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Africa/Global: Health Challenges & Threats

AfricaFocus Bulletin
October 13, 2015 (151013)
(Reposted from sources cited below)

Editor's Note

Last week was the first week since March 2014 that no new cases of Ebola were reported in West Africa. And late last month the World Health Organization announced official guidelines for beginning antiretroviral therapy for all persons infected with HIV even before they show symptoms of AIDS. Fully eradicating either disease and building sustainable health system remain formidable challenges, however. At the same time, U.S. policy to promote greater protection for large pharmaceutical companies in trade negotiations poses a still rising threat to global efforts to guarantee the universal right to health.

This AfricaFocus Bulletin contains one short article on the threat to health in the least developed countries from hard-line U.S. policy on protection for pharmaceutical companies, followed by links with short excerpts from other recent articles on Ebola, the cost of medicine and the current dysfunctional pharmaceutical system, HIV/AIDS, and a promising advance in medical technology providing cost-effective blood auto-transfusion in developing countries.

While progress has been made both on the long-term pandemic HIV/AIDS and the West African Ebola epidemic more recently, neither battle is completely won. Neither have the economic, personal, and societal damages been repaired, nor the world's health systems prepared for new epidemics, nor the necessary resources invested to guarantee the universal right to health.

For previous AfricaFocus Bulletins on health and related issues, visit

The WHO Ebola Situation Report is available at

Updates on AIDS are available at

Frequent updates on the status of access to medicines are available on the MSF / Doctors Without Borders website on this issue at

++++++++++++++++++++++end editor's note+++++++++++++++++

LDCs be damned: USTR and Big Pharma seeks to eviscerate Least Developed Countries' insulation from pharmaceutical monopolies

Professor Brook K. Baker, Health GAP and Northeastern U. School of Law

HealthGap blog, October 12, 2015 - Direct URL:

Professor Brook K. Baker, Health GAP (Global Access Project) & Northeastern U. School of Law, Program on Human Rights and the Global Economy
Honorary Research Fellow, Faculty of Law, Univ. of KwaZulu Natal, SA

In November of 2001, at the height of the global AIDS pandemic, every WTO member country in the world, including the United States, voted unanimously in the Doha Declaration on the TRIPS Agreement and Public Health that WTO Least Developed Countries members should be granted an unconditional extension of any obligation to grant or enforce patents, data protections, or exclusive marketing rights on pharmaceutical products. These countries desperately needed access to affordable generic medicines and freedom from the pillage of Big Pharma's monopoly pricing. This sensible and humane transition policy was confirmed by votes of the WTO TRIPS Council and General Council in 2002.

Fast forward to 2015, and LDCs are again seeking an extension of that same no-pharmaceutical-monopolies policy, which expires on January 1, 2016. Their request has reportedly received approval in nearly every capital of the world - except Washington D.C. (with some weakening opposition from Australia, Canada, and Switzerland). Nothing in the plight of least developed countries has changed - they remain desperately poor, they continue to lead the world in negative health statistics and early death, and they continue to struggle with development challenges and inadequate capacity in their industrial, technological, and administrative sectors. More to the point, they continue to need access to affordable medicines, and, if possible, new manufacturing capacity and expertise to produce at least some medicines on their own.

What the LDCs seek is simple: rather than another time limited extension (even a relatively long 15 year one like the one they first got), is an extension that lasts as long as they remain an LDC. Once an LDC member transitions to lower-middle income status, its obligation to begin to process, grant, and enforce patents and data protections on medicines would change. But in the meantime, countries that were still LDCs could import cheaper generics legally from abroad or manufacture them locally with no intellectual property restrictions whatsoever.

What does the United States Trade Representative want - what pound of flesh is it seeking from LDCs for an further extension that is guaranteed to them by paragraph 7 of the Doha Declaration and by Article 66.1 of the TRIPS Agreement? After all those documents state that initial TRIPS transition periods, like LDCs had for pharmaceuticals, were granted without prejudice to further extensions and that WTO member "shall, upon duly motivated request by a least-developed country Member, accord extensions [of LDC TRIPS-compliance transition periods]." In this context, "shall" means "must," no "ifs," "ands," or "buts."

