It seems that ever since the World bank / IMF announced that there is a world food crisis looming on the horizon, you cant turn on the news or open a paper without reading yet another article about escalating food prices. A number of connections have been made by the press – most notably to increasing use of corn to produce ethanol, the role of increasing oil prices on food price and the potential to cause political instability in a number of countries.
As far as I know no one has yet made a link to disease and public health. As food becomes difficult to come by, malnutrition associated disease will also rise.
It was refreshing to read a different take in the Guardian on the food crisis that is not just a rehash of the other stories:
______________________________________
A man-made famine
Raj Patel
April 15, 2008 8:30 AM
For anyone who understands the current food crisis, it is hard to listen to the head of the World Bank, Robert Zoellick, without gagging.
Earlier this week, Zoellick waxed apocalyptic about the consequences of the global surge in prices, arguing that free trade had become a humanitarian necessity, to ensure that poor people had enough to eat. The current wave of food riots has already claimed the prime minister of Haiti, and there have been protests around the world, from Mexico, to Egypt, to India.
The reason for the price rise is perfect storm of high oil prices, an increasing demand for meat in developing countries, poor harvests, population growth, financial speculation and biofuels. But prices have fluctuated before. The reason we're seeing such misery as a result of this particular spike has everything to do with Zoellick and his friends.
Before he replaced Paul Wolfowitz at the World Bank, Zoellick was the US trade representative, their man at the World Trade Organisation. While there, he won a reputation as a tough and guileful negotiator, savvy with details and pushy with the neoconservative economic agenda: a technocrat with a knuckleduster.
His mission was to accelerate two decades of trade liberalisation in key strategic commodities for the United States, among them agriculture. Practically, this meant the removal of developing countries' ability to stockpile grain (food mountains interfere with the market), to create tariff barriers (ditto), and to support farmers (they ought to be able to compete on their own). This Zoellick did often, and enthusiastically.
Without agricultural support policies, though, there's no buffer between the price shocks and the bellies of the poorest people on earth. No option to support sustainable smaller-scale farmers, because they've been driven off their land by cheap EU and US imports. No option to dip into grain reserves because they've been sold off to service debt. No way of increasing the income of the poorest, because social programmes have been cut to the bone.
The reason that today's price increases hurt the poor so much is that all protection from price shocks has been flayed away, by organisations such as the International Monetary Fund, the World Trade Organisation and the World Bank.
Even the World Bank's own Independent Evaluation Group admits that the bank has been doing a poor job in agriculture. Part of the bank's vision was to clear away the government agricultural clutter so that the private sector could come in to make agriculture efficient. But, as the Independent Evaluation Group delicately puts it, "in most reforming countries, the private sector did not step in to fill the vacuum when the public sector withdrew." After the liberalisation of agriculture, the invisible hand was nowhere to be seen.
But governments weren't allowed to return to the business of supporting agriculture. Trade liberalisation agreements and World Bank loan conditions, such as those promoted by Zoellick, have made food sovereignty impossible.
This is why, when we see Dominique Strauss-Kahn of the IMF wailing about food prices, or Zoellick using the crisis to argue with breathless urgency for more liberalisation, the only reasonable response is nausea.
Wednesday, April 16, 2008
Tuesday, April 15, 2008
Dengue Outbreak Sweeps Through Rio
New York Times April 15, 2008
By MERY GALANTERNICK and ALEXEI BARRIONUEVO
RIO DE JANEIRO — Heavy rains over the past month have created a fertile breeding ground for mosquitoes carrying the dengue fever virus, deepening a crisis that has claimed at least 80 lives in Rio State.
The dengue strain ravaging this tropical city is now believed to be stronger and more lethal than the virus responsible for an epidemic in 2002, considered the worst in recent history in Brazil, according to Dr. Jacob Kligerman, health secretary for the city.
The spreading epidemic has shown no signs of slowing. Since January, 75,399 people have been infected in Rio State, health officials say. The mortality rate is now more than three times as high as it was during the epidemic in 2002, which claimed 91 lives.
complete article
From Paho:
By MERY GALANTERNICK and ALEXEI BARRIONUEVO
RIO DE JANEIRO — Heavy rains over the past month have created a fertile breeding ground for mosquitoes carrying the dengue fever virus, deepening a crisis that has claimed at least 80 lives in Rio State.
