Medicins Sans Frontieres

RECENT POSTS

Gates-backed vaccine alliance targets cervical cancer in poor countries – for a price | 

The Bill & Melinda Gates Foundation’s biggest, and arguably most successful, project in global health has announced a new deal with vaccine manufacturers aimed at combatting one of the biggest killers of women in the developing world, cervical cancer.

Seth Berkley
Seth Berkley
GAVI

“This is a disease that is killing women in the prime of their life,” said Seth Berkley, CEO of the Global Alliance for Vaccines and Immunization (GAVI), an initiative launched by the Gates Foundation in 2000 which has in the last dozen or so years prevented millions of deaths in children by expanding access to new vaccines in poor countries.

Most cervical cancer is caused by a virus, human papillomoa virus or HPV, and the drug industry has developed a number of HPV vaccines. But these new vaccines are expensive (more than $100 per dose) and have been out-of-reach for most poor countries. Women in rich countries have access to cervical cancer screening (Pap tests) and curative treatment, but women in poor countries generally do not.

“As a result, we see an estimated 275,000 women dying from cervical cancer in these countries every year,” Berkley said. Girls and women in poor countries are hit by a ‘triple whammy,’ he said, of higher disease incidence, lack of diagnosis and lack of treatment. Without access to a preventive vaccine, Berkley said, that death toll will only increase.

GAVI will begin support for HPV vaccines in Kenya as early as this month followed by Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzania. – See more at: http://www.gavialliance.org/library/news/press-releases/2013/hpv-price-announcement/#sthash.gDPujj1x.dpuf

Today, at the World Economic Forum on Africa meeting in Cape Town, South Africa, GAVI announced that two drug companies, Merck and GlaxoSmithKline, have agreed to provide their HPV vaccines to poor countries for $4.50 and $4.60, respectively, per dose. Continue reading

Drug industry loses in India – fight over ‘patents vs poor’ to continue | 

green pills
Flickr, sparktography

The Indian Supreme Court has rejected a drug patent application by the international pharmaceutical firm Novartis, an event that merited coverage by the New York Times, BBC and many other media – news which you might think is mostly a matter for the business page or drug industry insiders.

In fact, the case may represent one of the most difficult dilemmas in global health. It is a fight that is far from over.

The Indian high court’s legal resolution (or perhaps ‘latest phase’) of this long-running battle between the Indian government and Novartis, as I wrote about last October in a post called Patents vs the Poor, is regarded on all sides as representing much more than what Novartis can charge for the particular cancer drug, Gleevec (or Glivec), at issue.

What’s at stake is one of global health’s most difficult balancing acts – how to expand access of life-saving medicines to the poor while also protecting the legitimate interests of the drug industry when it comes to patent protection and intellectual property. The high court’s decision is being reported as a victory of the generic drug industry, which is big in India, over Western drug makers. As the New York Times put it:

On the one hand, it will help maintain India’s role as the world’s most important provider of cheap medicines, which is critical in the global fight against HIV/AIDS and other diseases…. On the other hand, the ruling could cost lives in the future. Drug company executives and others argue that India’s failure to grant patents for critical medicines …  is a shortsighted strategy that undermines a vital system for funding new discoveries.

That’s what Novartis’ head of corporate research, Paul Herrling, told me:

Paul Herrling
Paul Herrling
Novartis

“If a breakthrough compound like this cannot be patented in India, that has major consequences for innovation in India and elsewhere,” said Paul Herrling. “This isn’t really about Gleevec … This is just one part of a much larger issue.” Continue reading

Novartis vs. India: Patents vs. the poor? | 

Flickr, Brooks Elliott

One of the biggest, thorniest dilemmas in global health is coming to a head in India.

(And the biggest player in this arena, the Bill & Melinda Gates Foundation, with a former top Novartis executive running the global health program, has no comment on it. More on that below).

At one level, it’s a narrow legal battle between the drug company Novartis and the government of India over an expensive cancer drug known in the U.S. as Gleevec, and everywhere else as Glivec.

Novartis has challenged India’s denial of patent protection for the drug and the case is now under consideration by the Indian Supreme Court. Those on either side of the argument say the case has major implications for all of global health.

Why? Because this legal battle pits one set of laudable goals, finding new and better drugs, against another equally critical aim, making sure all the people who need these drugs can afford them.

Novartis

Paul Herrling

“If a breakthrough compound like this cannot be patented in India, that has major consequences for innovation in India and elsewhere,” said Paul Herrling, head of corporate research at Novartis.

“This isn’t really about Gleevec,” added Herrling. “This is just one part of a much larger issue.”

On that last point, many global health advocacy organizations and activists would agree.

Organizations like MSF (Médecins Sans Frontières, aka Doctors without Borders) Oxfam and others focused on ensuring poor people have access to life-saving drugs see Novartis vs. India as central to a much bigger industry-wide push now taking place on a number of fronts.

Judit Rius, MSF

“This is part of a global strategy aimed at lowering the bar, of making it easier for these companies to extend their drug patent monopolies,” said Judit Rius, U.S. manager of MSF’s Campaign for Access to Essential Medicines.

A Novartis win in Indian court would seriously undermine the generic drug industry, Rius said, reducing the supply of cheap drugs that make a life-and-death difference in poor countries.

MSF, Oxfam and other health advocacy organizations have been fighting Novartis on this case for years. It has dragged on within the India court system since 2006, getting filed, denied and then re-filed, with advocates for the drug company arguing that India is improperly protecting its burgeoning generic drug industry while many public health advocates argue Novartis is profit-seeking at the expense of the poor.

