ACT UP PARIS
Contact: Gaëlle Krikorian: + 33 6 09 17 70 55/ + 33 1 49 29 44 75
15 MAY 2002
Accelerating "Access" serves pharmaceutical companies while corrupting health organizations.
May 11, 2002 marked the second anniversary of the "Accelerating Access" initiative, launched by UNAIDS in a partnership with several UN agencies (WHO, FNUAP, UNICEF and the World Bank) and five pharmaceutical companies (Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo SmithKline, Merck & Co., and Hoffman-La Roche).
Since the end of 2001 this initiative has been under the responsibility of the WHO.
According to the UN, Accelerating Access means "a redoubling of the efforts of the cosponsors and the UNAIDS Secretariat to finance health care for people living with HIV/AIDS." This initiative was supposed to provide developing countries with access to medicine at the lowest possible prices, as well as provide technical support for the implementation of national access programs for antiretroviral treatment.
Two years later, people with aids examine the results. Accelerating Access serves, above all, pharmaceutical companies who profit from a partnership with international institutions while using the program to maintain their monopolies and to limit any reductions in price.
According to the most optimistic of estimates,
after two years Accelerating Access has only resulted in getting
an additional 0.1% of people with aids on treatment (indeed,
WHO rates at 10 million the number of people requiring immediate
antiretroviral therapy). Further, many of these treatments are
actually based dangerous drug regimens - such as single-drug therapy,
which has been banned from Northern medical practice for the last
Why such bad results?
Because the pharmaceutical companies involved have mostly been busy negotiating agreements with developing countries that allow them to control the supply of ARVs and to stave off competition from generic makers. The companies' core strategy revolves around limiting price drops and imposing access restriction on developing countries.
Accelerating Access fails to offer any real progress in terms of price in the sense that because the proprietary pharmaceutical corporations have been content to just align their prices with those of the generics producers. But more significantly, their philanthropic discounts have systematically come with strings attached: discounts restricted to very specific drugs, quantities, countries, distribution sectors and medical settings, as well as tied to government commitments to increasing patent protection and not resorting to generic competition.
Far different from commercial, blanket price reductions, AAI discounts are philanthropic actions revolving around the signing of an agreement between each company and the health ministry, to set convoluted conditions under which the discounts are actually accessible. Governments are usually required by the companies to keep these agreements entirely secret to the point of leaving all media communication to the company.
Moreover, AAI has completely failed to create significant price discounts for the drugs that lack a generic competitor yet. For example, through Accelerating Access Swiss drug giant Roche continues to sell its leading protease inhibitor Viracept® for an astounding USD 3139 a year.
Because the WHO and UNAIDS have not provided any assistance to countries to enable them to launch or expand treatment access programs. Many countries have taken on the Accelerating Access offer and still have to receive, two years later, any technical assistance from WHO or UNAIDS, or to show a single treatment access program for their trouble (Togo, Congo, Burkina Faso, etc.). Also, no specific aid has been put in place by these agencies to ensure the quality and sustainability of AAI-mediated ARV provision.
Because the WHO and UNAIDS have proved unable to ensure that negotiations be transparent, respect basic ethical standards and eventually achieve results.
The Secretariats have provided no guidelines for relations between companies and interested countries. In each case so far, pharmaceutical companies have taken their negotiations directly to the government or to the providers of health services, country by country, each in an independent way, entirely bypassing any supervision by the UN agencies.
This means that the Accelerating Access label is attached toand serves as a guarantee label fornegotiations that the WHO and UNAIDS have no power over and cannot even really follow up on.
Because by only including proprietary pharmaceutical companies, United Nations agencies have pushed aside the generic manufacturers and trapped developing countries in an unequal negotiation system. Generic competition, the only sustainable way to get low prices, has been pushed aside in favor of subjecting countries to the goodwill and demands of multinationals.
Countless negative consequences
More than just bad results in terms of medicines provided and lives saved, AAI is causing numerous damages that the WHO and UNAIDS have not only been incapable of stopping but that have accepted to cover for. These damages are: instrumentalisation of international health institutions, discrimination between recipient countries, market fixing, short-circuiting of the national drug circulation systems, and spurring irrational dangerous prescriptions.
1. The WHO label, marketing added value for pharmaceutical companies
For two years Roche Pharmaceuticals has reaped PR benefits from its participation in the Accelerating Access Initiative supposedly facilitating access to medicines in developing countries, while in fact Roche has so far refused to grant price discounts on its products. There are no generic competitors for Roche's HIV products, which means it is not forced to reduce its prices.
At the end of April, Mr Nabarro, Executive Director of the WHO, even acknowledged that he "had problems with some companies" and "wished Roche would start to play by the rules" as soon as possible.
2. Accelerating Access: a tool that discriminates among poor countries
On top of concerning not multilateral but bilateral negotiations (one country at a time, one drug at a time, precluding regional, purchasing-power negotiations), AAI discriminates between developing countries in terms of the extent of price of price discounts arrived at through the "negotiations".
