News Link n. 21

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

News Link 21

-With An Army Of Vaccinators, India Subdues Polio http://www.npr.org/blogs/health/2012/10/18/162739833/with-an-army-of-vaccinators-india-subdues-polio?sc=emaf

-Takeaways from this year’s European Development Days http://www.devex.com/en/news/79489/print

-EDD12: A spotlight on inclusive growth, youth employment http://www.devex.com/en/news/79485/print

-Relazione tecnica del Governo ( TTF alle pagine 34-35 del documento) http://www.sanita.ilsole24ore.com/pdf2010/Sanita2/_Oggetti_Correlati/Documenti/Dal-Governo/stabilitafinale_relazionetecnica.pdf?uuid=3bb473ba-16ba-11e2-b74e-94f6a1458d07

-Rainews tassa sulle transazioni finanziarie: http://www.youtube.com/watch?v=HGYmfqGP_N0

-New WHO Mechanism Against Poor Quality Medicines To Convene In Buenos Aires  http://www.ip-watch.org/?p=24047&utm_source=post&utm_medium=email&utm_campaign=alerts

-A closer look at European perception of aid  http://www.devex.com/en/news/79471/print

-Global Fund Nears Selection Of New Director For Transformed Organisation  http://www.ip-watch.org/?p=24013&utm_source=post&utm_medium=email&utm_campaign=alerts

-Panellists: Global Health Justice Needs Government Commitment, New Innovation Models  http://www.ip-watch.org/?p=24010&utm_source=post&utm_medium=email&utm_campaign=alerts

-2012 Commitment to Development Index http://www.cgdev.org/section/initiatives/_active/cdi/

-Bridging  the gap: why the European Union must address the Global Fund’s funding crisis to tackle the escalating HIV and TB epidemics in eastern Europe and central Asia http://www.action.org/documents/ACTION-TBEC_Briding_the_Gap_Sept2012_EMBARGOED.pdf

 

The AIDS Story You May Not Have Heard

William F. Haddad: Chairman/CEO, Biogenerics, Inc., has been a pharmaceutical executive since 1986. As Chairman of the generic trade association, he initiated and negotiated Hatch-Waxman, the legislation that opened the door to generics in the United States. He was CEO of a major generic manufacturing company. Earlier he worked with Jack and Robert Kennedy and Senator Estes Kefauver. He was one of the founders of both the U.S. Peace Corps and the Office of Economic Opportunity (poverty program) and served as the Inspector General or both organizations. As a newsman at the NY Herald Tribune and the NY Post, he won a dozen awards for investigative reporting. He also learned about the wiretapping of Watergate three weeks before the break-in and reported it to the Democratic leadership. He exposed the worldwide tetracycline cartel by locating secret cartel minutes in two Latin American countries, destroying the cartel and leading to a $200,000,000 fine for Pfizer.  He also found the secret minutes of the Uranium cartel that led to Congressional hearings conducted by then Congressman Albert Gore and Haddad. Using New York State'€™s subpoena he uncovered of the role of the New York banks in profiting from the collapse of the City'€™s financial system; located and exposed secret state police files that contained the names of a million citizens almost all had neither been accused of or committed a crime; he investigated organized crime'€™s role in sports; and he subpoenaed the major television networks to explain covert arrangements with advertisers in advertising to children. As a volunteer, he worked with Cipla to remove the barriers to the use of generic AIDS medicines. He has published several books. He was a merchant marine officer at sea when he was sixteen.

 

(News Commentary and Background)

The AIDS Story You May Not Have Heard

William F. Haddad, Chairman/CEO, Biogenerics, Inc.

wfhaddad@aol.com

 

The United States government, the European Union, multinational pharmaceutical companies and powerful conservative organizations are once again trying to prevent generic companies from providing essential medicines to the poor nations of the world. This time their prime targets are India where recent court decisions may open the door to “€œcompulsory licensing”€ of essential medicines and the Global Fund the major source of financing for AIDS medicines. Also under attack is the World Health Organization’€™s (WHO) pre-qualification system for AIDS and other essential medicines.

India remains the major supplier of generic medicines to Third World nations.

Compulsory licensing can permit competition when a patent is claimed and an essential need identified.

The U.S. team includes former Ambassadors Mark Dybul and William Steiger who helped delay AIDS medicines to millions dying from the illness in poor nations. This was done after the formation of the President’s Emergency Program for AIDS Relief (PEPFAR) in 2003 when they insisted that only products approved by the U.S. Food and Drug Administration (FDA) would qualify for PEPFAR.  They intentionally and deliberately ignored the regulatory requirements created by western and other regulators for the World Health Organization (WHO), a system already in universal use without problems.

The Indian generic companies were excluded until 2007 -€“ 2008 when they received PEPFAR approvals.  During this period only big Pharma benefitted at their high prices while millions died or went untreated. This tragedy can singularly be attributed to the above persons. Their target now appears to be the Global Fund.

India and other nations were required to abandon national laws governing the manufacturing of medicines as a pre-requisite for joining the World Trade Organization (WTO). Uniquely, generic manufacturers in India had developed the strategies and science to clone brand products using methods that often avoided patent protections.  For decades Indian generic pharmaceutical companies have manufactured medicines, including the basic raw materials, that are approved by the U.S. FDA and universally used in the United States.

Poor nations depend on affordable Indian manufactured generics to meet their medical needs.  Branded medicines, often sold at U.S. prices, are simply unaffordable.

The WTO requirement ended that system and obedience to rigid patent laws replaced it in 2005 and was effectively back-dated to 1995. This retroactive action was repressive.

An “€œescape”€ provision in the WTO agreement permits the manufacturing of essential drugs under certain circumstances. In India the unaffordable price for a life saving medicine can qualify for that exemption. However, few of these safeguarding processes work according to their design. Behind the scenes politicians, some hired, some sincere, pulled the strings. In the United States it required thirty years to obtain legislation enabling the routine manufacture and approval for generic medicines.

The burr under the saddle of the multinational pharmaceutical companies (Pharma) is India’€™s apparent refusal to deny patients access to essential medicines because the demanded price is unaffordable. Recently, an Indian court ordered a Pharma company to reduce its price and accept a stipulated royalty for a life saving cancer medicine.

In another, the Indian high court summarily dismissed a challenge from Bayer Inc. claiming a new combination of off-patent medicines constituted a new and patent-protected product. The Court ruled the so-called new medicine was, in effect, “€œevergreening”€ a term used to describe drugs that combine existing medicines with no additional therapeutic impact yet are able to claim and often obtain new patents that can prevent competition for over twenty years although they offered no medical advantage beyond existing patents. These patents have been labeled as “€œfrivolous”€.

In India the multinational pharmaceutical companies often resort to frivolous patenting. They also conduct multiple patenting of the same product in different patent  jurisdictions hoping one of them would be approved.  This undermines the spirit of patenting.

Another shock for Pharma was the recent revoking of Pfizer’€™s patent for its cancer drug Sutent following “€œpost-grant”€ opposition to the patent by Cipla, Ltd.

Dow Jones also noted that Novartis AG has been unable to patent it’€™s cancer drug Glivec in India after its application was rejected in 2006 and that the patent office also rejected an application from Gilead Science for its HIV medicine Viread and noted Roche has been unable to obtain a court order prohibiting the sale of clones of the cancer drug Tarceva.

Conservative associations and their writers perpetuate and promulgate discredited arguments claiming generic medicines, clones of the brand, are “€œless effective”€ and will deny the multinational pharmaceutical companies, often the most profitable segments of any economy, the financing they require to discover new drugs. Although both claims are routinely denounced by the medical community and the FDA, they persist as alibis to deny essential and affordable generics in the poor nations of the world.

Essential AIDS medicines bypassed many of these clichés when WHO with western and other regulators created a “€œone stop”€ universal scientific approval process, “€œpre-qualification”€ accepted by all Third World nations (a first) and by all entities financing their use. Pre-qualification ended nation-by-nation approvals.

It should come as no surprise that pre-qualification is a target of Pharma and others because it deprives Pharma of their ability to use politics and the courts to stretch patents, denying or delaying the use of generic clones.  Many generic companies lack the resources to wage legal battles in each country.

It was this technique that was effectively used to deny AIDS medicines for most of the world. Out of the 36,000,000 afflicted in Africa only 4,000 were in treatment at a prohibitive cost  of $ 12,000 a year.

Pharma now fears a repeat of this defeat will open the market in poor nations to affordable medicines.

To challenge Pharma’€˜s monopoly of essential AIDS medicines, an Indian scientist, Dr. Yusuf Hamied of Cipla Ltd., created Triomune, a unique, regulated combination of the most effective AIDS medicines in one tablet taken twice a day and reduced the cost to a dollar-a-day in 2001. Unfortunately, Triomune, the so-called “€œtriple”€ could not be sold. Thirty-eight Pharma companies sued in a South African court to block the use of generic drugs.  That action effectively prevented the use of generic AIDS medicines.

