[Ip-health] High Drug Prices Hamper Drug-Resistant TB Treatment
Riaz K Tayob
riaz.tayob at gmail.com
Sat Jun 18 15:21:18 PDT 2011
High Drug Prices Hamper Drug-Resistant TB Treatment
By Kristin Palitza
Prices for DR-TB drugs remain too high worldwide. / Credit:Kristin
Prices for DR-TB drugs remain too high worldwide.
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CAPE TOWN , Jun 17, 2011 (IPS) - Access to treatment for drug-resistant
tuberculosis (DR-TB) remains compromised, especially in developing
countries, because too few pharmaceutical companies manufacture
quality-assured drugs. Lack of competition has led to skyrocketing
prices and this means that public health budgets are quickly spent.
Over the last decade, roughly five million people developed DR-TB
worldwide. But an "appallingly low number" -- less than one percent --
had access to appropriate treatment, according to medical humanitarian
aid organisation Médecins Sans Frontières (MSF). About 1.5 million
people died as a result.
The situation is particularly severe in countries with high numbers of
HIV infections, especially where access to antiretroviral treatment is
patchy and HIV-TB co-infections are common. South Africa is one of them.
One of the key access barriers to treatment is the limited availability
and high cost of quality-assured medicines to treat DR-TB. For some
medicines, there is only one quality-assured manufacturer or a single
source of the active pharmaceutical ingredient required to produce the drug.
"There has been little investment in research and development of TB
drugs, because TB is seen as a disease of the poor and therefore not a
lucrative market for the pharmaceutical industry," explains MSF South
Africa medical coordinator Dr. Eric Goemaere.
This has led to extremely high prices for most DR-TB medications. One
patient's treatment can thus cost up to 9,000 dollars, says MSF --
nearly 475 times more than the 19-dollar treatment course for
Alarmingly, prices have increased even further in recent years. "While
drug prices usually go down with increased demand, prices for DR-TB
drugs have gone up, some by 600 to 900 percent. That's simply wrong,"
says Goemaere, who heads a HIV and TB treatment project in South
Africa's third-biggest township Khayelitsha.
*The exorbitant pricing is less an issue of patents, he explains, but
rather caused by the lack of a working mechanism to control prices as
well as the termination of subsidies that kept prices lower. High prices
are also reflection of insufficient market competition. Only six
products (for five different DR-TB drugs) have been prequalified by WHO,
and only four sources (for two different medicines) are recommended for
purchase in 2011.*
The World Health Organisation (WHO) responded to the growing need for
affordable DR-TB drugs in 2000 by creating the Green Light Committee
(GLC), which reviews governmental and non-governmental treatment
projects and 'green-lights' them for access quality-assured drugs at
Although the GLC is theoretically a helpful initiative, its highly
bureaucratic application process has prevented many treatment programmes
around the world to become part of it. In 2010, only 12,000 patients
were enrolled in GLC-approved treatment programmes, compared to 440,000
new cases and 150,000 deaths, according to MSF. Only 13 percent of the
estimated DR-TB drug market is currently channelled through the WHO
Global Drug Facility.
"The WHO has a responsibility in this disaster," believes Goemaere. He
says it took years of pressure from NGOs like MSF until the WHO agreed
to establish the GLC. But the commission's strict conditions and
long-winded administration processes prevent many health care providers
from benefiting from it.
"The GLC offers little incentive because its quality approval process is
far too bureaucratic and centralised. The rules are self-limiting,
making the WHO a gatekeeper instead of offering support," says Goemaere.
WHO medical officer for TB in South Africa, Dr. Kalpesh Rahevar,
acknowledges the GLC's administrative barriers, but points out that the
WHO has started a process to reform the GLC in early 2010. One of the
planned modifications is to make participation in the GLC easier, he
"We are looking at simplifying the GLC application process", says
Rahevar. "The WHO is also planning to broaden its mandate to monitor TB
programmes worldwide, not only those participating in the GLC." But
until then, hundreds of NGOs and health departments have to continue
purchasing DR-TB drugs from pharmaceutical companies that may offer
uncertain quality and substantially higher prices. The South African
Department of Health (DoH) belongs to this group. Instead of applying
for GLC membership, the DoH purchases drugs at fixed prices directly
from South African subsidiaries of American drug manufacturers Sanofi
Aventis and Sandoz.
According to DoH acting director for TB advocacy, communications and
social mobilisation, Garvon Molefe, the health department decided to
purchase drugs exclusively locally, even if at a higher price, to
benefit the country's economy.
"The reason why the DoH is not following the GLC initiative is because,
as South Africa is already facing alarming rates of unemployment, the
DoH doesn't want to disadvantage pharmaceutical companies (that employ
South Africans) by procuring TB treatment from other countries," he told
The DoH currently pays 4,400 dollars for the DR-TB treatment of one
patient. Goemaere says, MSF, through the GLC, pays about 30 percent less
for those drugs. That means that the humanitarian organisation can treat
many more patients for the same amount of money.
Political will -- or lack thereof -- seems to be another deciding
factors for the success of the GLC. "Applying to the GLC is the
political decision of each government," says Rahevar. "As WHO advisor to
the South African government, I can only advise and encourage, not
impose." He is hoping the GLC reform measures, which he says will be
announced within the next couple of months, will change the South
African government's mind.
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