[Day 4] 28th Pan American Sanitary Conference: A binding research and development treaty to improve access to medicines – Feasible?

Day 4 at the 28th Pan American Sanitary Conference was welcomed by clear blue skies and sunshine as opposed to the clouds and day experienced the day prior.  Perhaps, this was a symbol of hope as PAHO moves into a new period with the election of the new Regional Director, Dr. Carissa Etienne yesterday. There is hope that the results of this meeting will not only be on paper, but will also become a reality in our region – the Americas.

During the morning plenary session, one of the more controversial resolutions that was tabled the day prior would be discussed amongst member states and civil society. At the World Health Assembly earlier in May, a report entitled Research and Development to Meet Health Needs in Developing Countries: Strengthening Global Financing and Coordination by the Consultative Expert Working Group (CEWG) on Research and Development. The report comes at a pivotal time when not only is the global economy unable to affordable the rising costs of medicines and treatments but also a time where there is a dearth of new medical products especially for those of neglected disease populations.

The report in its recommendations strives to align the incentives of industry in creating medical products for the purpose of profit with that of public health needs to allow for affordable access for patients. Additionally, the CEWG calls for member states to sign onto a binding treaty recommending a 0.01% of the GDP contribution towards a R&D fund. Many member states were adamantly against this proposal – most notably the first speaker, the United States stating that the first goal should not be asking for a dollar amount from countries in trying to overcome the R&D crisis, but rather focusing on implementing new models for innovation. Ironically, however, the United States did acknowledge that they contribute much more than 0.01% of their GDP towards R&D. Other countries voiced similar concerns including France as an observer state. There were a few countries however who voiced support for the recommendation of a binding treaty including Argentina, Colombia and Suriname.

Following member-states, Médecins Sans Frontières (MSF) and IFMSA as representatives from civil society were permitted to read their interventions. To read MSF’s statement, go here: ow.ly/dTnbF. Reshma Ramachandran of the IFMSA delegation read aloud IFMSA’s intervention as follows:

The International Federation of Medical Students’ Associations (IFMSA) welcomes the CEWG report on financing and coordination for R&D. Traditionally, the strengthening of intellectual property rights has been used as a primary method to spur innovation. This incentive, however, has not always proven fruitful especially for treatments not taken chronically such as vaccines and antibiotics – pharmaceutical classes that have seen a decline in R&D investment. In fact, in the Americas, case documentation has shown a rise in “superbugs” leading to patient deaths due to the lack of new antibiotics in the pipeline.

With such low investment in essential medicines due to failed R&D incentives, millions of our patients will continue to be neglected. Additionally, stricter intellectual property rights have led to the emergence of pharmaceutical monopolies and higher treatment costs, further burdening member states under economic strain. We, as future physicians, support the CEWG report in its mission to “align better commercial incentives and actions by the public sector with health needs, while also seeking to minimize costs.”

Representing over 1.3 million medical students worldwide, IFMSA respectfully urges member states to begin formal negotiations towards implementation of the CEWG report proposals. As healthcare providers, we wish to provide the best, most-evidence based treatments possible to our patients. This report provides a rare opportunity to merge the need for increased biomedical innovation with our professional responsibilities to our patients through coordinated public investment.

FIRST, public investments of innovative approaches to global health research such as those detailed in the report have led to great progress in overcoming current market failures. The CEWG proposals are already in place in the Americas. For example, the NIH National Center for Advancing Translation Sciences (NCATS) assists firms with their pre-clinical efforts in order to meet FDA requirements for investigational new drug applications so that drugs can reach first in-human clinical trials. Smaller companies and academic centers particularly benefit from this, garnering additional contributors to innovation. We therefore believe member-states should begin implementation of such successful models as outlined in CEWG report.