When Cipla joined forces with Doctors Without Borders (MSF) in 2001 the media exposed Pharma’€™s campaign to deny affordable AIDS medicines from reaching the millions suffering and dying of AIDS. At first there was disbelief. When the reality set it, the intensity and anger of the international condemnation grew. Why would Pharma block the use of a medicine known to prolong lives when it knew few to none in the Third World could afford their prices?  Why would they allow entire families and communities to be destroyed? Editorially, the answer was provided by the media:  Pharma feared price comparisons to their monopoly in western nations, where the cost of a year’€™s treatment was approximately  $12,000 to $15,000 per patient per year, would lead to demands to lower the cost.

Finally, unable to withstand the impact of the truth, the Pharma companies, walked out of court (some wrote “€œwith their tails between their legs”€) and abandoned their legal action. Generic AIDS medicines began to save lives.

This year, UNAIDS and others reported more than 8,000,000 persons were using generic AIDS medicines at a cost of approximately $85  per patient per year.

PEPFAR

President Bush in his State of the Union address on 31st January 2003, reacted to the dramatic change in the cost of AIDS medicines and used his State of the Union message to call for the largest contribution of any nation for AIDS treatment.

In an emotional statement, he told the U.S. Congress doctors would no longer be required to tell their patients “…we can’€™t help you. Go home and die….In an age of miraculous medicines no person should have to hear those words…(because)…the cost of these drugs have dropped from $12,000 a year to under $300 a year which places a tremendous possibility within our grasp.”

Congress responded with bi-partisan support and appropriated fifth billion dollars to finance PEPFAR. That donation has now been increased to fifty billion.

Without explanation a tight circle of government executives cooperating with Pharma began an effective campaign to insure only their high priced AIDS medicines would be financed, a goal diametrically opposite to the purpose of the Bush plea and the action of the Congress.

Coordinated Efforts to Deny Financing for Generic AIDS Medicines

As difficult as it is to believe, but after Congress authorized the fifteen billion dollars for PEPFAR, U.S. government officials began to erect roadblocks to prevent the financing of generic medicines. Their first action, without consultation or discussion, was to announce the WHO pre-qualification system, already in widespread use, could not be used to qualify AIDS medicines for PEPFAR funds. No other nation had placed domestic restrictions on their financing for AIDS medicines.

In the United States, the approval of FDA would be required for PEPFAR funds, an expensive and lengthy process. No justification for this action was provided. The worldwide acceptance of pre-qualification was no longer valid. In essence, at its very best, the process would deny generics access to PEPFAR funding undermining the purpose of both the President and the Congress.

By happenstance, the announcement coincided with a worldwide AIDS conference in Paris. There Non-Governmental Organisations (NGOs), Third World nations and the media confronted the U.S. representative, Secretary of Health and Human Services, “€œTommy”€ Thompson asking for an explanation of why the existing WHO system was bypassed?

The media also wanted to know why the expensive and lengthy new tests were required when the approved medicines were readily available and already in use.   Was there a problem with the medicines already pre-qualified by the WHO and universally accepted by all recipient nations?  None had been reported. Wouldn’t the new requirement discourage and delay competition?

Media bureaus around the world reported they could not find reports of failures of the AIDS generic medicines and WHO said had received none.  Was this a manufactured solution to a problem that did not exist?

At first, Secretary Thompson response was hostile refusing to offer an acceptable explanation. But the intensity of the NGO and media questioning continued.

When Secretary Thompson returned home, the FDA requirement was quietly withdrawn. Nations could use WHO’€™s pre-qualification to qualify for PEPFAR funding.

As it turned out, the withdrawal was not a decision, but a tactic. Six months later a lead story in the Sunday New York Times announced the FDA requirement was re-instated.  Again there had been no consultations. The generic companies organized and protested but their arguments were ignored.  Someone, somewhere had made the mysterious decision and it would remain.

Some Pharma executives and a cadre of U.S. officials believed generics either could not, nor would not, submit to the long and expensive FDA process. They were wrong. To their surprise, Cipla submitted to the FDA Triomune, the identical product previously approved by WHO and already recognized as WHO’€™s “€œfirst line treatment”€ for AIDS.

Three years later the FDA approved Triomune without change, opening the door for Africa and the world to purchase generic drugs with PEPFAR funds.

It was estimated one million people might be alive today if use of the generic had not been delayed by politics.

The Bad Guys Return: Déjà  vu All over Again

Two men responsible for delaying universal use of generic AIDS medicines, are no longer in the U.S. government, but are back again, this time their target is the Global Fund where, once again, they are in a position to deny the use of generic AIDS medicines. They are:

Former Ambassador William Steiger

Steiger formerly represented the United States at the Global Fund and WHO and from those positions he threatened that if the Fund financed generics, the United States government would terminate its contribution to the Fund, in effect pulling the financial rug out from under the Fund’s fiscal resources. He enhanced his threat by explicitly warning that he had influence beyond his position. He was, he said, the “€œgodson”€ of the first President Bush (true) implying he could pick up the phone and call the current President if necessary. He also bragged his father had introduced Vice President Cheney to politics (also accurate).

Steiger’€™s threats paralyzed the Fund’€™s operations until a courageous participant in those meetings asked an intermediary to meet him at the Geneva airport where he silently slipped a sealed manila envelope across the table. Inside was confirmation of Steiger’€™s threats. Confidential distribution of the memo ended Steiger’€™s influence and the Fund began to finance generic medicines. Today, as noted, almost all of Fund’€™s monies for AIDS medicines are used to purchase generics.

Unfortunately the story does not end there. Steiger is now back working directly with the Fund and in a position to influence whether brand or generic drugs are used.

When an NGO discovered his involvement, the Fund, at first, denied he was employed but upon reflection admitted “€œyes”€ Steiger had returned but only as a “€œconsultant”€.  Later it was learned his “€œadvise”€ would cover what appears to a revised concept in the purchase of AIDS medicines. A virtually hidden paragraph in the Fund’€™s mission charts a new purchasing policy, opening the door to use of higher priced brand drugs.  That power lies in one sentence consistent with Pharma’€™s age-old arguments against generic drugs. It reads “…the Global Fund procurement policies should not prioritize purchasing on price alone and should place more value on quality.”

Steiger comes to the Fund with renewed authority. He was a principal in a critical review of the Fund that has resulted in changes in the Fund’€™s management personnel.

Steiger working for former HHS Secretary Mike Leavitt helped conduct the review of the Fund following a critical investigative report by the Fund’€™s Inspector General.

Leavitt was recently appointed by former Governor Mitt Romney, now the Republican candidate for President, to manage his “€œtransition team”€ one of the most influential roles in creating an administration if Governor Romney wins the election.

Former Ambassador Mark Dybul

Steiger may be joined at the Fund by former Ambassador Mark Dybul who became the manager of the U.S. AIDS program and was recently summarily discharged from his position by President Barack Obama a day after his re-appointment was announced. It appears he was given a day to leave office but the reasons remain obscure.

Dybul’€™s opposition to generic drugs dates back to a meeting in Botswana organized, in part, to provide the rationale for requiring FDA registrations for generic medicines, a process, participants at the Conference argued, would both delay the urgent need for the medicines and was unnecessary because the medicines had been “€œpre-qualified”€ for use by WHO.

At the Conference Dybul and the others were confronted by a woman who managed a Catholic AIDS program in Africa. Reflecting the attitude of the NGOs  at the meeting she said the delay in PEPFAR funding for generic drugs would force her to treat one rather than four patients, a reminder of the days before generic AIDS medicines became available.  The official U.S. delegation that co-sponsored the meeting did not respond but her remarks lit a fuse and others sharply questioned the reason behind abandoning pre-qualification.

At this writing (October, 2012) it is reliably reported Dybul is on the short list for Executive Director of the Global Fund.

U.S. Official Warns India, But Gets Her Facts Wrong

Undersecretary of Commerce, Ms. Teresa Stanek Rea, who also serves as the Deputy Director of the Patent and Trademark Office recently told Congress of the efforts of the United States government to stop compulsory licensing  in several countries inaccurately claiming compulsory licensing was illegal under WTO’s TRIPS (Trade Aspects of Intellectual Property Rights). She said she was particularly outraged when an Indian Court awarded a compulsory license for a life saving cancer drug , Nexavar, to Natco to manufacture. The drug was not widely used in India because of its patent protected price of $5,500 a month. As a result of the pricing, only two percent of those needing the medicine could afford that price because India’€™s per capita yearly income is approximately $ 3,693.00.

The case was a classic example of a nation that could not afford to buy the medicine but its pharmaceutical companies, capable of manufacturing the medicine to western standards, were prevented from manufacturing and selling it at an affordable price. The proven and irrational result was sickness and death.

Fortunately, Ms. Rea had her facts wrong.

Article 31 of the TRIPS agreement expressively permits compulsory licensing, the result of long and hard fought discussions and compromises within WTO for the right to remove patent protection for an essential medicine sold at a price beyond the ability of a patient to purchase it.  Many nations demanded that right as a condition of joining WTO.

Anand Grover, the United Nations Rappoteur on the Right to Health and Senior Advocate for the Indian Supreme Court said “€œsetting an exorbitant price which makes the drug unavailable to those who need it…(is) grounds for the issuance of a compulsory license.”

Peter Maybarduk, Director of Public Citizens Access to Medicines added: “€œcompulsory licensing is a sovereign right to protect health and other interests. It has been around as long as patents have been around.”