The dengue strain ravaging this tropical city is now believed to be stronger and more lethal than the virus responsible for an epidemic in 2002, considered the worst in recent history in Brazil, according to Dr. Jacob Kligerman, health secretary for the city.
The spreading epidemic has shown no signs of slowing. Since January, 75,399 people have been infected in Rio State, health officials say. The mortality rate is now more than three times as high as it was during the epidemic in 2002, which claimed 91 lives.
complete article
From Paho:
Dengue in Rio de Janeiro, Brazil
From 1 January to 26 March, 2008, the Brazilian health authorities have reported 406 cases of dengue hemorrhagic fever (DHF), with 34 deaths nationally. This constitutes a significant increase in the number of cases in several states compared to the same period in 2007: Amazonas (9.8 times), Rondônia (5.3 times), Sergipe (4.7 times), Bahia (3.4 times), Rio Grande do Norte (2.8 times), Pará (2.5 times), and Rio de Janeiro (2.2 times). DEN 2 and DEN 3 are the circulating serotypes.
The state of Rio de Janeiro has reported 32,615 cases of dengue fever (DF), making up 38% of the total number of cases registered in the country, and 245 cases of DHF. A change in the age distribution of severe cases has been observed: of the 2,116 patients hospitalized, 53% were children under the age of 14 years. There have been 20 reported deaths due to DHF, 8 due to Dengue Shock Syndrome (DSS) and 19 due to DF with complications. More than 50% of the deaths have occurred among children aged 2–13 years. The number of deaths suggests a more severe evolution of clinical illness than expected.
The Ministry of Health (Ministério da Saúde / MS) is working closely with the Rio de Janeiro branch of the Center for Strategic Information in Health Surveillance (Centro de Informações Estratégicas em Vigilância em Saúde / CIEVS: about) to implement the required control measures and identify priority areas for intervention. The Ministry has already mobilized 100 health professionals to the federal hospitals of Rio de Janeiro to support patient management activities, including clinical case management and laboratory diagnosis. Additionally, 550 public health and emergency services professionals will be recruited by the end of next week to assist community-based interventions. Vector control activities were implemented throughout Rio de Janeiro State and especially in the Municipality of Rio de Janeiro. The fire department, military, and health inspectors from the National Health Foundation (Fundação Nacional de Saúde, FUNASA/MS) are assisting in these activities.
Sunday, April 13, 2008
Family Planning Gets Mere Sliver of Aid Pie
By Thalif Deen
UNITED NATIONS, Apr 11 (IPS) - The United Nations warns that a sharp decline in international funding for reproductive health is threatening global efforts to reduce poverty, improve health and empower women worldwide.
"This is especially evident in the case of funding for family planning where absolute dollar amounts are lower than they were in 1995," says Secretary-General Ban Ki-moon, in a report released here.
If this trend is not reversed, he cautions, it will have "serious implications for the ability of countries to address the unmet need for such services, and could undermine efforts to prevent unintended pregnancies and reduce maternal and infant mortality."
Compounding the problem further, the largest share of population funding is now being diverted to fight HIV/AIDS and other sexually transmitted diseases (STDs).
Thoraya Ahmed Obaid, executive director of the U.N. Population (UNFPA), says funding for family planning as a percentage of all population assistance has dropped considerably, from 55 percent in 1995 to 7.0 percent in 2005.
"The victims of this funding gap are poor women in poor countries who cannot exercise their reproductive rights and plan their families," she told IPS. "It is a serious problem that needs to be urgently addressed."
Addressing a weeklong meeting of the U.N. Commission on Population and Development (CPD), which concluded Friday, Obaid said there are some 200 million women in the developing world with unmet needs for effective contraception.
The highest number, she said, is in Africa.
"The result is increasing numbers of unwanted pregnancies, rising rates of unsafe abortion, and increased risks to the lives of women and children," she told the Commission.
The current crisis, Obaid pointed out, is also threatening to undermine the U.N.'s Millennium Development Goals (MDGs), including reduction in extreme poverty and improvement on maternal health.
"We will not attain the Millennium Development Goals, especially MDG 5 on maternal health, if we do not ensure universal access to reproductive health," Obaid said.
"Sexual and reproductive health is essential to women's empowerment and gender equality. And family planning is key to maternal and child health," she added.
full article
UNITED NATIONS, Apr 11 (IPS) - The United Nations warns that a sharp decline in international funding for reproductive health is threatening global efforts to reduce poverty, improve health and empower women worldwide.