SECOND, many institutions and governments have already adopted Open Knowledge R&D mechanisms as recommended by the CEWG. In May of this year, Argentina passed a law making all government-funded research freely available in an online repository. NIH in the United States through its Public Access Policy ensures that NIH-funded research is available for free online within one year of publication. Such commitments to open access not only benefit patients and providers but also allows for the free flow of information to hasten innovation.

THIRD, several countries in the Americas are currently involved in secret negotiations for the Trans-Pacific Partnership (TPP) Agreement. Leaked TPP text includes provisions that will severely limit access to research and affordable medicines through extended data exclusivity and patent periods as well as low standards for patentability allowing essentially copies of older medications to receive patents. We are concerned that the CEWG proposals will be undermined by adoption of such TPP provisions especially in those member-states in the partnership.

FINALLY, we believe it is necessary that member-states adopt the CEWG’s recommendation regarding financing by contributing 0.01% of their GDP. Such commitment to R&D requires secure financing and this can only be achieved through funding commitments, not voluntary contributions.  One model mentioned earlier, the Global Fund, has in fact suffered from a lack of accountability from voluntary national contributors leading to the lack of funding of new proposals in 2011 and an uncertain future. We urge member-states to make such a commitment through a binding convention in order to ensure the success of such proposals detailed in the report.

We again ask member states to begin negotiations to implement the report’s recommendations as there is a dire need for novel, life saving treatments for our patients, especially those of neglected disease populations

The intervention was well received by member-states as well as those in PAHO who drafted the CEWG, sparking interesting discussion between IFMSA members and others about the real possibility of a binding treaty. From IFMSA’s point of view, without such a binding treaty, there will be no accountability or hope that the recommendations will be adopted by member states. In November, discussion will continue regarding the CEWG report and its implementation. IFMSA hopes to be present there as well to offer its support and suggestions along with the rest of civil society.

During the lunch break, the IFMSA delegation attended the Second Information Session on the Global Fund. The overall objective of this meeting was “Improved positioning of the region of Latin America and the Caribbean in the Global Fund’s governance and operational structures”. The meeting was geared towards:

  • Reviewing recent changes on the funding modalities for the Caribbean and Latin America region
  • Exploring possible collaborations to increase the ability of the member states and the region to best address issues relating to Malaria, AIDS and Tuberculosis.

What is the Global Fund?

Malaria, TB and AIDS affect many persons worldwide and not only are these diseases devastating, but more importantly, they are preventable. The Global Fund dedicates financial support to about 150 countries to aid in the prevention and treatment of these diseases. This is especially important within the Caribbean and Latin America region where there are many developing countries that without these resources would have found it impossible to tackle these maladies.

One area of policy change of the Global Fund is that countries will now be placed in bands based on the earnings of the countries. The focus of the Fund will then be directed on those countries that experience the highest disease burden and have the greatest difficulty in funding interventions. It is purported that this change will ensure that there will be decreased morbidity and mortality from these diseases. The member states however questioned the use of the World Bank’s Income Classification in determining the economical status of each country. This classification uses the gross national income (GNI) per capita. It does not take into consideration debt or spending requirements of the countries.

Some countries within this region, however, thought this would present more harm than good for their nations. Jamaica, for example was listed as one of the countries that would have a cut in the funds that would normally be received. The Minister of Health, however, pointed out that as it relates to AIDS, this would have negative impacts for the island as the Ministry would now have great difficulty in funding wages for persons who were trained and now employed by the Ministry to head prevention and information campaigns in the move to eradicate HIV/AIDS.  The Minister suggested that when changes are to be made in funding policies, more time should be given to enable countries to better transition so that their achievements may be maintained or improved. Another issue with the changes was whether it would be taken into consideration those countries that have formed economical collaborations because they are unable to face to global market individually.

