[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.

Credit:Kristin Palitza/IPS
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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 
drug-sensitive TB.

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 
reduced prices.

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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