[Ip-health] Support South Africa at UN – we need better & affordable TB medicines!

Lotti Rutter lotti.rutter at mail.tac.org.za
Sun Aug 19 00:29:37 PDT 2018

*Support South Africa at UN – we need better & affordable TB medicines!*

*Statement at:
*Opinion piece at:

*Johannesburg, 18 August 2018* – Negotiations are currently underway in New
York for a United Nations (UN) political declaration on tuberculosis. In
order to have a meaningful impact on the TB epidemic, members states must
make concrete commitments to address the global TB crisis – a crisis that
kills more than 1.5 million people globally every year and that remains
South Africa’s leading reported cause of death.

On 26 September 2018, UN member states will come together in New York to
ratify this political declaration, yet current drafts of the declaration
are woefully inadequate and undermine efforts to ensure people living with
TB have access to better and more affordable TB medicines, vaccines and
diagnostics. While current drafts contain some good rhetoric, hardly any
concrete commitments are made. Such a lack of concrete commitments will
render the declaration and the process around it toothless.

While the South African government is leading the way in attempting to
redraft and improve the declaration, pressure is mounting against them,
particularly from wealthy countries. “South Africa has broken the silence
and is demanding that the declaration ensures we are able to access
medicines – but the United States and many other countries are resisting.
We urge our government to stay strong in the face of this pressure –
pressure that you have faced before and will face again. You are doing the
right thing!” says TAC National Chairperson Sibongile Tshabalala.

“For this UN process to have any meaning for the people in South African
townships, our hard-won rights to access medicines must be enshrined in the
main text of this declaration. These rights are not just a legacy from the
last two decades of people with HIV fighting for their lives as part of a
larger access to medicines movement, but also a lifeline for people who
will need affordable medicines, vaccines and diagnostics tomorrow. What use
are new tuberculosis medicines if high prices mean people cannot access
them? Our lives must be placed ahead of the greed of big pharma, especially
given that most big pharma companies have abandoned TB research altogether.”

There are a number of legal safeguards allowed under international law that
protect the right to access healthcare and medicines. However, these rights
 are missing from the current drafts of the declaration. With new medicines
for drug resistant TB (DR-TB) becoming available for the first time in over
50 years, using these safeguards will be vital for the future of treatment
in South Africa, and across the world. It will be imperative to address
patent barriers to lower prices and scale up treatment access, as was the
case with HIV treatment in the early 2000s.

Currently medicines are often priced out of reach of those who need them.
Bedaquiline for example, is a safer and far less painful alternative to the
current injectable medicines that cause hearing loss in nearly half of
those who take them. Importantly it also saves many more lives. In South
Africa, bedaquiline is priced at USD 400 per course, and in most other
countries it costs much more, as much as USD 30,000 in certain places. Yet,
researchers estimate a six-month course can be profitably produced for less
than USD 100.

Excessive medicine pricing is nothing new to South Africa – a country that
faces one of the highest global burdens of DR-TB, with over 19,000 cases
diagnosed in 2016. For several years, many people with DR-TB were unable to
benefit from the drug linezolid. While it was under patent it was priced at
over ZAR 700 (USD 47) per 600mg tablet, while generics in India were
available at a fraction of the cost at ZAR 25 (USD 2). People who say
medicine pricing is not an issue in TB are spitting in the faces of people
who needed linezolid and could not access it, and turning their backs on
people who need the newer drug bedaquiline, but cannot access it due to
high prices.

Using these public health safeguards is nothing new or controversial. UN
member states have repeatedly reaffirmed these rights and committed to
protecting and using these so called “TRIPS flexibilities” in the Political
Declarations emerging from the UN High Level Meetings on HIV in 2006, 2011
and 2016, the Political Declaration signed at the UN High Level Meeting on
Non-Communicable Diseases in 2011, the UN General Assembly Resolution on
Global Health and Foreign Policy in 2014, and in the Sustainable
Development Goals (SDG3b) signed in 2015. The UN High Level Panel on Access
to Medicines in 2016 recommended that all WTO members “should commit
themselves, at the highest political levels, to respect the letter and
spirit of the Doha Declaration,” and noted that when governments make “full
use of the flexibilities in the TRIPS Agreement, they can protect and
advance public health objectives.”