The meeting also reviewed the targets of the region for 2012-2013:

  • Promote treatment optimization in at least 5-7 countries
  • Accelerate Mother to Child transmission in at least 3-5 countries

Reshma Ramachandran (AMSA-USA) and Sachalee Campbell (JAMSA)

28th Pan American Sanitary Conference: [Day 2] “Health in the Americas”

A fresh and cloudy morning welcomed us as we headed to 525 Twenty-third Street. Walking was the best morning energizer to positively start our second day of work at the 28th Pan American Sanitary Conference in Washington D.C. A promising day to actively participate and speak out for our Federation with the intervention regarding the NDC’s regional strategic plan.

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The agenda started with the PAHO program and budget 2010-2011, the presentation of the PAHO Budget Policy and continued with the release of the report on “Health in the Americas” (link).

Average life expectancy in Latin America and the Caribbean rose from 29 years in 1900 to 74 years in 2010, and today 98% of children live to see their first birthday, while 100 years ago only 75% did. However, inequalities persist among and within countries, according to the 2012 edition of Health in the Americas. As Dr. Mirta Roses Periago, director of the PAHO, said: “Each country is a mosaic of situations, places, and communities, and every number, every piece of information, and every statistic represents the face, life, health, and hopes of a single, unique individual, each face has a voice, each voice expresses a need, and each need calls for action.”

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We therefore welcomed this report which we think represents our best opportunity to advocate for the renewal of the commitment to construct a sustainable and evidence based post MDG agenda.

IFMSA, representing medical students from more than 100 countries worldwide, advocates locally and globally to build a post-MDG agenda where Health Equity For All is built on a shared vision of development across the lifecourse and achieved through:

A)Policy integration,

We acknowledge the effort that has been made towards poverty eradication and development but outline the limited progress made in bringing together the historically independent social, economic and environmental policy at both national and international levels. The macroeconomic approach to solving poverty-related disease is simply insufficient to meet the demand of countries. We need to utilize the current momentum to keep the efforts and achieve cross- sectorial integration.

B)Partnerships,

Recognizing WHO’s considerable increasing work in this area – especially with NGOs, who we believe have a great capacity to positively influence the direction of the Organization. We call for cooperation and collaboration between organizations and countries working towards the same goals to address the unfinished agenda of unnecessary, preventable deaths of mothers, children, and other vulnerable population groups and to continue and renew efforts to sustain achievements in health.

C)Engagement of young people.

Youth comprise nearly 30% of the world’s population. Youth have the greatest at stake in our quest for a sustainable after 2015 agenda.

IFMSA is already working to shape the future health and sustainability agenda; we are agents of change and catalysts of development in our countries. The need for more meaningful opportunities of youth involvement in policy and implementation work is one of our major interests as representatives and voice of medical students worldwide so that together with our governments we can find and implement equitable solutions to improve the health and lives of people worldwide.

The agenda went on with the Strategy and plan of action on noncommunicable diseases. In the context of the epidemiological transition the growing importance of noncommunicable diseases as a cause of mortality is not new. What has changed is the recognition of the enormity of the social and economic consequences of a failure to act on this knowledge. It is evident that sums in the order of US$ 11 billion spent now on cost-effective interventions can prevent over US$ 40 trillion-worth of future damage to the world’s economies. Nevertheless, there remains a significant gap between rhetoric and reality when it comes to concrete action and the allocation of resources.1

Where Sachalee Campbell (IFMSA Jamaica) gave an outstanding intervention (http://psc28.wordpress.com/2012/09/18/civil-society-representatives-support-ncd-strategy/) that highlighted our concern about the proposed strategies. The intervention remarked that :

  1. 1.     The NCD crisis is about equity.

Multi-sectoral strategies to reduce the imbalance of social determinants of health must be integrated with efforts to control NCDs as further social inequity will only exacerbate the crisis.

  1. 2.     NCDs are a cross-sectoral issue.

NCDs are closely linked to all three pillars of sustainable development – economic growth, social equity, and environmental protection. The WHO and member states have a powerful voice in this debate and can highlight the potential of sustainable development policies to tackle NCDs. We therefore ask if member-states have consider the implications of both bilateral and multi-lateral free trade agreements such as the Trans-Pacific Partnership Agreement that includes multiple countries in the Americas on access to affordable treatments for NCDs and the potential threat to sustainable development policies including access to nutritious food, clean energy, and healthy environments?

