The work is part of Oxfam America's new public health initiative launched by the humanitarian response department. Its aim is to deepen the effectiveness of its emergency programs and to start building a bank of scientific data that the agency can use to advocate for changes that will improve the lives of poor people.
"Public health assessments provide true evidence of a problem, and they are a lot more effective than rhetoric in focusing attention on the issues," said Miriam Aschkenasy, an emergency medicine physician and Oxfam America's first public health specialist.
Hired in July to head the initiative, Aschkenasy will work on a variety of projects as the agency begins to map out its public health priorities and build a network of specialists who could respond in humanitarian emergencies when the need arises.
"Public health was going on, but no one was calling it public health," said Aschkenasy. "Some of the grants Oxfam awarded to partners were addressing problems such as diarrhea, HIV/AIDS, and access to care. All of these are public health issues, but they didn't fall into a particular person's portfolio. As the humanitarian response department did more of this work, it became apparent it needed someone who specialized in this area."
But Aschkenasy is not undertaking this task alone. A key component of the new program calls for collaboration between Oxfam and top medical facilities, many of which are located in Boston, the agency's headquarters. A formal partnership with the Harvard Humanitarian Initiative is the first of these relationships. The initiative, or HHI, is a joint academic program involving multiple entities within Harvard's academic and medical community. It combines expertise in public health, medicine, social science, and humanities to advance research, practice, and policy in the field of humanitarian assistance.
"Here in Boston we have access to some of the most skilled public health specialists in the world," said Michael Delaney, Oxfam's director of humanitarian response. "We give them the history, the politics, and the culture of a situation--the key ingredients to an effective humanitarian response--and they give us the voice of authority on public health matters when we meet with government officials to push for change."
Twice since last summer, teams from HHI have been dispatched to Ethiopia to quickly study a problem and make recommendations on situations in which people's lives were at grave risk.
In the first instance, an outbreak of ethnic fighting in the southern part of the country had forced tens of thousands of people to flee their homes and seek safety in the bush. Hunger, exposure to the elements, and extremely limited water supplies had begun to take a toll on many of those who had fled. Oxfam and HHI sent a small team?two doctors and a humanitarian response specialis--to conduct a rapid assessment of the situation and offer ideas for improving it.
"The humanitarian needs among the internally displaced people in both the Guji and Borena zones are significant," said Jennifer L. Chan, one of the Harvard doctors, after the visit. "At the time of the HHI/Oxfam assessment, immediate food, shelter, and non-food items were needed as well as establishment of long-term peace building activities." Oxfam had already provided some emergency assistance prior to the assessment.
Three months later, Oxfam and HHI sent a second team to Ethiopia to investigate and respond to the outbreak of cholera.
"The idea behind the assessments is to provide a superior response," said Aschkenasy. "Our affiliation with HHI does that. It provides us with a cadre of cutting edge public health professionals, academics, and their resources. And the evidence they help us gather strengthens our ability to call for change."
Aschkenasy will help lay the groundwork for some of that change when she travels to Ethiopia in mid-January on a prevention mission that may help stop a repeat of the widespread suffering that affected millions of people across East Africa last year. Their lives stood in the balance as a devastating drought gripped the region, killing the livestock on which they depended for food, drying up their water sources, and plunging countless families into debilitating hunger. By the time the extent of the drought became clear to the rest of the world, it had already caused profound damage.
In Moyale, a dusty border town between Ethiopia and Kenya, Aschkenasy and Chan will launch a drought early surveillance system developed by Oxfam America and HHI. Their goal is to help officials in the region track public health trends that will warn them in advance about which droughts could become killers. How much food do families have access to? Are they plagued by diarrhea? Do their children have respiratory problems? Do their goats, cows, and sheep have enough pasture? How much rain has fallen? Is the price of grain climbing?
They sound like simple questions, but their answers--plotted on a chart that can make trends frighteningly clear--could be key to getting people in this drought-prone region, many of whom are herders and extremely poor, the help they need before it's too late.
"If we can determine quickly what the effects of limited rainfall are, then we can start doing interventions long before things get so bad that severe malnutrition becomes widespread and feeding centers are our only recourse," said Aschkenasy.