Ms. Rea also argued: “€œwe are doing everything to respect the rights of U.S. innovators.”

She was wrong again.  Bayer, the company involved, is a German company.

She also said she was working hard to stem the tide of compulsory licenses and said her targets were foreign officials and judges.

Facing the factual challenges, Ms. Rea finally admitted she was wrong, yet she remains in office and the media has shown very little interest in pursuing her story although her behavior undermines years-long struggles by nations to provide access to essential medicines at affordable prices with “€œcompulsory”€ licensing as the right of a nation to protect its citizens.

Due to pressures, public and secret, only four nations have used compulsory licensing to lower the cost of essential medicines even as the AIDS pandemic devastated their nations.

Roger  Bate, the Generic Headhunter, Returns

Roger Bate, closely affiliated with the powerful and well financed American Enterprise Institute (AEI), has returned to once again harass generics. His was an important, skillful anti-generic voice and his access to the media was impressive.

Bate skillfully used that access and his affiliation with the AEI to advance what was/is recognized as an anti-generic agenda. Now, he is back and very dangerous.  It appears his new target is WHO’€™s pre-qualification program.  He recently promulgated an “€œacademic”€ study that implied approved malaria medicines were sub-standard.

The Bate conclusions are now the subject of an independent review to determine if conclusions of the study meet scientific requirements.

One early theory for his recent outrage may be that for the first time, FDA has delegated to WHO pre-qualification the right to certify malaria medicines but it now appears his target may have been the widely acclaimed October announcement that a jointly developed fixed dose malaria medicine, Mefliam Plus had obtained WHO pre-qualification making it eligible to bid on tenders that receive funding from international procurement agencies including UNICEF and the Global Fund.

Bernard Pecoul, executive director of the prestigious non-profit organization DNDi (Drugs for Neglected Diseases initiative) said the new drug (a combination of artesunate and mefloquine) meets an important public health need and forms a part of a malaria treatment necessary to control the disease.  The combination was originally developed by DNDi and  Brazilian government-owned pharmaceutical firm, Farmanguinhos and a technical transfer between Farmanguinhos and  Cipla achieved in 2010. WHO’€™s pre-clearance opens the door to delivery of an important new malaria drug to poor nations without the necessity to seek approval nation-by-nation.

But Bate’€™s return to the fray signals that the team of “€œhired hands”€ from conservative associations may be preparing to renew their attacks on generic medicines and pre-qualification that remains a target of Pharma companies.

The European Union’€™s Anti-Counterfeiting Campaign

Quite suddenly, the European Union began to remove generic cargoes touching European ports based on claims from multinational pharmaceutical companies that the medicines were “€œcounterfeits”€.   After several cargoes had been removed, it was revealed “€œcounterfeiting” was a merely a claim by Pharma companies that a generic cargo was destined for a location where the multinational corporations claimed patent rights might be violated.  The vague charge was sufficient to cause a ship to unload the medicines before it could continue on its voyage.

Upon investigation it was revealed the seized cargo contained AIDS medicines destined to the American Embassy in Nigeria.

Mistakes were admitted, but the so-called “€œcounterfeit”€ law remains in force although seizure may now require more proof than a claim by a competitor.  If truth be told, it is the branded product that is most often counterfeited because it can command a higher price. There is little doubt that “€œreal” counterfeit medicines are delivered and sold and generic companies cooperate with government officials to locate their source.

International Trade Agreements

Hidden clauses in international agreements have consistently included exclusive and often unwarranted protection of brand products and are often demanded by western nations.  The United States recently admitted it was pressuring Pacific nations to “€œsign off”€ on a new treaty many NGOs and generic companies believe will use “€œpatent claims”€ to prevent sale of generic medicines.  Most often these treaties that are negotiated in secret, contain measures that fly a “€œpatent flag”€™ but are blunt attempts to restrict generic competition.

Conclusion

The situations discussed in this document are accurately reported and only focus on recent activities. For decades similar anti-generic strategies were used, many with the cooperation of western officials.

The success with providing AIDS medicines at affordable prices has heightened the fear of Pharma companies and has only increased their political activities around the world. Compulsory licensing is perhaps the only remedy that will curb that influence.

Thank you for taking the time to read this document.

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News Link n. 20

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

News Link 20

– Tobin tax, finalmente http://www.avvenire.it/Commenti/Pagine/Tobin-tax-finalmente-becchetti.aspx

– Tanzania probes fake HIV drugs  http://www.bbc.co.uk/go/em/fr/-/news/world-africa-19914662

– GlaxoSmithKline opens door on data in bid to aid discovery of medicines  http://gu.com/p/3b38z/em

– UPDATE 2-GlaxoSmithKline to reveal more drug secrets  http://www.reuters.com/article/email/idUSL6E8LB1QQ20121011     

– Indonesia in bold move to obtain cheap drugs for HIV  http://gu.com/p/3b3dj/em 

– UN High-Level Meeting In India On Biodiversity Sees Need For Capacity-Building On Access And Benefit-Sharing  http://www.ip-watch.org/?p=23990&utm_source=post&utm_medium=email&utm_campaign=alerts

– ‘It is time for us to become a solutions bank’ http://www.devex.com/en/news/79441/print

– TRIPS-Related Patent Flexibilities and Food Security: Options for Developing Countries  http://ictsd.org/downloads/2012/10/trips-related-patent-flexibilities-and-food-security.pdf

– Africa Seen at Risk of Social Unrest From Food Shortages http://www.businessweek.com/news/2012-10-09/africa-seen-at-risk-of-social-unrest-from-food-shortages

– A good support system? http://www.devex.com/en/news/79417/print

– ‘One Billion Hungry’ Peak Missing From New FAO Numbers http://ictsd.org/i/news/bridgesweekly/146878/

– IMF, World Bank must support poor countries facing food price volatility, Euro crisis   http://www.oxfam.org/en/pressroom/pressrelease/2012-10-09/imf-world-bank…

– Al Ansari Exchange and Bill & Melinda Gates Foundation sign Memorandum of Understanding on collaboration for global health http://alansariexchange.com/en/news/gates.foundation.aspx#.UHbe-amBAqI.email

– Justine Greening eyes new approach for UK aid http://www.devex.com/en/news/79415/print

– India: Toilets versus temples  http://www.globalpost.com/dispatches/globalpost-blogs/india/india-toilets-versus-temples

– Changing the world on the quiet http://www.ft.com/cms/s/2/541445e8-0db4-11e2-97a1-00144feabdc0.html 

– U.N. Rapporteurs Call For Creation Of Global Fund As Social Safety Net For Vulnerable Populations http://globalhealth.kff.org/Daily-Reports/2012/October/09/GH-100912-Glob…

– An invisible issue: The presidential campaign and HIV/AIDS http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/presi…

– Innovative funding model allows urban poor to determine their own future   http://www.guardian.co.uk/global-development/poverty-matters/2012/oct/08/urban-poor-fund-communities-determine-future/print

– At WHO, Pharma Suggests Payment Plan For Influenza Virus Use http://www.ip-watch.org/?p=23927&utm_source=post&utm_medium=email&utm_campaign=alerts

 

 

 

 

 

Interview: Yusuf Khwaja Hamied, Cipla Ltd., India

By Daniele Dionisio, GESPAM Head

Interview: Yusuf  Khwaja  Hamied, Chairman and Managing Director, Cipla Ltd., India

GESPAM had the pleasure to interview Dr. Yusuf Khwaja Hamied as the Chairman and Managing Director of pharmaceutical  Indian company Cipla Limited.   

Cipla is renowed both locally and internationally for its high standards, quality, efficacy and affordability of medicines.

Born in 1936, Dr. Hamied obtained Ph.D in Organic Chemistry from Cambridge University. In the same year, he joined Cipla as a Research Officer. He was appointed as its Managing Director in 1976 and as Chairman in the year 1989.

Dr. Hamied has introduced over 30 new drugs to India and is marketing as cost-effective options to 180 countries worldwide. Under his guidance Cipla is now ranked as a leader in the domestic pharmaceutical industry and Cipla’s manufacturing facilities have been approved by various international regulatory authorities including the Food and Drug Administration (FDA)-USA, Medicines and Healthcare products Regulatory Agency (MHRA)-UK, Therapeutic Goods Administration (TGA)-Australia, Medicines Control Council (MCC)-South Africa, National Institute of Pharmacy (NIP)-Hungary, Pharmaceutical Inspection Convention (PIC)-Germany, World Health Organisation (WHO), Department of Health-Canada, State Institute for the Control of Drugs-Slovak Republic, ANVISA-Brazil

In numerous public dialogues Dr. Hamied has sought to make patient welfare the priority for multinational pharmaceutical companies and the World Trade Organization, rather than concerns about profitability, patents and economic returns.

Dr. Hamied’€™s vision is that every citizen in India should have full access to vital medicines and healthcare at affordable prices. Coherently, he has been at the forefront of the movement to break big pharma’€™s global monopoly over lifesaving drugs. And he got his latest success on 7 September 2012 when the Delhi High Court ruled that Cipla can sell its own generic version of the Roche cancer drug erlotinib, at a third of the proprietary version price. 