Instead of acceding to these clear TRIPS mandates, the USTR is unwilling to discuss an extension for as long as an LDC remains an LDC and instead is demanding a more miserly, time-limited extension. The US has been unwilling to state its position publicly. Instead, it has selectively listened to corporate "stakeholders" at home, namely PhRMA and BIO, who oppose an unlimited extension because ... well, because of what they say to back up every IP monopoly demand: "We need more profits, even from the poorest countries in the world, in order to research the next generation of life saving medicines."

Unfortunately, the USTR has not listened to access-to-medicines advocates who wrote a letter urging US support for the LDC extension over a month ago with no response to date. Nor is the USTR listening to other "key" US stakeholders including Senator Sanders, and Representatives Jan Schakowsky (D-Ill.), Rosa DeLauro (D-Conn.), Jim McDermott (D-Wash.), Raúl M. Grijalva (D-Ariz.), Keith Ellison (D-Minn.), Barbara Lee (D-Calif.), and Sam Farr (D-Calif.), elected officials who have all have expressed unequivocal support for the LDC request. Even the European Commission has voted unanimously in favor of the unlimited extension.

At a meeting in Geneva with 15 Ambassadors from the LDC Group on Friday October 9, Ambassador Michael Punke, Deputy United States Trade Representative and U.S. Ambassador and Permanent Representative to the World Trade Organization, and gave a startling, unbelievably craven and subservient justification for the US demand for a short-duration extension. He said that Big Pharma was disappointed with the additional intellectual property and pharmaceutical protections the US secured for it in Trans Pacific Partnership negotiations and thus that the US could not give ground on the LDC extension.

Right, the poorest countries in world should get shortchanged on their desperately needed access to more affordable generic medicines because Big Bio did not get 12 years of data exclusivity monopoly protections on their $100,000-plus per-patient-per-year biologics.

The USTR's policy positions on the LDC extension request are deadly. They cynically safeguard Big Pharma's global monopoly empire with potential catastrophic effects on LDCs ability to strengthen their human and technological well-being. At a time when we see migrants' bodies washing onto European beaches, the USTR wants to make sure that pharmaceutical capacity is stillborn in many of the countries those migrants come from. This dour and ethically demented policy position cannot stand.

Is President Obama's administration so out of touch with humanitarian values and common decency that it wants the US to be the sole country at the WTO to oppose a mandatory, unconditional pharmaceutical extension for LDCs that is their legal right?

Links on Ebola (with very short excerpts)

(1) - Direct URL:

Amy Maxmen, "To Prevent The Next Plague, Listen To Boie Jalloh," NPR Goats & Soda, Oct. 8, 2015

"This is a landmark week in West Africa. For the first time since the Ebola outbreak, there were no new cases reported in Guinea, Liberia and Sierra Leone.

There are many unsung heroes who deserve credit for this milestone. One of them is Dr. Boie Jalloh, age 30. Ten days after he showed up for his medical residency at 34th Military Hospital in Freetown, Sierra Leone, he received a letter requesting his presence at the hospital's newly constructed Ebola unit."

"To me, first and foremost, I wish the government and our international partners would invest in medical education. We really need more doctors and nurses here — we needed them before Ebola. You can supply all the drugs you want, but people won't be able to get those drugs if there is only one health care provider for 10,000 people. [Note: According to the World Bank, the number is 1.8 — compared to 100 in the U.S.]"

(2) / Direct URL:

Brooks Marmon, "In Liberia, Paying Tribute to Those Who Sang Against Ebola," Ebola Deeply, Sept. 22, 2015

Last week, the conference room of Monrovia's Young Men's Christian Association (YMCA) was decked out in red, white and blue balloons: the colors of Liberia's Lonestar flag. The event? A tribute by the Musicians' Union of Liberia (MULIB) to the artists – singers, hip-co stars, songwriters and other musicians – who joined the Ebola fight.