A fellow at HHI, Aschkenasy keeps her medical skills honed by working four eight-hour shifts a month at the Boston Medical Center. But she knew long before arriving at Oxfam that public health was where her heart was.
"When I was in my second year of residency, I had a chance to go to Nepal and work in the Tribhuvan University Teaching Hospital in Kathmandu. It doesn't take you long to realize that public health has a much greater impact on people than one-on-one patient care. I also realized how much I loved it," said Aschkenasy. "There's a role for one-on-one clinical care, and I enjoy it. But there's something much more satisfying about public health work. It has a broader impact. You're preventing something from happening."
And that's a central objective for Oxfam?s humanitarian response department: preventing events--natural or man-made--from cascading into disasters.
"Public health ties right in with our preparedness and livelihoods work. That triad is what development is all about," said Aschkenasy.
]]>In 2005, cancer patient groups in India used Indian intellectual property law to stop a patent application by Swiss company Novartis for its anti-cancer drug, Glivec. This allowed Indian companies to continue making generic versions at about $2,700 a year, as opposed to Novartis having a monopoly priced version for sale at about $27,000 a year.
Novartis recently appealed the decision in a direct challenge to India's right to use safeguards contained in trade rules agreed by the WTO in 2001 in the interests of public health.
What is Glivec?
Glivec (Gleevec in the US) is an important drug that means the difference between life and death for cancer patients suffering from leukemia (CML), stomach tumors, and other conditions. Glivec is a significant improvement over other forms of treatment and should be as widely available as possible, at affordable prices.
Why is Novartis enforcing its patent on Glivec in India and in other in developing countries?
Glivec is a key drug for Novartis worldwide. It's the company's second best selling drug with sales reaching $2.8 billion in 2005 and accounts for 9.6 per cent of Novartis's estimated share value. Research indicates that there are multiple diseases that respond to the drug. In only five years, Glivec is now approved in the US for seven different diseases. There is a danger that the company could apply for a new patent based on these "new uses" elsewhere, which would extend its monopoly and delay availability of affordable generic versions of Glivec for people who need it.
Novartis says that there is virtually no commercial market for Glivec in India and that it is taking the case in part to "align Indian IP laws with TRIPS", The World Trade Organization's agreement on intellectual property. This action is one that will affect India's right to produce not only generic versions of Glivec but also for other new medicines in the future.
What would happen if Novartis were successful in its appeal?
Not only would it increase the price of the drug it would also jeopardize India's generic export industry. India is the world's leading supplier of inexpensive generic medicines to developing countries with approximately 67 percent of its exports going to developing countries. As a result people needing cheaper versions of medicines in many developing countries would lose out.
Oxfam believes that generic competition reduces the price of many patented medicines and makes them much more affordable to poor people in developing countries. Lower prices via generic competition could ensure free or subsidized medicines for millions of poor people through increased public sector funding for health, through health insurance and because many poor people are willing to pay out of pocket for medicines because the health and well being of themselves and their family a top priority.
]]>Many experts thought these tight-knit communities were relatively safe from the AIDS epidemic, but with the death and displacement of hundreds of thousands, the social landscape—like the coastline itself—was recreated in a moment.
The rumors reached Jose Michael, director of Oxfam's HIV program in India—that people living in crowded temporary houses and communities were experiencing new pressures that could increase their risk of HIV infection.
"There were many possible triggers, but we had no evidence," says Michael, so while he continued the Oxfam HIV/AIDS awareness program, he and Hari Krishna, an Oxfam disaster response specialist, engaged a well-known Indian health research organization to determine whether and how the tsunami disaster and its aftermath was increasing the vulnerability of the coastal communities to HIV infection.
"We did not set out to determine actual rates of HIV infection in the villages," says Hari Krishna. "That would have revealed very little about the changes precipitated by the disaster and even less about how and why they took place." Instead, the research focused on how people felt their own HIV-related behavior had changed since the tsunami, and what brought about those changes.
The central difficulty in carrying out the research is obvious: who wants to talk about your own behavior if it's something dangerous or strongly condemned in your community? But the inventive staff of the Swasti Health Resource Center, Oxfam's research partner, came up with a plan and a new research tool, which they call the polling booth.