Continue reading

Doctors Without Borders criticizes Gates-backed global vaccine strategy | 

UN

Bill Gates at World Health Assembly

The global health strategy to expand childhood immunizations, largely backed by the Bill & Melinda Gates Foundation, is too focused on new vaccines and neglects the fundamental need to improve basic public health and immunization programs in poor countries.

So says Medicins Sans Frontieres (MSF), aka Doctors Without Borders, in a new report issued today by the organization entitled The Right Shot: Extending the Reach of Affordable and Adapted Vaccines.

The medical relief and aid advocacy organization is critical of a new, 10-year, multi-billion dollar “Global Vaccines Action Plan” expected to be adopted by global health leaders at the World Health Assembly meeting next week. The plan is largely funded by the Gates Foundation.

MSF says it favors expanding access to new vaccines — just not at the expense of basic immunizations.

“Twenty percent of the world’s children aren’t even getting the basic vaccines,” said Kate Elder, MSF vaccine policy adviser. The Gates Foundation is driving much of the global health policy decisions around vaccinations, Elder noted, and “Bill Gates’ priority is new vaccines.” The philanthropy’s influence is distorting the agenda to favor new vaccines over basic improvements, she said.

Daniel Berman, MSF’s deputy director for access, cited a recent initiative to distribute a new $7-per-dose pneumococcal vaccine in DR Congo in the middle of a measles outbreak. Why, Berman asked, are donors and health agencies pushing this new, expensive vaccine in Congo if Congolese children still aren’t getting a 30-cent measles vaccine?

The approach appears aimed more at supporting drug industry desires to promote new products than at finding the most efficient and sustainable means for fighting the diseases of poverty, he said.

UNICEF

The Right Shot may be a new report from MSF, but it is hardly a new criticism of the Gates Foundation’s approach to vaccines. Others have criticized the philanthropy before for a tendency to place industry interests above the concerns of poverty advocates.

The Seattle philanthropy, though contacted in advance of the report’s release, declined to comment or respond today to the MSF criticism – or to the group’s call for a new global strategy with more emphasis on beefing up basic, routine immunizations. The organization sponsored by the foundation to promote the new global strategy, the Decade of Vaccines collaboration, also did not respond.

Jeffrey Rowland, spokesman for the Global Alliance for Vaccines and Immunization, GAVI, did respond to the criticism. Continue reading

Gates initiative on “neglected diseases” advances cause, but neglects key questions | 

The Bill & Melinda Gates Foundation today announced, together with more than a dozen drug makers and others, a new initiative aimed at fighting a select group of mostly developing world ailments called “neglected tropical diseases” such as river blindness, parasitic elephantiasis and others.

Uniting to Combat NTDs

These diseases affect an estimated 1.4 billion people, killing perhaps half a million a year, but have not been high on the global health radar screen. As Dr. Peter Hotez writes for Huffington Post, for only 50 cents per child many of these diseases may now be eliminated.

The new public-private initiative aims to rid the world of 10 of these diseases by 2020.

It’s widely regarded as a positive step forward for global health, but there are some important questions that went unanswered:

  1. What is a neglected disease? This is actually a hotly debated question in global health circles right now.
  2. Many think the solution to fighting diseases of poverty should be to focus on poverty as much as on disease. Will this initiative get at the root problem or just address symptoms?

We’ll get back to the neglected issues of neglected diseases in a bit. First, more on the news:

For this initiative called the London Declaration on Neglected Diseases, the Gates Foundation pledged $363 million to support research into new treatments. Drug makers like GlaxoSmithKline, Merck, Johnson & Johnson and others have likewise pledged to step up research as well as to expand donation programs of medications to poor countries.

Others involved in the initiative include the World Bank, the United Arab Emirates as well as the U.S. and U.K. governments The total estimated commitment is $785 million. Continue reading

Three reasons not to get too excited about the Gates-Glaxo malaria vaccine | 

Last week, the biggest news out of the Gates Foundation’s Malaria Forum were some interim results of an ongoing test of an experimental malaria vaccine.

Many, if not most, media reported the findings in somewhat hyperbolic fashion as a “major milestone,” a “breakthrough” or “world’s first malaria vaccine.”

Google News on the malaria vaccine

Despite the hype and fanfare, many experts at the Seattle meeting said this experimental vaccine (known as RTS,S) actually so far represents only incremental progress — a scientific achievement which may still turn out to have little practical utility in the real world. They usually only said so privately, given that the Gates Foundation preferred to hear “optimistic” assessments rather than cranky ones.

1. No breakthrough. Let’s first put to bed the claims that these findings represent a major milestone. In fact, the findings largely repeat earlier ‘interim’ results that have continued to find the vaccine protects only half of those immunized — and appears to wane fairly rapidly over time.

So that’s the first reason — a point also made in this (terribly titled) Huffington Post article A vaccine that works only half the time is not the shot in the arm malaria needs. The author, Tido von Schoen-Angerer, director of Médecins Sans Frontières‘ essential medicines campaign says:

But while the latest advance toward the development is scientifically important, there are several reasons to be cautious about the difference this vaccine could make, on the basis of current results.

2. The cost question. The second reason this halfway effective malaria vaccine may not work is cost. The manufacturer GlaxoSmithKline has refused to say what it thinks it will have to charge for the vaccine, other than to say it would be “at cost” plus 5 percent. Neither the PATH Malaria Vaccine Initiative, which is working with GSK on the malaria vaccine trial, or the Gates Foundation (which funds the PATH initiative) will say what price they think is feasible. Many say anything over a dollar might be too much for poor countries.

3. The science. It is promising that researchers have shown a vaccine against malaria is possible. But there’s a lot of other research out there indicating why it may be quite difficult to get a malaria vaccine that can perform as well as most of us expect a vaccine to perform — providing ideally something like 90 percent protection but hopefully not lower than 70 percent. Continue reading