Under Dr. Hamied’€™s leadership, Cipla was the first to offer the HIV triple drug cocktail, Triomune, which can transform the life of an HIV positive patient at a fraction of the international cost.

Dr. Hamied  has also established the Cipla Palliative Care Centre in India, and the Hamied Institute for Education and Research into Palliative Care, at a time when Cipla continues its ongoing support of education and community welfare both directly and through charitable trusts.

Thanks to Dr. Hamied, Cipla has launched breakthrough medicines including one in cancer chemotherapy, a once-daily novel 4 drug kit Qvir for HIV, and an innovative ‘€œMother-Baby Pack’€ for preventing mother-to-child transmission of HIV. And, as part of a  partnership with Drugs for Neglected Diseases Initiative (DNDi), Cipla just announced the prequalification of the fixed dose combination (FDC) of Artesunate (AS) and Mefloquine (MQ) -€“ ASMQ FDC -€“ by the WHO. This Cipla-manufactured ASMQ FDC is the first artesunate-mefloquine FDC to be prequalified by WHO and is recommended for the treatment of malaria. 

Meanwhile, DNDi and Cipla are committed to develop a 4-in-1 new formulation to fill the gap in appropriate HIV medicines for infants and young children.

Dr. Hamied’€™s contributions as a scientist, a business man and a humanitarian personality have been recognized by a number of awards to the company and himself.

 

GESPAM: Dr. Hamied, India’s obligations to the World Trade Organization (WTO) prevent local companies from making generics for medicines introduced since 2005. These developments threaten the supply of generic medicines from India that serve as a lifeline to resource-limited countries. What about India’€™s relevant patent law?

 

Yusuf Hamied: India changed its patent laws in 1972, exactly 40 years ago. Prior to this India followed the British Patent Law of 1911. The 1972 law abolished product patent for drugs, but retained process patent. The effect of this was that the indigenous drug industries in India made enormous strides and is today regarded as the pharmacy capital of the world. In 2005, India changed its patent laws and reintroduced product patents back-dating the cut-off date to January 1995.

 

GESPAM: Under Section 3(d) of its 2005 Amended Patents Act, India is free to reject frivolous patent applications to any new forms of old medicines unless therapeutic efficacy has increased significantly. And earlier from 1 January 1995, a mailbox facility was put in place in India to receive product patent applications. In cases where Indian companies were already rolling out these products before 1 January 2005, they can continue to produce under Section 11A(7), against ‘€œreasonable royalty’€.  

Bearing these safeguards in mind, do you think India’€™s patent law amendment in 2005 was a fair process?

 

Yusuf Hamied: This was totally unfair. The government passed the 2005 patent bill without a debate and only on show of hands on an issue affecting the lives of millions of Indians. The problem is that after 2015 India will enter into a system of monopoly. We are against monopoly, not against valid patents. Today drug patents are being filed in India frivolously with no real novelty. Also same patents are being filed in multiple locations e.g. Mumbai, Chennai, Delhi, etc. so that they are approved somewhere.

 

GESPAM: In this connection, which is your fight today?

 

Yusuf Hamied: Our fight today is against frivolous patenting in India. Our fight also is that as WTO’€™s TRIPS rules allow a compulsory licensing system*, India should adopt this immediately for all drugs .  This was mandated in the Doha Declaration and was a system followed by Canada from 1969 to 1992 under the Canadian Bill S-91. In our opinion, this is the best legal way possible for India.

—————————————————————————————-

*Compulsory license (WTO rule): when a resource-limited country’s government allows the manufacture domestically or importing of copies of patented drugs at prices much cheaper than those imposed by the patent holder and without his consent. Both importing and exporting countries need to have enabling legislation in place (a corresponding compulsory license for export has to be issued by the exporting country)

 

GESPAM: In other terms?

 

Yusuf Hamied: India on intellectual property must decide its own destiny and not follow the dictates of the EU or the USA. India will want like minded countries to follow its example.

 

GESPAM: Thank you Dr. Hamied for your upfront vision.

News Link n. 19

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

 

 

News Link 19

-India Ratifies Nagoya Protocol On Biodiversity Access And Benefit-Sharing   http://www.ip-watch.org/2012/10/05/india-ratifies-nagoya-protocol-on-bio…

-ONG: la cooperazione è una priorità http://www.cooperazioneallosviluppo.esteri.it/pdgcs/italiano/news/viewne…

-Calls for adoption of Financial Transaction Tax as way forward for global development http://www.unitaid.eu/resources/news/releases/1001-the-globalization-of-…

-A $400,000 Drug and Why It Matters for Global Health  http://blogs.cgdev.org/globalhealth/2012/09/a-400000-drug-and-why-it-matters-for-global-health.php

-South-South Cooperation Comes to WIPO  http://ictsd.org/i/news/bridgesweekly/146488/

-BANGLADESH: Urbanization strains health care http://www.irinnews.org/Report/96466/BANGLADESH-Urbanization-strains-health-care

-US department of Commerce heavily redacts FOIA request regarding Thailand compulsory license http://keionline.org/node/1563

-General Statement of India to the WIPO General Assembly 2012 (raises concerns on public health and green technology) http://keionline.org/node/1558

-Land grabs Q&A | Oxfam International http://www.oxfam.org/en/grow/landgrabs/questions-answers

-Video of the Week: Turning the Tide on Global Hunger http://blog.usaid.gov/2012/10/video-of-the-week-turning-the-tide-on-glob…

-What the World’s Hungry Would Have Liked to Hear Last Night http://www.huffingtonpost.com/rep-mike-honda/what-the-worlds-hungry-wo_b…

-Nature Examines Future Of AMFm  http://globalhealth.kff.org/Daily-Reports/2012/October/03/GH-100312-AMFm-Future.aspx#.UG_pl3hN2n8.email

-Europe and global health: looking for a leader http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961…  

-MSF Launches Patent Opposition Database http://www.ip-watch.org/?p=23788&utm_source=post&utm_medium=email&utm_campaign=alerts

-External Financial Aid to Blood Transfusion Services in Sub-Saharan Africa: A Need for Reflection  http://dx.plos.org/10.1371/journal.pmed.1001309

-Who Sets the Global Health Research Agenda? The Challenge of Multi-Bi Financing http://dx.plos.org/10.1371/journal.pmed.1001312

-Scientists Debate Climate Change Impacts on Tropical Diseases http://www.ipsnews.net/2012/09/scientists-debate-climate-change-impacts-…

-Missing in Africa: How Obama Failed to Engage an Increasingly Important Continent  http://www.foreignaffairs.com/articles/138158/todd-moss/missing-in-africa

-Increased Cases Of Polio Reported In Nigeria  http://www.npr.org/2012/10/01/162071418/nigeria-reports-increase-in-polio-cases?sc=emaf

-UGANDA: Concern over allegations of misuse of Global Fund money http://www.irinnews.org/Report/96431/UGANDA-Concern-over-allegations-of-…

-On TPP Secrecy, US And Five Others Decline To Answer UN  http://www.ip-watch.org/?p=23764&utm_source=post&utm_medium=email&utm_campaign=alerts

-‘Some progress, but aid is still not transparent’ http://www.devex.com/en/news/79315/print

-A new entity for the negotiation of public procurement prices for  patented medicines in Mexico  http://www.who.int/bulletin/volumes/90/10/12-106633.pdf

-Public health round-up  http://www.who.int/bulletin/volumes/90/10/12-011012.pdf

-World Bank brass heads to Tokyo http://www.devex.com/en/news/79362/print

-Jim Yong Kim wants a more efficient, flexible World Bank http://www.devex.com/en/news/79378/print

-WHO Prequalifies A New Artemisinin-Based Combination Treatment (ACT) for Malaria. Artesunate-Mefloquine Fixed-Dose Combination (ASMQ FDC) to be rolled out throughout Asia http://www.dndi.org/press-releases/1275-asmqprequal.html

-EU seeks a new focus on resilience building http://www.devex.com/en/news/79365/print

 

 

Fondo Globale: più performance dalla ristrutturazione

Il Fondo Globale per la Lotta all’AIDS, Tubercolosi e Malaria (GF) è un partenariato fra governi, società civile, settore privato  e comunità afferenti, quale finanziatore internazionale di programmi per la prevenzione e terapia di HIV/AIDS, tubercolosi (TB) e malaria http://www.theglobalfund.org/en/

Spinto da un deficit finanziario, il Fondo ha avviato  un processo di ristrutturazione per  migliorare efficienza e prestazioni, fondato sulla ridistribuzione dello staff, su modelli flessibili di business e  allocazione delle risorse, e su nuovi approcci per semplificare e accelerare l’erogazione dei  â€œgrants”, incrementare le donazioni e perfezionare la capacità previsionale.

 

 

FONDO GLOBALE:  PIU’ PERFORMANCE  DALLA   RISTRUTTURAZIONE 

Daniele Dionisio*

 

Dal suo inizio nel 2002, il GF è ormai il principale finanziatore di iniziative di lotta ad AIDS, TB e malaria, con 23 miliardi di dollari disponibili per oltre 1.000 programmi  in 151 paesi. In risposta ad articolati programmi nazionali, il GF elargisce fondi vincolati all’impegno di risultati documentabili.