Eight women sit in a circle, each with a cardboard box in front of her to conceal the choice of cards she places in a jar. In the center of the circle stands a facilitator who asks a set of questions aimed at determining how vulnerable these women are to contracting HIV.
This is a demonstration of the polling booth technique. The equipment involved is simple: a jar, a cardboard box, and a stack of numbered cards—green to indicate yes and red for no—are all it takes to build a "booth." But with willing participants—and researchers who have earned their trust—it can be used to carry out the very delicate task of eliciting honest answers to tough questions.
After the polling booth survey, the facilitator and participants tabulate and discuss the results. In a real-life situation, the facilitator might begin by saying, "Two people answered that they use condoms and six said they don't. Why do you suppose people in this village might choose not to use condoms?" Such a question could launch a valuable discussion of community perceptions of condom use and the spread of HIV—with no one having to reveal his or her own personal decision.
"What we share in a polling booth is fact," says S. K. Shashikala, who participated in the Swasti research and later helped demonstrate the technique to observers. "In this process, there is no inhibition."
Researcher Manoj T.J. led groups of men in these polling booth sessions. "The participants had a chance to talk about issues that they might otherwise be silent about," he says. "The discussion often revealed realities on the ground. When you know those realities, you can plan accordingly."
A research participant named Vasanthamma added a gender dimension: "This is good for women where we come from a culture of silence."
Although the researchers were successful in their mission, they had bad news to report. After interviewing around 1,000 people in 30 tsunami-affected communities, they determined that in 10 out of 11 of the temporary shelter settlements studied, HIV vulnerability rose in the aftermath of the tsunami. (Read a summary of the report.)
The lingering trauma of the tsunami disaster combined with life in the crowded temporary shelter settlements and disruptions in employment triggered changes in sexual behavior which, in the absence of strong knowledge about safe sex practices, put men and women at risk. Strict community standards of behavior were unenforceable when villages were scattered into temporary camps, and many survivors were drawn to alcohol and extramarital relations—including commercial sex—as a means of coping with stress, boredom, and overwhelming grief.
Now that the tsunami recovery is well underway, many of the conditions that caused HIV vulnerability to spike have been resolved. The need for AIDS education and services remains acute, but most people can report that they've moved out of temporary shelters and are back to work, and that the trauma of the tsunami has subsided. But for emergency aid providers, the research has implications far beyond the coast of India.
"If aid providers don't supply enough water or food or shelter after an emergency, it's clear to everyone what's wrong, but a rise in HIV risk after a disaster can go undetected until it's too late," says Mike Delaney, Oxfam America's Director of Humanitarian Response. "Now we know much more about how responders in future emergencies can help communities reduce their vulnerability. This is research that could save lives."
]]>But, he adds proudly, he does know how to wash his hands properly after going to the latrine—something he rarely did just a few weeks ago. And he proceeds to demonstrate to the group of children, who—like Osman—have started attending Oxfam's child-to-child educational programs that aim to equip the children of Kalma camp with knowledge that could save their lives.
Football matches, songs, volleyball tournaments, and playground games are just some of the innovative ways in which the Oxfam Public Health Promotion (PHP) team here is teaching children how to stay healthy.
Kalma is one of the largest camps in Darfur—mile after mile of tightly packed shelters and rapidly constructed sanitation systems currently home to around 89,000 displaced people. As in most camps, the vast majority of residents are women and children. Two years ago there were just 19,000 people here, but rapid growth since then has created an abundance of health risks, to which children are the most vulnerable.
"Children everywhere need to be taught to wash their hands and keep clean," says Khaled Suleiman, one of Oxfam's PHP officers in the camp. "But here especially so, as the consequences can easily be fatal."
To make sure the messages sink in, Khaled and the team try to make them as fun as possible. Oxfam has built a series of community shelters where child-to-child interactive classes and activities are held.
Songs are enthusiastically sung about how to prevent malaria and diarrhea ("Our food should be washed, our water should be covered," the children sing, accompanied by stomping of feet and clapping of hands).
Other songs encourage children to participate in community clean-up campaigns, and explain how to set up mosquito nets and use the latrines properly. Oxfam has installed around 9,000 family latrines and 1,500 communal latrines in Kalma.
