty. His father was a rickshaw puller, so every penny the family had was laboriously earned. They had spent several months' income on treatment, but the young man had been given a drug that had lost its effectiveness. Now there was no money and no more treatment.

It is a story repeated daily in towns and villages across the developing world. Whatever the recorded cause of death—leishmaniasis, tuberculosis, pneumonia—the real cause is poverty. Poor people in tropical countries are at risk from a range of diseases for which they cannot get treatment—either because medicines are available at prices they cannot afford or, worse still, because no medicines are available.

The most common treatments for leishmaniasis were discovered by British doctors in the closing years of British rule. They applied their minds to leishmaniasis because they needed to keep their soldiers healthy. For the same reason, the U.S. invested in malaria research during the Vietnam war. But when there is no pressing military or colonial imperative, the developed world loses interest in tropical diseases. Multinational pharmaceutical companies neglect the diseases of the tropics, not because the science is impossible but because there is, in the cold economics of the drugs companies, no market.

There is, of course, a market in the sense that there is a need: millions of people die from preventable or curable diseases every week. But there is no market in the sense that, unlike Viagra, medicines for leishmaniasis are needed by poor people in poor countries. Pharmaceutical companies judge that they would not get sufficient return on research investment, so why, they ask, should we bother? Their obligation to shareholders, they say, demands that they put the effort into trying to find cures for the diseases of affluence and longevity—heart disease, cancer, Alzheimer's. Of the thousands of new compounds drug companies have brought to the market in recent years, fewer than 1% are for tropical diseases.

We could just shrug, of course, and say that's what you get for being poor. Or, if we were feeling more charitable at the dawn of the new millennium, we could post off a batch of (probably outdated) medicines and feel better. The companies have their own equivalent of those care packages in donation programmes—short-term gestures that look good in the annual report. They can also be cited to counterbalance charges of neglect or of dumping drugs in developing countries that cannot be marketed where regulation is more stringent. (That is so widespread that there is a grim little joke in the industry: if there are no side effects, they say, it must be Honduras.) The trouble with charitable gestures is that they are only gestures. If we want to have an effect, something more systematic is required.

Why should we? Because, as the economist Jeffrey Sachs points out, it is no good waiting for developing countries to attain the degree of affluence that would allow them to buy themselves an effective health service, equipped with the medicines we take for granted. The fact is that ill health in tropical countries is a huge drag on development, and without intervention in health, other aid is the less effective.

And who should intervene? The pharmaceutical companies have the capacity to do so, as well as a moral debt that they have not begun to pay. But it is unrealistic to suppose that they act without public stimulus. The World Health Organisation has the public authority but not the technical capacity. As a partnership, the industry and international public health bodies could make a significant difference, if they were prepared to set aside, respectively, corporate greed and bureaucratic complacency.

There are signs of a change of approach at the WHO, as the impact of the arrival of the former Norwegian prime minister, Gro Harlem Bruntland, is felt. For the first time in years, the organisation is displaying energy and initiative. How far this will go, though, will depend on how the industry responds.

In the corporate headquarters of major drug companies, the public relations posters display the image they like to present: of caring companies that bring benefit to humanity, relieving the suffering of the sick. What they don't say, is that, so far, their humanity has not extended beyond the limits of the pockets of the sick.

SIGNIFICANCE

On the advent of the 25th anniversary of the beginning of the AIDS epidemic, over forty million people are living with HIV worldwide. Over 4,900,000 new infections occurred in 2005. HIV/AIDS is a pandemic with increasing rates of infection. There is immediate need for intervention on a global scale; however, the scientific community is divided on the issue of how to halt one of the largest public health threats of the twenty-first century.

In 2003, WHO launched the 3 by 5 Initiative to treat three million HIV positive people with anti-retroviral (ARV) therapy in poor countries by the end of 2005. This approach involves a strategic framework for antiretroviral therapy in five categories: global leadership, partnership and advocacy; urgent, sustained country support; standardized tools to implement ARV therapy; effective and dependable medical and diagnostic supplies; and quickly recognizing and applying advances.

Health disparities are exacerbated as this disease continues to thrive in marginalized populations (i.e. developing countries, drug users, the poor, rural areas, and minorities). HIV infection in American infants has nearly vanished due to prophylactic (preventative) therapy with antiretroviral (ARV) drugs. In North America and Europe, death rates within ten years of diagnosis for those with HIV have dropped almost eighty percent with ARV use. However, in developing countries, of the six million in need of treatment, only 400,000 actually received ARV therapy in 2003. Fifty percent of the population requiring treatment is located in subSaharan Africa and India. Moreover, most of the fourteen million HIV/AIDS orphans in the world reside in Africa. Without timely intervention, this figure is estimated to climb as high as twenty-five million by the year 2010. According to the WHO,

immense advances in human well-being co-exist with extreme deprivation. In global health, we are witnessing the benefits of new medicines and technologies. But there are unprecedented reversals. Life expectancies have collapsed in some of the poorest countries to half the level of the richest—attributable to the ravages of HIV/AIDS in parts of sub-Saharan Africaandtomorethana dozen 'failedstates.'

Anti-retroviral therapy is a key component to fighting HIV/AIDS worldwide, but access to therapy in developing countries remains problematic. In January 2006, Oxfam (a United Kingdom-based international aid agency) submitted a letter to the WHO asking for a review of global trade agreements. Oxfam argues that these treaties unfairly increase intellectual property rights, which in the end hinders the impoverished access to affordable drugs.

In 2003, UNAIDS established a Global Reference Group on HIV/AIDS and Human Rights. The result is that access to HIV/AIDS therapy is now a human rights issue (as well as a financially sound strategy). In the end, an integrated approach is needed using medical, structural, and cultural interventions, with the cooperation of politicians, governments, private industry, and others.

FURTHER RESOURCES

Books

World Health Organization. Treating 3 Million by 2005: Making it Happen. Geneva, Switzerland: World Health Organization, 2003.

World Health Organization. World Health Report 2006. Geneva, Switzerland: World Health Organization, 2006.

Periodicals

de Carvalho Mesquita Ayres, J.R., et al. "Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS." American Journal of Public Health. 96 (2006): 1001–1006.

Desvarieux, M., et al. "Antiretroviral Therapy in Resource-Poor Countries: Illusions and Realities." American Journal of Public Health. 95 (2005): 1117–1122.

McCoy, D., et al. "Expanding Access to Antiretroviral Therapy in Sub-Saharan Africa: Avoiding the Pitfalls and Dangers, Capitalizing on the Opportunities." American Journal of Public Health. 95 (2005): 18–22.

Web sites

Oxfam GB. "Drug Companies vs. Brazil: The Threat to Public Health." May 2001. <http://www.oxfam.org.uk/what_we_do/issues/health/papers.htm> (accessed May 14, 2006).

Oxfam GB. "Public Health at Risk." April 2006. <http://www.oxfam.org.uk/what_we_do/issues/health/papers.htm> (accessed May 14, 2006).