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Date: Sun, 16 May 1999 12:13:32 -0600
From: Science-Week <[log in to unmask]>
Claire Haller
Managing Editor
Science-Week
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ON ACCESS TO ESSENTIAL DRUGS IN POOR COUNTRIES
In the last issue of this publication (SW 7 May 99 3:19), we briefed a
report on the current situation concerning the availability of anti-AIDS
drugs in developing countries. A similar situation exists for a number of
other serious epidemic diseases, in particular for a complex of tropical
and other diseases common in Africa. For more than a century, researchers
in chemistry, biology, and medical science have joined together in an
intensive research effort to combat the deadly diseases that have ravaged
the human species. But it seems that at present only a small part of the
world population, the richer part, is experiencing the benefits of this
effort.
... ... B. Pecoul et al (4 authors at Medicine Without Frontiers
Foundation, FR) present an extensive analysis of the current problems
concerning access to essential drugs in developing countries, the authors
making the following points:
1) At the present time, entire populations lack access to essential
quality drugs, and the situation appears to be deteriorating. The result
is a further marginalization of much of the world's population.
2) Effective treatment is lacking in poor countries for many diseases,
including *African trypanosomiasis, *Shigella dysentery, *leishmaniasis,
tuberculosis, and *bacterial meningitis. Treatment may be precluded
because no effective drug exists, the drug is too expensive, or the drug
has been withdrawn from the market. Moreover, research and development in
tropical diseases have come to a near standstill.
3) A serious problem concerns the local standards for drug production,
since many of the poorer countries do not have the technical, financial,
or human resources required for the application of necessary standards,
and some developed countries may be less strict when the product being
manufactured is designed for export. The quality of drugs and their
effectiveness and safety are less certain in populations of the poorest
people, who are attracted by lower-priced drugs sold outside pharmacies.
Also, both large- scale and small scale counterfeiting of drugs is a
serious problem. In 1995, for example, during a meningitis epidemic in
Niger that caused 41,000 reported cases of the disease, an estimated
60,000 persons were inoculated with totally inactive counterfeit vaccines
apparently substituted for the original vaccines donated by Pasteur
Merieux, SmithKline Beecham, and the neighboring Nigerian government.
4) Drugs necessary for the treatment of certain tropical diseases have
begun to disappear from the market because they are commercially
unprofitable. Many of these drugs were discovered in the 1950s and 1960s
or earlier and are currently seldom or never used in wealthy countries,
which means a profitable market has ceased to exist.
5) The prohibitive cost of *antiretroviral drugs for treatment of AIDS is
well known, but there are many other examples of drugs that are simply not
affordable, most of which have been recently marketed and are still
patent-protected.
6) Tuberculosis caused the deaths of 3 million people in 1997, but the
current treatment regimen is impractical in poor countries and compliance
is poor. At present, people with *multi-drug-resistant tuberculosis in
countries with limited financial resources are not receiving treatment,
"which from a medical and humanitarian perspective is completely
unacceptable."
7) Directors of pharmaceutical companies in the developed world have
stated repeatedly that the reason for not conducting research on tropical
diseases is the lack of patent protection for innovations in some in some
of the poor countries, which would also explain the limited investments of
the pharmaceutical companies in the countries concerned. However, with or
without patent protection, it is unlikely that Western manufacturers will
devote much of their effort to financially nonsolvent populations. All
things considered, even if patents are widely enforced, the future of
tropical disease research may not be promising.
8) The authors conclude: "Access to essential drugs is a basic human right
often denied to people in poor countries. However, it would serve no
purpose to demand new public health or human rights in a manner that would
suggest that such rights will soon become a reality. The current situation
points to the opposite. For a great proportion of the world, health
conditions are worsening, and without fundamental change in the
pharmaceutical market, perspectives [prospects] for improvement are not
encouraging."
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B. Pecoul et al: Access to essential drugs in poor countries.
(J. Amer. Med. Assoc. 27 Jan 99 281:361)
QY: Bernard Pecoul [[log in to unmask]]
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Text Notes:
... ... *African trypanosomiasis: (sleeping sickness) Transmitted by
tsetse flies (Glossina). There are two varieties of the African parasite:
Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense. American
trypanosomiasis is transmitted by "cone-nosed bugs" (Triatoma, etc.). the
American parasite, labelled Trypanosoma (Schizotrypanum) cruzi, causes
Chagas' disease. Trypanosomes are motile protozoans residing in blood
(hemoflagellates).
... ... *Shigella dysentery: Shigella is a genus of nonmotile bacteria.
The species S. dysenteriae (Shiga bacillus) causes dysentery in humans and
in monkeys.
... ... *leishmaniasis: Infection with Leishmania, a genus of motile
protozoa related to the trypanosomes. Leishmaniasis is a clinically
ill-defined group of diseases, usually divided into 4 types, one of which
is kala-azar. Each disease is transmitted by a sandfly species.
... ... *bacterial meningitis: In general, meningitis is any inflammation
of the membranes (meninges) of the brain or spinal cord.
... ... *antiretroviral drugs: An "antiretroviral drug" is any drug acting
against retroviruses. Retroviruses are single- stranded RNA viruses that
have an enzyme called reverse transcriptase, and with this enzyme the
viral RNA is used as a template to produce viral DNA from cellular
material. This DNA is then incorporated into the host cell's genome, where
it codes for the synthesis of viral components. The HIV virus is a
retrovirus.
... ... *multi-drug-resistant tuberculosis: Tuberculosis is a specific
disease caused by Mycobacterium tuberculosis, which may affect almost any
tissue or organ of the body, but most commonly the lungs. A number of
drug-resistant strains of M. tuberculosis have evolved, including some
strains that are resistant to all or nearly all the drugs known to be
active against the pathogen.
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Summary & Notes by SCIENCE-WEEK [http://scienceweek.com] 14May99
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from SCIENCE-WEEK May 14, 1999 -- Vol. 3 Number 20
A Weekly Email Digest of the News of Science
A journal devoted to the improvement of communication
between the scientific disciplines, and between scientists,
science educators, and science policy makers.
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