The children in Kalma love to make noise. The merest glimpse of a new Oxfam worker elicits a chorus of hundreds of voices shouting in unison, "OK, OK"—the nickname the children of Kalma have given to foreign visitors and the first English word every child in the camp learns. The welcome is followed by mischievous smiles and laughter all round, and the children's enthusiasm for loud, energetic fun extends into the classroom.
"My favorite is the singing and dancing," says Osman of the child-to-child activities, his arms waving frantically about his head as he mimes the actions to a song about swatting away flies. "And I like to learn new things." He has spent most of his short life in the camp after arriving here with just his mother. Nobody is sure what happened to his father and brothers.
Nine-year-old Hawa also likes to sing. "I enjoy the classes as I can make friends with lots of other children and learn at the same time. We sing the songs when we go home as well. I would like to go to school but so far I have not been able to," said Hawa, who has been in the camp for two-and-a-half years since her family fled their village of Shataya, nearly 100 miles to the west.
The PHP team works with community volunteers to come up with new songs that they think the children will find both educational and entertaining. "Kalma is as big as a city, so it is divided into eight 'sectors,'" says Khaled. "Recently we heard children from sectors 7 and 8—the only parts of the camp where Oxfam does not work—singing our songs! The children at our classes had been singing at home and gradually the songs spread around the entire camp."
The programs have proved extremely popular—almost too popular. The teachers—themselves displaced people living in the camp—say they often have 400 children trying to cram into a single room at the community shelter. "Every time we open the door, another dozen or so burst in," says Khadija, who teaches children in Sector 3 of the camp.
"Having such large classes can make it very hard for us to get the message across successfully," she says. "So we have split them into groups. Group 1 comes between 8:30 and 10:30 and Group 2 between 11 and 1 pm. Of course, some children try and come to both!"
"We are trying to ensure that the children are exposed to our messages at every possible opportunity," says Khaled. "The songs are just a part of our activities and it is clear that children's health has improved since the programs began."
Cartoon drawings explaining how food can breed germs, and how failing to clean latrines will spread disease and attract rodents, are pinned to the walls of the community shelters. Football matches and other events are organized for children to attend, where health-related information is disseminated.
The PHP team is also coordinating its efforts with the four primary schools in Kalma camp. A number of children from each class are chosen as supervisors and join teachers for training in hygiene promotion. The skills and facts they learn are then passed on to their classmates and pupils.
]]>Amid cheers from a throng of enthusiastic supporters and international media, Make Trade Fair won the day.
Oxfam's trade campaign was launched.
Within hours of the Hong Kong debut, events were held in 25 cities including Brussels, Dublin, Geneva, Mexico City, San Salvador, and Washington, D.C. These events ranged from press conferences and symposiums to a rock concert in London’s Trafalgar Square.
Oxfam's trade campaign seeks to unite concerned citizens around the world in calling for fair trade policies that will help move millions of people out of poverty.
Nobel Prize Professor Amartya Sen, UN Secretary-General Kofi Annan, and musician and social activist Bono were among those who endorsed the campaign. "Oxfam has got it right," said Bono. "It wouldn't cost much to change the rules of trade so that poor countries can work their way out of poverty. But the world's leaders won't act unless they hear enough people telling them."
Also in this issue of EXCHANGE, writers Frances and Anna Lappé discuss their book Hope's Edge: The Next Diet for a Small Planet, and we bring you updates on Oxfam's work with water and sanitation, drought in Ethiopia, and indigenous women in the highlands of Peru who are speaking out after decades of violence.
]]>?Oxfam?s experience is that aid air drops can help but are hugely expensive and very limited in what they can deliver,? said Michael Delaney, director of humanitarian response for Oxfam America.
Air dropping aid does not guarantee that food and other relief supplies will reach the people most in need. In many cases it is the strongest and fittest who get to the aid first, and not the sick or injured who most need help and assistance. In a natural disaster such as Cyclone Nargis or conflict like Darfur it?s not only food that is needed but also sophisticated equipment such as clean water and sanitation systems weighing tons as well as highly skilled staff to operate them, all of which cannot be dropped from the sky.
?If there isn?t an aid operation on the ground to distribute the aid, the air drops can exacerbate any tense relations within communities with only the fittest and fastest benefiting,? said Delaney.