Oggi, i programmi sostenuti dal GF assicurano terapie per  HIV e TB a 3.6 milioni e 9.3 milioni di persone rispettivamente (incrementi del 21% dalla fine del 2010), e 270 milioni di zanzariere impregnate di insetticida per la prevenzione della malaria http://www.theglobalfund.org/en/about/diseases/

E, grazie ai programmi sostenuti dal GF, il numero dei casi di malaria in trattamento è aumentato a  260 milioni mentre I servizi per TB/HIV sono più che raddoppiati, le sedute di testing e  counselling per HIV sono salite a 210 milioni (una crescita del 43%), e il numero delle gravide con HIV sottoposte a ciclo completo di terapia antiretrovirale ha toccato il milione e mezzo  http:/ /www.theglobalfund.org/en/

Complessivamente, mentre quasi 9 milioni di vite sono state risparmiate grazie ai programmi del GF, l’istituzione punta oggi a destinare almeno 8 miliardi di dollari in “grants” per la lotta ad HIV, TB e malaria durante i prossimi 20 mesi, di cui 5 miliardi per la sola Africa  http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-07-05_General_Manager_Says_Global_Fund_Offers_Outstanding_Value_for_Money/

 

Drastica ristrutturazione

Ma queste prospettive potrebbero rivelarsi vuote ora che il GF è stretto da una crisi di bilancio per  rallentate o congelate donazioni in conseguenza della crisi economica globale http://www.nytimes.com/2012/02/02/opinion/why-the-global-fund-matters.ht…  

Urgono misure per mantenere il GF all’altezza del compito e delle attese, tanto più necessarie oggi che i donatori premono per migliore performance e maggiori ritorni dai loro investimenti. 

Coerentemente, il 23 Novembre 2011, il Board del GF decise di rifiutare nuove richieste di “grants” almeno sino al 2014, di finanziare solo programmi correnti a termine entro il 2014, e di ridurre ulteriormente il supporto economico ad alcuni paesi con più alto medio reddito. Il Board decise inoltre la nomina di un General Manager incaricato di traghettare il GF, attraverso una drastica ristrutturazione, verso migliori prestazioni  http://www.theglobalfund.org/en/mediacenter/newsreleases/2011-11-23_The_Global_Fund_adopts_new_strategy_to_save_10_million_lives_by_2016/   

www.devex.com/en/news/78725/print 

Così, sin dalla nomina di Gabriel Jaramillo lo scorso Febbraio, il GF si è lanciato in una “rivoluzione” interna per la gestione ottimizzata dei “grants”, l’aumento delle donazioni, e il rafforzamento delle capacità previsionali http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/gener…  

Il ridisegno include un approccio perfezionato alla gestione del rischio frode Paese, mediante stretta attenzione ai risultati delle investigazioni condotte dall’Ufficio dell’Ispettore Generale nel periodo 2005-2012 http://www.plusnews.org/Report/95941/HIV-AIDS-Straight-Talk-with-Mark-El…     http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-07-10_Glob…

Queste indagini hanno rivelato che almeno il  3% dei sovvenzionamenti sono stati spesi male o inappropriatamente, o rendicontati insufficientemente.  

Non stupiscono, perciò, le profonde modifiche associate alla globale ristrutturazione in corso al GF:

• taglio del 40% nel settore burocratico con riconversione del 75% dello staff alla gestione dei “grants”.

• implementazione delle raccomandazioni espresse da un panel per la supervisione dei controlli finanziari attuati dal GF e delle modalità di spesa dei fondi.

• costituzione di 3 unità per il controllo di 20 Paesi espressivi di oltre il 70% del carico globale di HIV, TB e malaria: due unità sono devolute all’Africa ed una all’Asia.

• “country-teams” per la gestione dei “grants” formati da membri  di differenti dipartimenti posti a  lavorare insieme.   

• apertura ai partners nelle commissioni del GF, per aumentare confronto e condivisione sugli investimenti da decidere. Oltre ai Paesi donatori, i partners includono, tra gli altri, la società civile, il settore privato, e istituzioni quali PEPFAR (U.S. President’s Emergency Plan to Fund AIDS Relief), PMI (President’s Malaria Initiative), RBM (Rollback Malaria), Stop TB.   

• riforma delle commissioni per HIV, TB e malaria per verificare mensilmente il progresso delle operazioni e correggere il tiro. 

• rafforzamento delle iniziative di prevenzione.

• sostituzione del “rounds-based grant system” con un nuovo modello di finanziamento mirato a interventi, Paesi e popolazioni più bisognosi e alla semplificazione e sveltimento del processo di erogazione  www.theglobalfund.org/en/blog/29479/    http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-14_Global_Fund_Adopts_New_Approach_to_Funding_Grants/.  In termini generali:

-I fondi saranno canalizzati a specifici gruppi di Paesi e ulteriormente suddivisi per ciascun Paese del gruppo in funzione delle criticità e priorità per la salute. 

– I richiedenti sottoporranno una nota di concetto più breve e snella di quanto sinora previsto e riceveranno sollecito feedback su eventuali modifiche utili al rapido conseguimento del “grant”.

-le richieste di “grant” non saranno più presentate a scadenze fisse, ma secondo tempistiche “nazionali”.

Perfezionamenti sono attesi al prossimo meeting del Board GF in novembre. In ogni caso:

• il GF continuerà a focalizzare sui Paesi a basso e a basso-medio reddito, e ad implementare circa il 40% dei “grants” tramite la società civile per il massimo effetto  in aree remote e nelle fasce a maggior rischio. Al riguardo, i Country Coordinating Mechanisms (CCMs) manterranno il ruolo di entità primaria responsabile in ciascun Paese della formulazione delle richieste e della sorveglianza sui “grants”. E ogni CCM embricherà con tutti gli addetti, società civile inclusa, per la produzione di robuste richieste al GF.

• il GF continuerà ad incoraggiare I percettori dei “grants” ad applicare le flessibilità previste dall’ Accordo TRIPS dell’ Organizzazione Mondiale del Commercio per consentire il più basso prezzo per farmaci di certificata  qualità http://www.worldtradelaw.net/uragreements/tripsagreement.pdf   .

• il GF implementerà la collaborazione con i ministeri per la salute allo scopo di rafforzare I sistemi nazionali, migliorare trasparenza e responsabilità, dare impulso ai canali locali di fornitura e approvvigionamento di farmaci, e supportare la formazione dei quadri medici e paramedici.

 

Di nuovo in business?

Dopo tutte le modifiche fatte o in divenire, è il GF pronto a riguadagnare business? Probabilmente sì se lo scorso Maggio il Board ha previsto la disponibilità di 1.6 miliardi di dollari per il periodo 2012-14 grazie a nuove donazioni, accelerati esborsi e rinuncia di alcuni governi a parte dei finanziamenti a favore delle nazioni a basso reddito http://www.hivhaven.com/2012-04-13-23-02-40/hiv-world-news/859-board-of-…

 Infatti, Paesi come India, Russia e Cina giocano oggi parti importanti sia come donatori al GF sia come beneficiari di “grants”.  

Purtroppo, il passo corrente difficilmente permetterà il conseguimento entro il 2015 degli obiettivi del Millennio per la salute. E appena il 41% dei Paesi sostenuti dal GF raggiungeranno il traguardo del taglio alla mortalità infantile e quelli connessi alla lotta ad AIDS, malaria e altre infezioni http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-07-05_Gene…

Ecco perchè il GF instancabilmente persegue opera di persuasione affinchè  Paesi a rapida crescita come Cina, India, Brasile, Indonesia, Messico, Corea del sud, Arabia Saudita e Turchia (accanto a donatori principali quali Francia, Giappone, Stati Uniti, Inghilterra Germania, e la Fondazione Gates) donino e incrementino considerevolmente i loro contributi http://www.ip-watch.org/2012/04/27/confidential-documents-show-tough-sta…   www.devex.com/en/news/78794/print  http://www.gatesfoundation.org/press-releases/pages/renewing-commitment-to-the-global-fund-120126.aspx

Ma, sono i Paesi avanzati pronti ad abbracciare oggi gli appelli del GF come un’opportunità di sicurezza nazionale e vantaggioso ritorno sui loro versamenti, piuttosto che come un pesante fardello in tempi di recessione economica? Questo farebbe davvero la differenza.