For the United States to attempt to roll back these rights in a TB
declaration, a declaration on a disease that impacts mostly poor people of
all things, is deeply cynical.

“Why is language that has been in every HIV declaration for the past two
decades and is included in the sustainable development goals not been
included in the TB High Level Meeting declaration?” asks Tshabalala. “Why
is the United States bullying our governments to take this language out?
Why is the EU silently supporting them? Do these countries really not care
whether we live or die? Whether we get TB treatment or not? Or is your only
real concern that we will get on planes and bring TB to your countries? Is
the UN declaration nothing more than PR for them?”

In addition to excessive pricing, TB is also typical of a wider crisis of
underinvestment by both pharmaceutical companies and governments in
diseases mainly impacting poor people. As it stands the global patent
regime skews the incentive to research and develop new medicines and
medical tools to where the most money can be made. Current drafts of the
declaration continue to include problematic wording around this that
wrongly suggests patents incentivise R&D – a myth repeatedly peddled by the
pharmaceutical industry, and repeatedly proven to be wrong, particularly in
relation to TB.

“The entire world only invests around USD 0.7 billion on TB medicine
research every year – a third of the USD 2 billion that the World Health
Organisation estimates is needed. This means in many cases as people with
TB we are stuck with older treatments that are painful and have low success
rates. There is urgent need for new medicines, diagnostics and vaccines. We
need a new system of financing innovation that will prioritise R&D based on
need not greed. This is something the declaration should be calling for.
Countries negotiating must remember that prioritising the health of your
people can be done without harming future innovation. We have just such an
example of an innovative drug development framework in the Life Prize,
again, with the exception of South Africa, governments have not been
willing to back this project,” said Umunyana Rugege, Deputy Director of

We urge the South African government to stay strong in the face of
political pressure and to ensure the inclusion of a strong commitment on
the use of TRIPS flexibilities in the main operative text of the TB
declaration. This must include commitments to a) use to the full extent of
TRIPS flexibilities to ensure access to medicines, and b) to ensure that
intellectual property provisions in trade agreements do not undermine the
Doha Declaration.

We further call on all other governments, and particularly other
high-TB-burden countries such as India and China, to support South Africa’s
proposals on the use of TRIPS flexibilities and proposals on alternative
models of R&D. We found incredible international solidarity on these issues
in 2001, if countries are serious about TB we will again find solidarity on
this in 2018.

We are not alone in this. Civil society groups from across the world have
made similar demands. It is time governments listen. Our people are dying
of TB – governments must now show they are serious.

*For more information contact:*

Lotti Rutter | lotti.rutter at tac.org.za | +27 81 818 8493

*Global solidarity:*

Below are a list of statements and actions that have taken place so far in
support of the inclusion of TRIPS flexibility language in the declaration:

1. Global Coalition of TB Activists and Treatment Action Campaign
intervention at AIDS2018 panel on TB:





2. Indian civil society groups letter to their government:


3. European AIDS Treatment Group (EATG) open letter calling for the EU to
support developing countries and include TRIPS flexibilities in the


4. AIDS Kampagne Letter to the German government:


e_-_hlm_-_july_2018_-_english.pdf /

5. Media report on US Groups letter to US government:


6. Asia Pacific Network of People living with HIV/AIDS (APN+) statement and
briefing note:



7. Communiqué issued from delegates from 11 countries convened under the
umbrella of the Nairobi Strategy on Tuberculosis and Human Rights:


*Lotti Rutter*
Advocacy & Campaign Manager

Treatment Action Campaign
Tel: 011 100 4721
Cell: 072 225 9675 / 081 818 8493
Skype: lotti.rutter
Twitter: @TAC @FixPatentLaw @lottirutter

*www.tac.org.za <http://www.tac.org.za/>*

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