?At best aid air drops can only be a partial solution, at worst they give the illusion that somehow we are addressing this ever-worsening humanitarian crisis. The biggest risk is that aid air drops will be a distraction from what is really needed ? a highly effective aid operation on the ground. The highest diplomatic effort is still required to ensure that aid and aid experts are allowed into Myanmar to help save lives,? added Delaney.
In any humanitarian response, including in Myanmar today, what?s always needed more than air drops is a well coordinated and widespread aid operation on the ground. The humanitarian relief operation mounted in Aceh after the 2004 Indian Ocean tsunami is a text book case of what?s required following a major humanitarian catastrophe. Within days of the tsunami relief flights carrying equipment and relief personnel were permitted to land to assist those affected by the disaster.
?There can be no substitute for an aid operation on the ground. It?s the best way to save lives and to ensure aid is targeted at the most vulnerable people,? said Delaney.
And that is the quandary in cyclone-affected parts of Myanmar today. Should aid be parachuted in or should agencies such as Oxfam alongside local partners be allowed to operate on the ground? Oxfam wants to be allowed to operate in Myanmar because it has years of experience responding to natural and man-made disasters around the world.
?We support a call for international aid agencies such as Oxfam to be permitted to work in cyclone-affected parts of Myanmar,? said Delaney. ?We have the experience and expertise to save lives and we?d obviously welcome a chance to play our part assisting the millions of people affected by this natural disasters.?
In readiness to respond Oxfam has pre-positioned relief supplies as well as aid workers in the region. In total Oxfam has nearly 90 highly-trained experienced disaster response specialists including logisticians, water engineers and public health experts on standby and ready to leave at a moment?s notice.
]]>?This funding will help save lives and prevent further suffering to hundreds of thousands of people in Zimbabwe,? said Raymond C. Offenheiser, president of Oxfam America. ?With the oncoming rainy season, an already devastating cholera outbreak could become catastrophic unless issues of unsafe water and sanitation are addressed.?
The funding will enhance Oxfam?s existing response by providing safe water for drinking, cooking and personal hygiene. In addition, the initiative will sensitize community members to effectively identify the disease and instruct them to seek immediate treatment when it occurs, and teach them how to prevent contamination to others. Lastly, the funding will also support community members initiating their own community based Cholera Early Warning Systems to collect data and identify potential risks to their water sources to reduce the spread of the disease.
?Immediate treatment for those affected, and the implementation of prevention measures, are critical to helping stop the further spread of this disease in Zimbabwe,? said Chip Lyons, director of Special Initiatives in the Global Development Program at the Bill & Melinda Gates Foundation. ?Oxfam?s long-standing track record of responding to international emergencies make them well positioned to not only provide relief, but also to establish a foundation for community awareness around prevention.?
?Not only will this award be used for immediate response, but it will also be used for prevention,? said Ransom Mariga, head of Oxfam America?s program in Zimbabwe. ?This is especially important for the many people in Zimbabwe who are hungry and for whom cholera would be lethal.?
Cholera is a water-borne disease. This outbreak is a result of the breakdown of health, basic water and sanitation services and has already killed over 1,600 people since August and infected over 33,000 around the country, according to the World Health Organization. Zimbabweans are desperately short of food, health care, clean water and safe sanitation. In addition to the cholera outbreak, at least 3.8 million people do not have enough to eat ? going without food for days at a time. Oxfam has been responding to the humanitarian emergency through food distribution and limited water and hygiene work.
]]>The Zimbabwean government has declared a national health emergency. Oxfam welcomed the declaration, saying that it should spur international donors to respond more urgently to the humanitarian needs.
"People have been going without enough food for months. They are hungry, weak, and vulnerable to infection. Some donors have immediately made sums available, and that will make a real difference. But this is far from enough. Unless the international community steps up to provide money for food and medical assistance immediately, the already dire situation will get much worse,? said Peter Mutoredzanwa, Country Director for Oxfam in Zimbabwe.
"Millions of people were already facing starvation. With unemployment over 80 percent, and food unavailable across the country, they now have to contend with cholera and other diseases as the water and sanitation systems break down. With the rainy season upon us, the epidemic will spread even more rapidly. Aid agencies urgently need support from the international community to scale up their efforts,? Mutoredzanwa added.