———————————————————————————————————————————————— 

*Daniele Dionisio è membro del Gruppo di Lavoro del Parlamento Europeo per Innovazione, Accesso ai Farmaci e Malattie della Povertà. E’ consigliere “Medicine per I Paesi in via di Sviluppo” per la Società Italiana di Malattie Infettive e Tropicali (SIMIT), e già direttore della Divisione di Malattie Infettive dell’Ospedale di Pistoia. Dal febbraio 2012, Dionisio è responsabile del progetto di ricerca  Geopolitics, Public Health and Access to Medicines (GESPAM). d.dionisio@tiscali.it

 

 

 

 

News Link n. 18

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

News  Link 18

Mai più malattie-silos. Interventi coordinati per malattie acute e croniche in Africa Sub-sahariana http://saluteinternazionale.info/2012/09/mai-piu-malattie-silos-interventi-coordinati-per-malattie-acute-e-croniche-in-africa-sub-sahariana/

-Cooperazione internazionale, requiem griffato http://comune-info.net/2012/09/requiem-griffato-per-la-cooperazione-internazionale/  

-Gauging national responses to undernutrition http://www.savethechildren.org.uk/node/2781

-Remarks at the Clinton Global Initiative  http://www.state.gov/secretary/rm/2012/09/198094.htm

-A Global Health Mystery: What’s Behind the US Government Position on AMFm?  http://blogs.cgdev.org/globalhealth/2012/09/a-global-health-mystery-whats-behind-the-us-government-position-on-amfm.php

-Will India Still Supply Cheap Drugs to the World? http://www.ipsnews.net/2012/09/will-india-still-supply-cheap-drugs-to-the-world/

-A $400,000 Drug and Why It Matters for Global Health http://blogs.cgdev.org/globalhealth/2012/09/a-400000-drug-and-why-it-matters-for-global-health.php

-UN general assembly: latest updates on UK aid http://www.dfid.gov.uk/News/Latest-news/2012/UN-General-Assembly/

-U.N. Women Demands End to Impunity for Wartime Rape and Violence  http://www.ipsnews.net/2012/09/u-n-women-demands-end-to-impunity-for-wartime-rape-and-violence/

-‘Reaching the Moon’ in Global Health http://blog.usaid.gov/2012/09/reaching-the-moon-in-global-health/

-HIV budgets come under pressure  http://mg.co.za/article/2012-09-21-00-hiv-budgets-come-under-pressure/

– News from HEALTH ECONOMICS AND HIV/AIDS RESEARCH DIVISION (HEARD)  http://www.heard.org.za/

-France wants FTT in place ‘before the end of the year’ http://www.euractiv.com/euro-finance/france-pushes-ftt-year-news-514989?utm_source=EurActiv%20Newsletter&utm_campaign=613bbabf78-newsletter_daily_update&utm_medium=email

-Q&A With Newly Appointed KIPO Commissioner  http://www.ip-watch.org/?p=23607&utm_source=post&utm_medium=email&utm_campaign=alerts

-African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and malaria response in Africa  http://www.au.int/en/sites/default/files/Shared_Res_Roadmap_Rev_F[1].pdf

-Mitt Romney fleshes out vision for US foreign aid  http://www.devex.com/en/news/79273/print

-Building on Ethiopia’s development progress  http://www.devex.com/en/news/79280/print

-COCA-COLA AND THE GLOBAL FUND ANNOUNCE PARTNERSHIP TO HELP BRING CRITICAL MEDICINES TO REMOTE REGIONS http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-25_Coca-cola_and_the_Global_Fund_Announce_Partnership_to_Help_Bring_Critical_Medicines_to_Remote_Regions/?mkt_tok=3RkMMJWWfF9wsRogv6jIZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAGSMB0dvycMRAVFZl5nQhdDOWN

-Agricultural Innovation Needed In Africa, With Farmers’ Participation, WTO Panellists Say  http://www.ip-watch.org/?p=23666&utm_source=post&utm_medium=email&utm_campaign=alerts

-Cipla goes through a quiet revolution  http://www.business-standard.com/india/news/cipla-goes-throughquiet-revolution/487619/

-Cipla looking to expand contraceptive pills business; in talks with International Planned Parenthood http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/pharmaceuticals/cipla-looking-to-expand-contraceptive-pills-business-in-talks-with-international-planned-parenthood/articleshow/16442289.cms

-Engaging China’s Innovators as Partners in Global Health  http://www.impatientoptimists.org/en/Posts/2012/09/Engaging-Chinas-Innovators-as-Partners-in-Global-Health?mkt_tok=3RkMMJWWfF9wsRogv63NZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAGT8B0dvycMRAVFZl5nQhdDOWN

-THE BIG PUSH: Join HuffPost, Global Fund In Fight Against HIV, Tuberculosis, Malaria  http://www.huffingtonpost.com/news/big-push/

-Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change  http://heapol.oxfordjournals.org/cgi/reprint/czs090?ijkey=xEo9aLNgJ3xHatJ&keytype=ref

-Starving for an Equitable Food System  http://www.ipsnews.net/2012/09/starving-for-an-equitable-food-system/

-US presidential candidates outline health policies  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961649-3/fulltext?rss=yes

 

News Link n. 17

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

News Link 17

-Cresce l’aspettativa di vita in America Latina http://www.cooperazioneallosviluppo.esteri.it/pdgcs/italiano/news/viewnews.asp?idx=5440

-TWAS changes name, but not its mission http://www.scidev.net/en/science-and-innovation-policy/south-south-cooperation/news/twas-changes-name-but-not-its-mission.html

-Subsidies Help Get Modern Malaria Drugs To Millions In Africa  http://www.npr.org/blogs/health/2012/09/18/161344518/subsidies-help-get-modern-malaria-drugs-to-millions-in-africa?sc=emaf

-Sanofi, TB Alliance Form Research Collaboration To Search For New Treatment Compounds  http://globalhealth.kff.org/Daily-Reports/2012/September/21/GH-092112-Sanofi-TB-Alliance.aspx#.UF2obGxpDHY.email

-U.N. Report On MDGs Shows Declining Aid; SG Ban Urges Increased Global Partnership  http://globalhealth.kff.org/Daily-Reports/2012/September/21/GH-092112-UN-MDG-Report.aspx#.UF2oP3Ap2n0.email

-Transparency – Still An Uphill Battle In The EU  http://www.ip-watch.org/?p=23521&utm_source=post&utm_medium=email&utm_campaign=alerts

-Aid at America’s front lines  http://www.devex.com/en/news/79169/print

-A Brief Look At Botswana’s New IP Law  http://www.ip-watch.org/?p=23486&utm_source=post&utm_medium=email&utm_campaign=alerts

-Nigeria still lags behind in improving maternal, newborn health http://www.ngrguardiannews.com/index.php?option=com_content&view=article&id=99186:nigeria-still-lags-behind-in-improving-maternal-newborn-health-&catid=93:science&Itemid=608  (see also GESPAM #www.equilibri.net/nuovo/articolo/nigerias-public-health-gains-and… )

-WHO Says Nigeria Not On Track To Turn Back Polio Despite Having Tools, Capacity http://globalhealth.kff.org/Daily-Reports/2012/September/12/GH-091212-Nigeria-Polio.aspx#.UFC-QHR9rfQ.email  (see also GESPAM #www.equilibri.net/nuovo/articolo/nigerias-public-health-gains-and… )

-Brazil and Chile pledge ongoing support to UNITAID http://www.unitaid.eu/resources-2/news/990-brazil-and-chile-pledge-ongoing-support-to-unitaid

-Studying the Crisis in Human Resources for Health from the Health Labour Market Perspective – African Development Bank http://www.afdb.org/en/news-and-events/article/studying-the-crisis-in-human-resources-for-health-from-the-health-labour-market-perspective-9728/?mkt_tok=3RkMMJWWfF9wsRoguKzIZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAHS8p0dvycMRAVFZl5nQhdDOWN#.UF2zlFy-XaE.email

-Blog Examines U.S. Presidential Candidates’ Foreign Policy, Science Stances With Respect To Global Health http://globalhealth.kff.org/Daily-Reports/2012/September/18/GH-091812-RR-Presidential-Candidates-Global-Health.aspx#.UFnFIAqSkAY.email

-India: Balancing Public And Private Interests In The Intellectual Property Regime  http://www.ip-watch.org/2012/09/18/india-balancing-public-and-private-interests-in-the-intellectual-property-regime/

-HIV vaccine ‘still a decade away’, say researchers http://www.scidev.net/en/health/news/hiv-vaccine-still-a-decade-away-say-researchers.html

-ACTA: Will It Ever Become A Valid International Treaty? http://www.ip-watch.org/2012/09/13/acta-will-it-ever-become-a-valid-international-treaty/

-Treatment Access Is Essential Component Of Fight Against NCDs  http://globalhealth.kff.org/Daily-Reports/2012/September/14/GH-091412-Opinion-NCD-Treatment.aspx#.UFhBM9RXV6Q.email

-GLOBAL FUND ADOPTS NEW APPROACH TO FUNDING GRANTS  http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-14_Global_Fund_Adopts_New_Approach_to_Funding_Grants/

 

 

 

 

 

 

 

 

 

 

 

Nigeria's Public Health: Gains and Challenges

Despite the collaborative efforts of both Nigerian Government, Donor Agencies and NGOs to provide an efficient and effective health care delivery in Nigeria, confronting problems render these efforts much less than desired. Some of these challenging problems include emerging and re-emerging health problems such as HIV/AIDS pandemic, inadequate payment of health workers salaries, poor quality of care, inequitable health care services, brain drain, and irrational appointment of health workers among others. The weight of these problems is further compounded by insufficient budget allocation, lack of strategic plan and preparedness for epidemics/pandemics

 

Nigeria’s Public Health: Gains and Challenges 

 

 

by Marycelin Baba*

and Babatunji Omotara 

 