Thus in poor countries considered "too rich", such as Morocco or Thailand, drug firms refuse to grant the same reductions as in sub-Saharan Africa. Yet no one ignores that in Morocco and in Thailand people are already poor enough that every dollar added to the price deprives many of medicines without they die. Further, pharmaceutical companies feel free to threaten countries with calling the discount deals off as soon as they suspect that the government might be buying from generic producers (Thailand).
3. Captive markets
Following their defeat in the South Africa court case of April 2001, drug companies stepped up their efforts to recruit developing countries into the Accelerating Access Initiative. Indeed, through AAI they have been able to impose themselves and their vision of drug competition on these countries.
The consequences are plain to see. Despite immediate advantages brought by generic competition (blanket prices without stings attached, lower prices), very few countries have dared to turn to generics. In Burkina Faso, the International Summit on Access to Generic HIV/AIDS Medicines, which should have taken place in the capital from May 3-7 2001, was canceled after the minister of health signed an price discount accord with some of the pharmaceutical companies.
Indeed, through Accelerating Access companies manage to force countries to sign confidential agreements that aim to prevent generic competition even where they do not hold exclusive intellectual property rights. These include intellectual property provisions that go further than what is mandated by WTO agreements ("TRIPS+") as well as commitments of renewed purchase over several years.
Thus, even countries which have no legislation on intellectual property are forced to buy all their antiretrovirals from proprietary multinationals
In certain countries, in order to access cheaper medicines, people with aids finally have to resort to NGO importation of generic medicines (MSF in Cameroon, ANSS in Burundi, etc) rather than the governments. The control of medicine circulation, which should have been centralized by the government and which Accelerating Access is supposed to guarantee, is thus voided.
4. Corrupting national procurement networks
Since it was created, Accelerating Access has operated in parallel to national health care systems. Right now, this initiative bypasses official procurement systems.
For years WHO has been promoting the creation of central purchasing stores on a national scale, working on the basis of transparent public tender. Today, however, WHO supports the signing of drug purchase contracts between Ministries of Health and pharmaceutical firms that create a system of procurement parallel to that of National Medical Stores, a lack of transparency with regards to prices, and the impossibility of competition.
The pharmaceutical industry thus bypasses public procurement systems, increases its power over a few officials or doctors as well the opportunities for corruption by setting up a totally opaque business.
3. Irrational and Dangerous prescriptions and drug uses
Since Accelerating Access only includes a reduced number of pharmaceutical companies and price discounts only apply to some of their HIV/AIDS products, this means that the entire therapeutic palette necessary to treat aids patients is in effect not available. Even though one of the prerequisites for participation in Accelerating Access is supposed to be the guarantee of a "secure, efficient system of distribution," in reality this initiative has caused for prescriptions to be based not on medicine but on which drug-makers have made a discount deal with the government. What follows are prescriptions for therapeutic combinations that are inefficient and even dangerous in terms of their side effects, all under the name of corporate clinical trials or philanthropic access programs.
Certain companies, playing on their influence over doctors, push the prescription of absurd drug combinations. In Kenya, Merck & Co. promote the combination of both their HIV products, indinavir (Crixivan®) and efavirenz (Stocrin®) - not only is the combination one drug short (three is the norm) but, efavirenz being adverse to indinavir, patients need more indinavir, which has serious dose-dependent renal toxicity In South Africa, BMS continues to promote the prescription of its three medicines ddI, d4T and hydroxyurea, a combination that researchers have shown to be potentially dangerous.
Appendix I: List of countries involved in Accelerating Access (March 22, 2002)
Countries having signed an agreement with pharmaceutical companies: Benin, Burkina Faso, Burundi, Cameroon, Congo, Cote d'Ivoire, Gabon, Mali, Morocco, Rwanda, Senegal, Uganda, Barbados, Chile, Honduras, Jamaica, Trinidad and Tobago, Romania.
Countries in the process of negotiation as of last March: Botswana, Republic of Central Africa, Chad, Ethiopia, Gambia, Guinea, Kenya, Malawi, Nigeria, Swaziland, Togo, Tunisia, Guatemala, El Salvador, Mexico, Venezuela, Ukraine, Vietnam.
Accelerating Access is a striking example of a dishonest compromise between international institutions and the pharmaceutical industry at the expense of people and public health.
The WHO must not allow developing countries to enter into agreements with private companies unless they can guarantee transparent negotiations that respect basic ethical standards and eventually provide results.
The WHO must change its strategy immediately.
For the price of medicines to really be affordable, several measures must be taken:
* Development of international and regional bulk procurement of medicine, on a large scale that will allow for the best price negotiations;
* the reinforcement of capacities and technology transfer in order to promote local drug production in developing countries;
* compulsory licensing and parallel imports;
* competition between proprietary medicines and generics.
Access to generics is a major issue for developing countries and the only long-term option for access to the largest and most complete variety of treatments at the lowest prices.
The WHO must provide countries with the most complete information possible on the sources of medicines, naturally and necessarily including generic producers.
It is particularly necessary for public central buying offices and any other potential users to have access to unbiased information on the prices of ARVs.
The WHO must support the development of bulk purchase of medicines for countries at the lowest price, as well as local production.
The WHO must provide countries that wish to set up treatment access programs with genuine technical assistance.
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