Ordinary Zimbabweans desperately need health care, clean water and sanitation. Cholera, a water-born disease, has surged due to the breakdown of city sewerage systems, poor maintenance of water supply systems, including hand pumps, severe drinking water shortages, and the lack of basic hygiene items such as soap.
?With close to half the population weakened by serious food shortages, cholera when it hits is even more likely to be lethal,? said Mutoredzanwa. ?Indications are that more than 5 million people will urgently need food aid by January.?
Oxfam is distributing 12,000 metric tons of maize meal, vegetable oil and pulses in collaboration with the World Food Program (WFP), reaching 150,000 vulnerable people. The agency?s cholera response will now be scaling up to target 615,000 people, and focusing on three of the worst hit areas: Beitbridge on the South African border; Budiriro, a suburb of Harare; and Mudzi, an area bordering Mozambique. The aid agency also plans to start moving into areas where cholera has not hit, to proactively prevent the spread of the disease.
?We are very concerned that unless donors pledge additional money now, food aid rations will have to be cut,? said Mutoredzanwa. ?No one should wait for a political solution in Zimbabwe before pledging to help—this will be too late for millions of vulnerable Zimbabweans.?
]]>As part of its campaign calling for better essential services like health care, Oxfam calls on rich countries to lead the fight against the pandemic by fully funding the Global Fund for AIDS, Tuberculosis and Malaria, and supporting poor countries to build their health systems, including the recruitment, training and retention of more health workers.
“In the global response to AIDS, the lack of trained doctors, nurses and community health workers is without doubt slowing us down. To effectively treat HIV and AIDS, there needs to be more and better training, decent working conditions and adequate salaries for tens of thousands of new doctors and nurses. This will only happen if donors provide more of their aid for health through sector and general budget support, and if developing countries prioritise health services in their national budgets,” said Enida Friel, Oxfam Internatinal Lead on HIV/AIDS.
In four provinces in Angola, Oxfam has been working closely with HIV support groups. Dolmingas dos Saleios Correia is the Advocacy Officer for Accao Humana, an Oxfam partner which operates in Luanda. She is HIV positive and has lost her husband and two children to AIDS.
“Things are improving in Angola. Anti-retrovirals are now freely available in syrup forms for children. However there are still many problems,” Dolmingas says. “In public hospitals for example, there are 10,000 adults on ARV treatment and only ten doctors. Additionally there are 15,000 children receiving ARVs with only two doctors available. The need for more health workers is urgent.”
In Malawi, one of the worst-affected countries in the world, around two out of every three of the 187,000 HIV-positive people are now receiving treatment.
Just five years ago virtually no-one in Malawi was getting treatment. Survival rates are now at around 70%, which is a massive success story says Oxfam.
However, the lack of treatment and care for tens of thousands of patients remains a huge problem. Lingalireni Mihowa, an HIV and AIDS Advisor for Oxfam: "It’s a sad situation when poor Malawians waited this long to have access to free ARV drugs, and now the main barrier to accessing those drugs is the lack of doctors and nurses to administer those life-saving medicines.
“There are just not enough doctors and nurses to respond to the demands of patients. Luckily enough, the Government of Malawi is working with donors and the Global Fund to sort out the situation, but we have still reached a crisis point,” she said.
In India, which has between 2 million to more than 3 million people living with HIV, the largest number outside of Africa, Oxfam runs various programs.
Like in many other countries Oxfam believes that while prevention programs are important, these alone are not enough to halt the increase in infections.
“Sub-Saharan Africa and especially Southern Africa are the regions worst affected by HIV and AIDS. Even though the HIV prevalence is slowing down in some African countries such as Zimbabwe or Kenya, the need to invest in training and support of health professionals is now more imperative then ever.
Building health systems that also deliver reproductive health care is a long term investment in halting and reversing the epidemic worldwide,” said Dr. Friel.
]]>The report, "Investing for Life," looks at the world’s top 12 pharmaceutical companies, including their drug pricing policies, their record in developing medicines relevant to poorer countries and their stance on protecting intellectual property rights.
Oxfam says the industry is failing to ensure universal access to medicines because it refuses to put the issue at the heart of its business model. As a result, it is failing to capture the full potential of emerging markets touted as the "new frontier" for its business success.