Professors, College of Medical Sciences, University of Maiduguri, Nigeria


Nigeria, the most populous country in Africa with 140 million people, has more than 250 ethnic groups http://www.columbia-icap.org/wherewework/nigeria/index.html. The vast oil wealth accounts for 40% of the country’s gross domestic product. However, years of military rule, and mismanagement have limited the country’s economic growth and resulted in rising levels of poverty. The rating  by  the United Nations Human Poverty Index in 1999  revealed that  Nigeria  has been ranked  among  the poorest nations in the world.  Per capita income is estimated at $692 25th USD, with an estimated two-thirds of the population living in poverty. However, in addition to rebuilding the economic and political system of the country, the Nigerian government embarked upon rebuilding its heath infrastructure and since Nigeria operates a mixed economy, private providers of health care significantly contribute to health care delivery. Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country and is  structured such that, the Federal government’s role is mostly limited to coordinating the affairs of the University Teaching Hospitals, Federal Medical Centres (tertiary health care) while the state government manages the various general hospitals (secondary health care) and the local government focuses on dispensaries (primary health care) [1], (which are regulated by the federal government through National Primary Health Care Development Agency-NPHCDA). Although the recurrent expenditure on health has risen from Nigeria nairas 12.48 million in 1970 to 98.200 million in 2008 [2], health care system remains inefficient and plays a key role in the poverty status  of the country. Over the last two decades, Nigeria’s public health care system has deteriorated in large partly because of a lack of resources and a “brain drain”  syndrome of Nigerian doctors as well as skilled health workers to other countries. For instance, infant mortality rates have been deteriorating from 85 per 1000 live births in 1982, 87 in 1990, 93 in 1991 to 100 in 2003, according to the Nigeria Demographic and Health Survey, 2003. And in 2007, the Federal Ministry of Health reported 110 deaths per 1000 live births. Its under-five mortality rate is 197 deaths per 1000 live births, and HIV, malaria and diarrheal disease account for about a quarter of the deaths among adults http://www.psi.org/nigeria . In rural areas, access to even basic health care services is difficult.  According to the world development indicators, the life expectancy at birth in 2006 for male and female in Nigeria was 46 and 47 years, respectively [3].

Map of Nigeria showing the different states

National Health Insurance Scheme

In May 1999, the government created the National Health Insurance Scheme (NHIS), which encompasses government employees, the organized private and  informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. Health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers http://www.nigeria.alloexpat.com/nigeria_information/healthcare_nigeria.php   

However, there are few people who fall within the three instances. Moreover, for  the past two or more  decades,  many Donor agencies and  Non-Governmental Organizations (NGOs), usually in partnership with the States and Federal Ministries of Health, have played prominent roles in intervening in the provision of public health services to the teeming Nigerian population. Many of Donor Agencies and NGOs concentrated their activities  on  the prevention and control while few others  focus on therapeutics and management   of  many endemic, emerging and reemerging diseases. Below are some of the public health interventions.

HIV/AIDS 

Nigeria has 2.9 million people living with HIV/AIDS, the largest number in the world after India and South Africa. The HIV/AIDS pandemic, which has already left at least 930,000 children orphaned, and the high rates of maternal death and disability, are outstanding public health issues in Nigeria [4]. A high incidence of unsafe abortion is driven by legal restrictions and social stigma, while an extremely low rate of contraceptive use contributes to an estimated 1.4 million unintended pregnancies each year.  In response to the growing HIV/AIDS pandemic treatment, USAID/Nigeria provides antiretroviral drugs and services to eligible patients, as well as laboratory support for the diagnosis and monitoring of HIV-positive patients.  The treatment program features reduced target costs, cost-leveraging, and health care worker training by all implementing partners to harmonize and standardize treatment services. This program provides much-needed drugs to many Nigerians with HIV but can nowhere near address the growing HIV/AIDS infection rate.  The Nigerian government has set a 2010 goal of providing universal access to HIV prevention, care, and treatment. To this end, it has implemented a number of strategies to scale up HIV services, including a national counseling and testing program and increased collaboration with external donors and non-governmental organizations.

Mental Health

The majority of mental health services are provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. The formal centres often face competition from native herbalists and faith healing centres. The ratio of psychologists and social workers is 0.02 to 100,000 [5]. 

Malaria

Malaria remains the foremost killer disease in Nigeria. It accounts for over 25% of under-5 mortality, 30% childhood mortality and 11% maternal mortality (http://www.psi.org/nigeria , Federal Ministry of Health-FMOH, 2002). To address the importance of both malaria treatment and prevention, the Society for Family Health (SFH) malaria programming centers on Pre-Packaged Therapy (PPT) and Long Lasting Insecticide Treated Nets (LLINs). Recently, the Federal Ministry of Health has implemented the new treatment policy on malaria which includes the use of Artemisinine-based Combination Therapy (ACT) as the new first line drug for the treatment of uncomplicated malaria. A new brand of ACT for Children KidACT was developed and launched in 2008. The brand is heavily subsidized for affordability to poor and vulnerable Nigerians who bear the brunt of malaria. Like other NGOs, SFH is promoting the government policy and in addition distributes PermaNet which is a long-lasting insecticide-treated net. The nets are inexpensive and distribution is an easy way of preventing malaria and possibly other vector-borne diseases from burdening the health and economic well-being of Nigerians.

Reproductive Health

Despite considerable gains in the past decade, Nigeria’s reproductive health indicators are still very poor. Country-wide, the total fertility rate is 5.7 children per mother, with a contraceptive prevalence rate of less than 10%. Furthermore, these statistics mask wide regional variations—for example, the total fertility rate in the northwestern region is as high as 7.3, with a contraceptive prevalence rate of 3% http://www.pathfind.org/our-work/where-we-work/nigeria/ . Lack of sexual health information and services make young people vulnerable to sexually transmitted infections (STIs) and unintended pregnancy. However, Nigerian government both at Federal and State is working in collaboration with many organizations to improve adolescent reproductive and sexual health through advocacy and prevention programming.

Child Survival

Child survival in Nigeria is threatened by nutritional deficiencies and illnesses, particularly malaria, diarrhoeal diseases, acute respiratory infections (ARI), and vaccine preventable diseases (VPD), which account for the majority of morbidity and mortality in childhood. Other threats include high maternal morbidity and mortality.  Regarding child health, the country has adopted and implemented to a certain extent a number of major global initiatives affecting children, such as the Safe Motherhood Initiative and its follow-up Making Pregnancy Safer, Baby-Friendly Hospital Initiative (BFHI), and Integrated Management of Childhood Illness (IMCI). Others are Roll Back Malaria Initiative (RBM), Elimination of Iodine –Dependent Diabetes, Vitamin A Deficiency Control, and National Program on Immunization (NPI), the latter with a special emphasis on the eradication of poliomyelitis. Yet the impact of interventions in child survival to a large extent have not achieved as much as would have been expected despite the amount of funds and resources that have been put into these programs. For instance, Nigeria is still one the three countries of the world harboring and spreading the three serotypes of wild polio viruses to different parts of the world despite ongoing  intensive immunization activities  because of non-compliancy to polio vaccination.  It may be recalled that in 2003, there was a political propaganda that Polio vaccine contained infertility agents, spread HIV and was reported generally unsafe [6]. Although the safety of the polio vaccine was later proven beyond all reasonable doubt globally, and frantic efforts have been made to disabuse the minds of the people,  pockets of parents still refuse their wards/children to receive the vaccine. 

Tuberculosis control

Nigeria is ranked 4th among the 22 worst affected countries in the world and the first in Africa [7]. As such, about 460,000 new TB cases occur yearly in Nigeria (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf). 

Lagos state carries 8.4% of Nigeria’s TB burden and consistently has been responsible for about 11% of the cases of TB registered in Nigeria  (Lagos State Ministry of Health – www.lagosstateministryofhealth.com/programme_info.php?programme_id=13).

The State program is implementing the internationally recommended STOP TB Strategy. 

USAID/Nigeria implements its HIV/AIDS and TB activities under a comprehensive approach with other United States Government agencies, including the Centers for Disease Control and Prevention and the Department of Defense, which are all working as part of the President’s Emergency Plan for AIDS Relief (PEPFAR) (USAID, 2012 http://nigeria.usaid.gov/program/3). Activities are designed to reduce TB transmission, improve diagnosis, and manage multi-drug-resistant-TB cases, especially among HIV positive patients.  Routine HIV testing is also a priority in USAID’s TB Directly Observed Treatment Short-Course. The control and prevention of Tuberculosis in contemporary times has many faces and challenges. These, among others, include the impact of HIV/AIDS and the emergence of multi-drug resistant tuberculosis (MDR-TB). The HIV/AIDS pandemic is not only fuelling the burden of Tuberculosis but also poses great challenge to its diagnosis and management. The recorded HIV prevalence among TB cases in Nigeria is estimated at 27% (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf).

Leprosy control Program

It has been estimated that about 5,000 leprosy cases occur yearly (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf). By the 1940s and 50s Nigeria was ahead of many countries in its leprosy control activities.  There has been significant reduction in the registered prevalence of leprosy with some evidence of reduced transmission. This has been attributed to increased and sustained control activities resulting in the elimination of the disease as a public health problem at national level. However, there are still endemic pockets at the sub-national level. An issue of concern in leprosy control remains the rehabilitation of a large number of ex-leprosy patients who have been cured of leprosy but have disabilities. In collaboration with many NGOs, effective, integrated leprosy control programs in which both female and male patients are identified, diagnosed and treated in the early stages of leprosy by the health system are ongoing. These programs also work to prevent and reduce impairments associated with leprosy, and to provide appropriate rehabilitation and education and vocational training opportunities for persons affected by leprosy [8].

