BASEL, Switzerland — The controversial Swiss pharmaceutical company Novartis has started work to expand health-care access in low-income countries through its nonprofit Novartis Foundation.
The role of pharmaceutical companies in developing countries usually begins and ends with drug supplies. The expansion into a role that builds health systems is stirring all kinds of questions.
Novartis’ program is “trying to create the conditions in particular countries to essentially facilitate the use of their products and a particular set of products which the company has chosen,” Rohit Malpani, director of policy and analysis at Doctors without Borders’ Access Campaign, said in an interview with Humanosphere. “We don’t actually think that it’s the role of the pharmaceutical companies to build health systems or essentially to facilitate health systems to make use of their products.”
But Anne Aerts, head of Novartis Foundation, stressed that any conflict of interest is mitigated by the foundation’s interest in building health systems and prioritizing governments and communities to build their own health-care agendas.
“This is absolutely crucial for us,” Aerts told Humanosphere. “We always work first of all with the local authorities, so that it’s not us proposing what needs to be done in a country – that doesn’t make sense at all.”
Aerts said the for-profit side of the company “has nothing to do with the foundation.”
“Our role, as a foundation of a health-care company, is really to strengthen health systems in low- and middle-income countries, because bringing drugs only is not enough to solve health problems,” Aerts said, referring to the for-profit side of Novartis. “You need very resilient health systems.”
Malpani pointed to the Novartis company’s “very aggressive pursuit” of changing intellectual property laws and is concerned that the for-profit side of the company is too close to the philanthropic. He argued that Novartis is trying to shape health systems so that it can increase access to profitable markets, not access for patients.
Novartis is no stranger to controversy in developing countries.
In 2013, Novartis lost a six-year legal battle with the Indian High Court to patent a new version of Glivec, a widely available cancer drug. It was accused of “evergreening,” a practice where a pharmaceutical company makes minor modifications to a drug’s compounds to claim patenting rights.
Novartis is currently embroiled in a case with the Colombian government over price controls for Glivec. The government set a new lower price for the drug in a bid to lower health-care costs. According to a Reuters report the drug was not under patent in Colombia between 2003 and 2012, sparking competition from generic producers whose prices are 197 percent cheaper than those of Novartis, according to the health ministry. The current patent is valid until mid-2018. Colombia stopped short of declaring a compulsory license, which would have overridden Novartis’ patent and permitted other companies to make cheaper generic versions. Last week Novartis threatened to file suit over a government decision.
Given the legal challenges, critics argue that the foundation is a setup for the for-profit business.
So what role, if any, does the private sector play in places where there is acute need for both medicine and health-care systems to deliver it?
Peter Piot, director of the London School of Hygiene and Tropical Medicine and a member of the Novartis Foundation’s board of trustees, said that while pharmaceutical companies should not be building health systems, they play a part in the delivery of care.
“I agree that it’s not the role of pharmaceutical companies to build health systems. That’s not their expertise, and there is indeed a conflict of interest,” Piot said in an interview with Humanosphere. But he said that this conflict can be mitigated if, like the Novartis’ efforts in creating the foundation, “it is set up as a separate business.”
Piot argues that involving drug companies in overcoming staffing shortages deficits can be a good thing and can improve the overall quality of services for patients.
“Pharmaceutical companies can really play a role in training. You could say that there is a conflict of interest, but they are very experienced in performance management, in improving the quality of services,” he said. Pointing to the deficit of doctors in West Africa during the Ebola crisis, the role of the private sector in bridging gaps can be useful, Piot argued.
For Piot the bottom line is simple: The private sector can improve quality, but the public sector must focus on expanding access.
Much of Piot’s work comes from his experience fighting the HIV/AIDS epidemic, where the private sector was involved. Community health workers and NGOs, among others, are also under the broad private sector umbrella definition.
But one of the biggest changes occurring in low-income countries is a shift from treating communicable disease to noncommunicable disease.
The world has made great progress in tackling infectious diseases over the last 15 to 20 years. Life-saving antiretroviral drugs for HIV sufferers are more widely available, and there has been a 60 percent reduction in malaria-related deaths.
Meanwhile, the burden of noncommunicable diseases has risen in the developing world as people’s living standards and livelihoods have, for some of the world’s poor, improved. The WHO estimates that around 28 million people die from cardiovascular diseases, diabetes, respiratory diseases and cancers in these countries every year; 75 percent of these occur in low- and middle-income countries.
“The main part of our work now is how to address noncommunicable diseases in lower-middle income countries as we have seen that the burden of diseases in low-income settings has really shifted. The infectious disease agenda is not finished, I agree, but noncommunicable diseases have risen much faster than the decline in infectious diseases,” Aerts said.
Noncommunicable diseases are a huge burden for any health-care system. And it means that even more people are going to need access to ongoing health care from robust health-care systems.
The Novartis Foundation invited Humanosphere to attend the Improving Care for Chronic Patients in Lower-Income Countries: the Patient Journey conference in Basel, Switzerland, and provided accommodation and travel expenses.
Correction: This story has been updated to identify Peter Piot’s relationship with the Novartis Foundation. He is a member of the board of trustees.