  1. 3.     Progress should be measured by both health and non-health indicators.

In order to accurately evaluate the effectiveness of integrating sustainable development policies to control NCDs.

  1. 4.     Young people should be involved.

Young people in the Americas and worldwide are interested in improving the health statuses of their countries. It is important that we recognize that young people are able to influence development in our region.

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We as IFMSA represent medical students from more than one hundred countries – young people who also suffer from NCDs. As the health professionals of tomorrow, we are committed to combating this major health challenge of our generation.

As Zac Ephron (High School Musical) said “We are all in this together”!

Hugs from Washington,

Altagracia Mares

[Day 1] Welcome to the PAHO/WHO Regional Meeting!

IFMSA, being active on the international scene as usual, has an exceptional delegation to the 28th Pan American Sanitary Conference (also the 64th World Health Organization Regional Meeting). Altagracia Mares de Leon (IFMSA-Mexico), Daniel Tobon Gracia (ASCEMCOL-Colombia), Sachalee Campbell (JAMSA-Jamaica), Reshma Ramachandran (AMSA-USA) and I are representing the IFMSA delegation at the PAHO Meeting in the hopes to represent and voice out IFMSA’s views on the WHO Reform, Child health, NCD strategy and the Consultative Expert Working Group on Research and Development: Financing and Coordination.      Image

Any WHO meeting has some sort of thrill to it. The first day, and even the first speeches, usually determines the direction that the conference will take. From Dr. Mirta Roses (Director of PAHO) to Dr. Margaret Chan (WHO Director General), the focus was not only on social determinants of health and the past progress of the region in terms of health outcomes but also about the post-2015 health agenda and how Universal Health Coverage needs to be at the forefront of global negotiations. PAHO is a very active Regional Office and it is very well respected by its respective member states. Looking at PAHO’s track record, we can observe that major trends emanating from World Health Assembly resolutions actually come from previous PAHO activities: NCD prevention campaigns, vaccination week, etc.

The question that remains is how to move past the Millennium Development Goals? Are Sustainable Development Goals the answer? Official UN processes are already in place for such goals to be formed, but do they really represent the importance of health? Through discussion with Dr. Margaret Chan today, we learnt that if health has a chance in being included within the seven Sustainable Development Goals, it needs to be a goal which encompasses many avenues and doesn’t exclude specific diseases.

According to Dr Margaret Chan, the answer is simple: Universal Health Coverage. It is broad enough so countries can specify their needs and what needs to be covered but, at the same time, it doesn’t exclude any particular disease group such as infectious diseases or NCDs. We all have come to realize that the best indicator for sustainable development is health. Growing economies are only prosperous if there is a significant trickle down effect which entails an improvement in the health of the general population. Hence, this is why health has become a major issue in the Rio+20 discussion this past June. We can no longer deny the multi-sectorial effect of health and the multifactorial factors on health.

Take NCDs for example: healthy lifestyles are promoted, laudable goal, but it is fairly unrealistic to the majority of the population at-risk of NCDs. NCDs are prevalent in populations that do not have a choice but to make the wrong choice. Most of the time it’s not a case of health education, it’s a case of unavailability of making healthy choices. Low-income parents can only feed their children the cheapest way possible; what if the cheapest way is having breakfast at a fast food chain? Can you blame the individual for feeding their children while managing to pay rent? What if their two years old child gets sick, how would they be able to pay for patented drugs?

Such broad questions demand an answer. At PAHO, Member States are determined to give a direction to such solutions, realistic or not. Only time will tell if we are on the right track.

Stay tuned for the updates of the PAHO meeting!

Best,

Alexandre Lefebvre

IFMSA Treasurer 2011-2012,

On behalf of the IFMSA PAHO Delegation