According to a major consultancy firm, a loss of faith in the industry on the part of its investors has so far cost pharmaceutical's shareholders $1 trillion dollars.
“The industry is burying its head in the sand. More than 85% of world consumers are underserved or have no access to its medicines. The industry must recognise that charging high prices, quashing generic competition, developing medicines only for those rich enough to pay and fighting for harsher patent laws is an ineffective business strategy for new markets, as much as it is a moral outrage,” said Jeremy Hobbs, Oxfam International executive director.
“Investors are worried about the industry’s performance. They know that emerging markets are key for the industry’s future growth but companies have been responding to the challenge of breaking into emerging markets in an ad-hoc and inconsistent way. This is bad for the industry and bad for poor people who are still facing devastating diseases like malaria, tuberculosis, asthma, cancer, and HIV/AIDS without affordable medicines,” Hobbs said.
The report reveals shortcomings where the industry:
Oxfam notes that some companies are offering differentiated prices but this is extremely limited and mainly for high-profile diseases such as HIV and AIDS.
However, these offers are not systematic worldwide and are often still priced well above the means of people living in developing countries. Oxfam says that drug companies often adapt pricing in developing countries solely as a reflection of the publicity that surrounds the disease or the country.
For instance, Abbott Laboratories was selling Kaletra—a second line anti-retroviral medicine—at $2,200 per patient per year in low middle-income countries like Guatemala, where a person’s average wage is $2,400 a year. Only until Thailand, in response to the needs of poor HIV patients, issued a compulsory license to reduce the price of Kaletra to $1,000, did Abbott reduce the price of Kaletra worldwide to $1,000 per patient per year. Also in Thailand, French giant Sanofi-Aventis offered its cardiovascular disease medicine Plavix at a price that was 60 times more expensive than Emcure, the Indian generic version. In March 2007, it responded to Thailand’s use of compulsory licensing by offering a 70% cut.
Oxfam’s report says that companies are still not investing enough into researching and developing medicines for diseases that predominantly affect poor people in developing countries. Between 1999 and 2004, there were only three new innovative drugs targeted at diseases affecting the developing world out of 163 medicines brought to the market.
“Even people suffering from tuberculosis—which kills nearly two million people a year—need six months of treatment and the most recent medicine is 30 years old,” said Helena Vines-Fiestas, author of the report.
On the industry’s approach to intellectual property rights, Vines-Fiestas continued: “High levels of intellectual property protection have not resulted in new cures for diseases that affect poor people.”
Despite this, the report notes that the industry continues to insist that the global intellectual property regime does not prevent poor people from accessing affordable medicines. Oxfam says not only is the industry’s view narrow-minded and wrong, but that the evidence is overwhelming that generic competition is the most effective and proven method to reduce drug prices.
In recent years companies have mounted legal challenges or exerted direct pressure to protect their patents against the legitimate use of safeguards in Thailand, Brazil and India. “These challenges are made at the direct expense of poor people,” Oxfam said.
Pfizer even challenged the Philippines government over their use of public health safeguards in relation to the drug Norvasc.
“The industry is failing to make the systematic changes needed to serve developing country markets and meet its responsibility to make medicines universally available. Public pressure will intensify if companies continue to offer only patchy concessions, for example around high profile diseases such as HIV/AIDS and malaria,” said Vines-Fiestas.
The report concludes by arguing that companies will need to revamp their approaches on pricing structures, R&D investment and patent policies in order to serve these markets and make its medicines more accessible to poor people. Companies should adapt to the realities of developing country markets because up to 80 per cent of people in developing countries are vulnerable to falling or staying below the poverty line if they have to bear the cost of expensive medicines, particularly where treatment is long-term.
“The industry is operating in a short-sighted way because it could gain enormous benefits from emerging markets, including lower research and development costs and cheaper manufacturing. Yet instead it continues to blindly use its same strategies in poor countries. Even today, the richest 15% of the world consumes over 90% of its pharmaceuticals. At this rate, both the industry and millions of sick patients are losing out,” concluded Jeremy Hobbs.
]]>The decision will protect India's special role as the world's leading provider of affordable medicines to the poor. The agencies welcome Novartis's response today that it is unlikely to appeal the ruling.