Regulation of pharmaceuticals

In 1989 legislation made effective a list of essential drugs. The regulation was also meant to limit the manufacture and import of fake or sub-standard drugs and to curtail false advertising. However, the section on essential drugs was later amended [9]. Drug quality is primarily controlled by the National Agency for Food and Drug Administration and Control (NAFDAC). Several major regulatory failures have produced international scandals:

• In 1993, adulterated paracetamol syrup entered into the health care system in Oyo and Benue State, the end result of was the death of 100 children. A year after the disaster, batches containing poisonous ethylene glycol, the major cause of the deaths, could still be purchased.

• In 1996, about 11 children died of contamination from an experimental trial of the drug trovafloxacin. The usually long delayed action of the government to prosecute the perpetrators is considered a tragedy on its own.

• In 2008-2009, at least 84 children died from a brand of contaminated teething medication http://www.rtbot.net/Health_in_Nigeria  

Geographic inequality

Health care in Nigeria is influenced by different local and regional factors that impact the quality or quantity present in one location. Due to the aforementioned, the health care system in Nigeria has shown spatial variation in terms of availability and quality of facilities in relation to need. However, this is largely as a result of the level of state and local government involvement and investment in health care programs and education. Also, the Nigerian ministry of health usually spends about 70% of its budget in urban areas where 30% of the population resides. It is assumed by some scholars that the health care service is inversely related to the need of patients. 

Emigration

Migration of health care personnel to other countries is a taxing and relevant issue in the health care system of the country. From a supply push factor, a resulting rise in exodus of health care nurses may be due to dramatic factors that make the work unbearable, and knowing and presenting changes to arrest the factors may stem the tide [10]. However, because a large number of nurses and doctors migrating abroad benefited from government funds for education, it poses a challenge to the patriotic identity of citizens and also the rate of return of federal funding of health care education. The state of health care in Nigeria has been worsened by a physician shortage as a consequence of severe ‘brain drain’. Many Nigerian doctors have emigrated to North America and Europe. In 2005, 2,392 Nigeria doctors were practicing in the US alone, in UK the number was 1,529. Retaining these expensively trained professionals has been identified as an urgent goal. Within the country, 70% of the population reside in rural areas yet many health professionals prefer urban cities for their practice leaving the rural poor void of adequate medical care.

Challenges

• As a multiethnic, cultural, and religious country, many Nigerians still attribute many health problems to witches, demons and other mythical beliefs. Therefore, even when health care facilities are available, affordable and accessible, many prefer seeking treatment from  untrained herbalist to orthodox health care institutions.

• Many health intervention programs fail because the decision and the implementation started from the top to the bottom. For example, people who never had fever are compelled to take paracetamol. The beliefs, attitudes and the behaviors of the community on a particular health problem usually is not sought before imposing the intervention strategy on the people.

• Professional conflict in the health sector is another canker worm that is killing the system. The claim of superiority of a particular health professional over others  has greatly impacted negatively to health care delivery in Nigeria.

• Persistent ‘brain drain’ is a ghost that is hunting efficient health care delivery in Nigeria.

• Lack of maintenance culture allows waste of resources in terms of equipment, finance and human resources. For instance, there is no need to procure sophisticated equipment if the operators are not properly trained to use and maintain such equipment. This negates one of the strategies of implementing Primary Health Care-Use of Appropriate Technology. Also after procuring the equipment, trained engineers  are not engaged to   regularly  service and repair  the equipment. Similarly employing experts without proper motivation and basic facility to work is effort in futility.

• Nepotism where health workers are employed based on sentiment (tribal or religious)  certainly impedes the efficiency of health care delivery in Nigeria

• Improper implementation of health policy or intervention strategy affects health care delivery adversely.

• Drug resistance, due to indiscriminate drug use and abuse, has been on the increase and  poses a serious threat to treatment efficacy

• Stigmatization associated with HIV/AIDS, Tuberculosis and Leprosy hinders early detection and control of spread.

• CORRUPTION is a plague that must be eradicated even before wild polio viruses if health care delivery in Nigeria must meet expected impact.

Conclusion

Despite the collaborative efforts of both Nigerian Government, Donor Agencies and NGOs to provide an efficient and effective health care delivery in Nigeria, confronting problems render these efforts much less than desired. Some of these challenging problems include emerging and re-emerging health problems such as HIV/AIDS pandemic, inadequate payment of health workers salaries, poor quality of care, inequitable health care services, brain drain, and irrational appointment of health workers among others. The weight of these problems is further compounded by insufficient budget allocation, lack of strategic plan and preparedness for epidemics/pandemics. 

References

1. “Federal Medical Centre Abeokuta: A Case Study in Hospital Management pp 1”. docstoc. Retrieved 13 June 2011

2. Bakare, A.S and Olubokun, S. (2011) “Health Care Expenditure and Economic Growth in Nigeria: An Empirical Study” Journal of Emerging Trends in Economics and Management. 

3. Nathaniel Umukoro (2011):Governance and Nigeria’s Public Health Care System: A Study of their Role in the Acceleration of Poverty Trap in the Niger Delta

4. Planned Parenthood (2012): Nigeria country program www.plannedparenthood.org/about-us/newsroom.htm

5. Oyedeji Ayonrinde, Oye Gureje, Rahmaan Lawal; ‘Psychiatric research in Nigeria: bridging tradition and modernisation’, The British Journal of Psychiatry (2004) 184: 536-538.

6. Guerrera M. 2007. Finish Polio: Evolutionary medicine principles and the eradication ofpolio in evolutionary medicine, Central Connecticut State University. Topics in Biology (Bio 490 / 540).

7. Dim CC, Dim NR, Morkve O. (2011):Tuberculosis: a review of current concepts and control programme in Nigeria. Niger J Med. 2011 Apr-Jun;20(2):200-6.

8. Canadian International Development Agency: Project Browser. Project profile for Leprosy Control project in Sokoto State (www.cida.gc.ca). 

9. National Drug Policy in Nigeria, O. Ransome Kuti. Journal of Public Health Policy > Vol. 13, No. 3 (Autumn, 1992), pp. 367-373

10. Clark D A, Paul F. Clark, James B. Stewart; The Globalization of the Labour Market for Health-Care Professionals. International Labour Review, Vol. 145, 2006

 

*Corresponding author: Professor, Department of Medical Laboratory Science and Director, WHO National /ITD Laboratory, University of Maiduguri, Maiduguri Borno State, NIGERIA marycelinb@yahoo.com  

 

 

 

 

News Link n. 16

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

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-APEC Leaders Discuss Food Security  http://globalhealth.kff.org/Daily-Reports/2012/September/10/GH-091012-APEC-Food-Security.aspx#.UE9Geo3Qr2A.email

-Call to Action: EU Leadership on Global Health R&D Convention | msfaccess.org  http://www.msfaccess.org/content/call-action-eu-leadership-global-health-rd-convention#.UE9F4YCWLcM.email

-Members of Congress and Governors backing PhRMA/BIO, calling for 12 years data protection for biologic drugs in TPP http://keionline.org/node/1544

-Data on Chinese patent applications and grants suggests growing gap between political rhetoric and current realities http://keionline.org/node/1543

-TPP IP text would restore right to sue surgeons and other medical professionals for patent infringement. Why?  http://keionline.org/node/1514

-IRIN Africa | HEALTH: Global South leads the way towards universal healthcare coverage | Ghana | Kenya http://www.irinnews.org/Report/96280/HEALTH-Global-South-leads-the-way-t…

-Delhi High Court dismisses Roche’s patent suit against Cipla – Economic Times http://economictimes.indiatimes.com/news/news-by-industry/healthcare/bio…

-A ‘STEP FORWARD’ FOR A HUMANITARIAN PLAN IN SUDAN?  http://www.devex.com/en/news/blogs/a-step-forward-in-aid-access-in-khartoum

-An Alternative Framework for Analyzing Financial Protection in Health   http://dx.plos.org/10.1371/journal.pmed.1001294

-Global Fund Must Resolve Leadership, Governance Issues By End Of 2012 http://globalhealth.kff.org/Daily-Reports/2012/September/07/GH-090712-Op…

-U.S. Commitment To Foreign Assistance, Global Health To Rise Or Fall With Presidential Election Outcome http://globalhealth.kff.org/Daily-Reports/2012/September/05/GH-090512-Op…

-Al Jazeera Program Interviews Bill And Melinda Gates  http://globalhealth.kff.org/Daily-Reports/2012/September/04/GH-090412-Gates-Al-Jazeera.aspx#.UEc1LPUIaqU.email

-VOA Examines Global Polio Eradication Efforts http://globalhealth.kff.org/Daily-Reports/2012/September/04/GH-090412-Gl…

-Barroso: what EU federation would mean for aid, development  www.devex.com/en/news/79116/print