Bernard Benson, better known as D.J. Blue, the manager of Hott FM, one of Liberia's most popular radio stations, was the M.C. for the event. He set the tone by noting, 'We took Ebola from 100 percent to 0.0 … no one must underestimate what Liberian music did. It resonated to every Liberian, to the people that matter.' G. Bennie Johnson, MULIB's vice president, echoed his words, adding that 'musicians have the power, real power, to do something good for this country.'

Nearly a dozen videos accompanying Ebola awareness songs were screened as part of the festivities."

[see full article at link above for embedded videos.]

Links on Cost of Medicines (with very short excerpts)

(1) - Direct URL:

MSF / Doctors without Borders, "The Cost of Medicine," Alert, Fall 2015, pages 10-12 on "Fundamental Changes Needed in the Biotechnical Innovation System."

"A primary driver of biomedical innovation is public funding coupled with the granting of patents and other intellectual property rights that give pharmaceutical companies exclusive domain to make and sell a new medicine or vaccine for a stipulated period of time. This in turn gives companies monopoly control over the market for that product, allowing them to charge high prices and inhibiting competition that would drive down costs.

Companies therefore decide where to allocate resources based on the revenues they believe a particular product could generate, not the public health burden they could address. What this means in practical terms is that public health priorities and needs rarely determine how corporate efforts are directed. In the current ecosystem, companies watching their profit margins and stock prices are effectively dis-incentivized from focusing resources and attention on diseases and conditions that primarily affect people in the developing world, people who don't represent a lucrative market.

From our vantage point, it's a broken system that is both inefficient and ineffective at responding to the most pressing global public health needs. And our field teams witness these costs on a daily basis."

"In addition, there is a lack of transparency from the pharmaceutical industry, so we don't really know what the R&D costs are for specific products, what proportion of a given product was publicly financed, or how much it costs to manufacture. The accuracy of industry-funded estimates on the cost of developing a drug is questionable at best.

(2) / Direct URL:

MSF Access, "TPP trade pact will deepen global crisis of exorbitant drug prices unless dangerous terms are removed." Press release, Sept. 25, 2015

"As public outrage about exorbitant drug prices features in new headlines in the US and around the world, negotiators and trade ministers from the 12 Trans-Pacific Partnership (TPP) countries are converging in Atlanta to potentially finalize the trade pact, which has been negotiated in secret over a period of more than five years. Recent leaked copies of the TPP's intellectual property chapter confirm the inclusion of harmful rules that will lock in high prices and block affordable generic medicines for years. MSF urges all TPP countries to firmly reject provisions that will deepen the global crisis of unaffordable medicines and health products."

Also includes link to 4-page briefing paper on the TPP: "Trading Away Health"

Links on HIV/AIDS (with very short excerpts)

(1) - Direct URL:

Health GAP, "Celebration and Call to Action - New WHO Guidelines on HIV Treatment and PrEP

"(September 30, 2015) Health GAP welcomes the World Health Organization's release of new global guidelines on HIV treatment, recommending that all people living with HIV be started on HIV treatment regardless of disease stage and encouraging expanded availability of pre-exposure prophylaxis (PrEP) to groups at particularly high risk of contracting HIV.

Earlier guidelines recommended that health care providers wait until people with HIV reached a certain level of disease progression before starting treatment, despite the fact that years ago many wealthy countries including the United States had already begun providing treatment immediately upon diagnosis to all people living with HIV regardless of how advanced their disease. The shift in guidelines comes after new results from the NIH-funded START trial, which provided conclusive evidence of the benefits of immediate initiation in May of this year."

"Only 15 million people are currently on treatment and 37 million are infected, meaning that an additional 22 million people are now eligible for immediate treatment. HIV testing has to be significantly increased, people need to be enrolled in treatment when they test positive, and they will need durable connection to quality care."