Novartis had challenged a law that allows India to refuse a patent for an existing medicine when it had been modified only slightly. The agencies said the case was a direct attack against India's right to protect public health.
Novartis and the pharmaceutical industry have been given a clear message to respect developing countries' legal right to use the World Trade Organization TRIPS (trade-related intellectual property) safeguards to strike the right balance between protecting public health and intellectual property, the agencies said.
India—known as the 'pharmacy of the developing world' due to its massive generic drug production industry—supplies most of the world's affordable generics to developing countries where patented medicines are priced out of most people's reach. More than two-thirds of generic medicines exported from India are sold in developing countries at a fraction of the cost of patented brand medicines.
Novartis's legal challenge posed an enormous threat in developing countries to millions of people suffering from cancer, HIV and AIDS, diabetes and other diseases who are too poor to pay for expensive patented medicines.
Sandhya Venkateswaran, Head of Advocacy for CARE International in India said: "This ruling is a lifeline for the millions of people who cannot afford brand-name drugs, and ensures that essential medicines from India will reach those who rely on them. CARE and other agencies can breathe easily now and continue to deliver treatment programs.
"More than 5 million people with HIV around the world still cannot afford anti-retroviral medicine, but this ruling reduces the number of people for whom HIV is a virtual death sentence. CARE has been able to buy more than twice the amount of anti-retrovirals to treat the HIV and AIDS patients we work with in Peru, thanks to the generic industry in India."
A global campaign by civil society has seen nearly half a million people around the world campaigning against Novartis to drop its case.
Celine Charveriat, head of Oxfam's Make Trade Fair campaign said: "This ruling is a vindication for India and a victory for campaigners. Developing countries should not be bullied by pharmaceutical companies and forced into having to defend themselves in court for correctly using the safeguards available to them to protect public health."
Linda Hartke, coordinator of the Ecumenical Advocacy Alliance, which mobilized church leaders to campaign against Novartis’ case in India, said, “This is a victory for all those who believe people, not profits, must come first in public health.”
CARE, Oxfam, and the EAA call on Novartis to continue to take positive steps to promote access to medicines in developing countries, to promote research and development for neglected diseases and to strike an appropriate balance between protecting public health safeguards in developing countries and intellectual property rights.
]]>G8 countries are "running to stand still" said Max Lawson, Senior Policy Advisor at Oxfam, as last minute talks between officials ended inconclusively, with some countries reluctant even to reiterate past aid promises on the eve of the summit.
Lawson: "G8 officials have today been involved in feverish negotiation over the final texts but have failed to agree. Italy, Canada and Japan are leading the scramble for reverse gear, refusing even to reiterate promises to increase aid that they made in 2005 - mainly because they have been busy breaking those promises ever since."
"The extra aid that was promised at the G8 summit in Gleneagles two years ago could put millions of kids into school, employ nurses, doctors and teachers, buy medicines for people with AIDS—literally save lives. But collectively, the G8 looks set to fall short of their pledge by a massive $30bn. If they do not get back on track, 5 million extra people will die by 2010. This is about a lot more than numbers on a piece of paper."
Climate change is the other issue that remains controversial ahead of the official summit start on Wednesday, with Germany pushing for consensus on a global stabilization target and proposals for multilateral negotiations on a post-2012 framework. The first phase of the Kyoto protocol runs from 2008-2012.
Lawson: "Over the last few days we have seen a plethora of new initiatives on climate change, led by former leading naysayers, but we don't need a new process or approach. There is already a process in place at the UN that countries should follow, and the G8 should support, so that they can come up with a global solution to global problem.
"We are already seeing poor people in developing countries suffering the effects of climate change. They can't wait for the results of a beauty parade of different country initiatives. They need the G8 to provide money now to help them adapt to climate change, while at the same time agreeing on measures to cut emissions and limit global warming to as far below 2 degrees as possible."
Also over the weekend, violent protests attracted the attention of G8 watchers and the media. Peaceful campaigning was overshadowed by violence and injury.
Lawson: "This summit must not be remembered for broken promises and burning cars. There is huge potential here and a huge chance for the world richest and most powerful countries to live up to their responsibility to support development and poverty reduction in the developing world. Failure to act on this would be unforgivable."
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