"Unfortunately donors and major funders are acting as if additional resources are not needed. Just a few days ago the US announced a major initiative to expand treatment and to reduce infections among young women, but it identified no additional resources. 'Preliminary estimates show that the US must add at least $300 million new dollars each year over the next few years to existing global AIDS funding to help meet the new treatment and prevention goals,' said Professor Brook Baker, Health GAP's Senior Policy Analyst."

(2) - Direct URL:

"Vancouver Consensus: antiretroviral medicines, medical evidence, and political will," The Lancet, August 8, 2015

"In 1996, the global HIV community gathered in Vancouver, Canada, for the XI International AIDS Conference and shared the clear evidence that triple-combination antiretroviral treatment held the power to stem the tide of deaths from AIDS. The HIV treatment era had begun. As we gathered again in Vancouver in July, 2015, it was clear that a new transformative moment is upon us. The Vancouver Consensus statement,1 which emerged at the recently concluded 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015), signals the scientific affirmation that, rather than limiting access to those who are immune compromised, immediate access to antiretroviral medicines holds the power to rapidly advance the fight to end AIDS.

The consensus—signed by more than 500 researchers, clinicians, and civil society experts—is clear: 'All people living with HIV must have access to antiretroviral treatment upon diagnosis. Barriers to access in law, policy, stigma and bias must be confronted and dismantled. And as part of a combination prevention effort, PrEP (Pre-Exposure Prophylaxis) must be made available to protect those at high risk of acquiring HIV. The strategic use of ARVs—through treatment and other preventive uses—can save countless millions of lives, reduce new infections, and move us vastly closer to our goal of ending the epidemic. A new era of opportunity against this epidemic has dawned, and we must seize it.'


Medical evidence is unambiguous. At this point, further delays threaten not only millions of lives but also threaten a resurgence of this pandemic. But if we act rapidly, we can drive down HIV incidence, death, and long-term costs. Political will is needed to complete the work of what can be one of the most effective public health interventions in history."

Links on technical advances for developing countries

Sisu Global Health (

A recent start-up led by three women from Michigan, Sisu Global Health was initially based in Grand Rapids, Michigan, and has recently moved to Baltimore, near the Inner Harbor.

"The Hemafuse [now being tested by doctors in Zimbabwe and Ghana] is a manual autotransfusion device is that used to retransfuse a patient's own blood during an internal hemorrhage, specifically ruptured ectopic pregnancies or road traffic accidents. The current procedure commonly used in Sub-Saharan Africa consists of salvaging blood with a kitchen soup ladle and filtering it with gauze. Compared to this soup ladle autotransfusion, Hemafuse takes 1/3 of the time, 1/9 of the staff, and is significantly safer. The Hemafuse functions much like a giant syringe to suction blood through a filter when a handle is pulled up. When the handle is pushed down the blood is transferred directly to a blood bag in a closed system."

"This device is surgical - meaning that it can intervene during a pivotal moment in an individual's care. Compared to most moments when autologous blood transfusion occurs, the Hemafuse, as an intervention, will be both more urgent and more evident in terms of results. Its handheld, sleek design reduces both blood flow issues and failure modes from a slippery, gloved hand mid-surgery. In many of the surgical suites that we've been in, space is at a premium. Improvements on hospitals and buildings are not keeping up with the increase in patient admittance and population growth, meaning smaller rooms for more people.

This device, as one Tanzanian doctor put it, will eliminate a 'messy' and sometimes futile process.

All opinions from these doctors point to the success of this device, however, the glaring fact that autotransfusion, the recycling of a person's own blood, has been debated solely in Western countries. Of all the published material concerning African healthcare, only 1-2% have contributions from the continent's own physicians. Additionally, these articles and the repository services that attempt to collect thousands of articles are often not internationally indexed to include African medical papers. They come from a continent that has been performing autotransfusion for years, but whose voices have not been given the mechanism to be heard in the medical community."

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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