"This is especially evident in the case of funding for family planning where absolute dollar amounts are lower than they were in 1995," says Secretary-General Ban Ki-moon, in a report released here.
If this trend is not reversed, he cautions, it will have "serious implications for the ability of countries to address the unmet need for such services, and could undermine efforts to prevent unintended pregnancies and reduce maternal and infant mortality."
Compounding the problem further, the largest share of population funding is now being diverted to fight HIV/AIDS and other sexually transmitted diseases (STDs).
Thoraya Ahmed Obaid, executive director of the U.N. Population (UNFPA), says funding for family planning as a percentage of all population assistance has dropped considerably, from 55 percent in 1995 to 7.0 percent in 2005.
"The victims of this funding gap are poor women in poor countries who cannot exercise their reproductive rights and plan their families," she told IPS. "It is a serious problem that needs to be urgently addressed."
Addressing a weeklong meeting of the U.N. Commission on Population and Development (CPD), which concluded Friday, Obaid said there are some 200 million women in the developing world with unmet needs for effective contraception.
The highest number, she said, is in Africa.
"The result is increasing numbers of unwanted pregnancies, rising rates of unsafe abortion, and increased risks to the lives of women and children," she told the Commission.
The current crisis, Obaid pointed out, is also threatening to undermine the U.N.'s Millennium Development Goals (MDGs), including reduction in extreme poverty and improvement on maternal health.
"We will not attain the Millennium Development Goals, especially MDG 5 on maternal health, if we do not ensure universal access to reproductive health," Obaid said.
"Sexual and reproductive health is essential to women's empowerment and gender equality. And family planning is key to maternal and child health," she added.
full article
Thursday, April 10, 2008
South Asia to fall short on the Millennium Development Goals
April 8, 2008 - A new World Bank-IMF report, Global Monitoring Report: MDGs and the Environment—Agenda for Inclusive and Sustainable Development, warns that most countries in South Asia will fall short on the Millennium Development Goals (MDGs), a set of eight globally agreed development goals with a due date of 2015. Though much of the world, including South Asia, is set to cut extreme poverty in half by then, prospects are gravest for the goals of reducing child and maternal mortality, with serious shortfalls also likely in primary school completion, nutrition, and sanitation goals.
Health
Malnutrition
- While much progress has been made in reducing under-five malnutrition, South Asia will likely not reach the goal of halving its incidence. South Asia has the highest incidence of child malnutrition; the child malnutrition rate in India is double the African average. The risk of malnutrition increases with high food prices.
- South Asia actually has a slightly higher incidence than Sub-Saharan Africa of moderate stunting, but a lower incidence of severe stunting this is part of the malnutrition piece.
Maternal Health
- The percentage of births attended by skilled personnel is low in South Asia (41 percent) and Sub-Saharan Africa (46 percent).
Child Mortality
- South Asia is also off track for reaching the MDG child mortality target.
Thursday, April 3, 2008
Grim outlook for an AIDS vaccine
http://www.nytimes.com/2008/03/30/opinion/30sun3.html
Editorial
Grim Outlook for an AIDS Vaccine
Published: March 30, 2008
Back in 1984, federal health officials, flush with excitement over discovery of the virus that causes AIDS, famously predicted that they would have a vaccine ready for market within three years. Now, after almost a quarter-century of toil and struggle, the effort has crashed in failure. No one yet knows whether a vaccine to prevent the disease will ever be possible.
David Baltimore, a Nobel-winning biologist, sounded a note of despair in an address to the American Association for the Advancement of Science in February. He noted that the virus has evolved in a way that makes it virtually impossible to attack by priming the immune system, the usual goal of a vaccine. Repeated efforts have failed, he said, leaving “no hopeful route to success.” The best hope, he said, may lie in the biological equivalent of a “Hail Mary” pass — a wholly new approach that would combine gene therapy, stem cells and immunologic therapy to thwart the disease.
At a conference at the National Institutes of Health last Tuesday, AIDS experts assessed how to proceed after the failure of the most promising vaccine candidate in two large clinical trials last year. Early results showed that those who received the vaccine may actually have been more likely to become infected with the virus than those who did not.
At least one organization that treats AIDS patients has called for giving up on a vaccine and shifting the money to testing, treatment and prevention. That is too defeatist. Federal health officials are rightly determined to increase financing for basic laboratory research, curtail big clinical trials of existing vaccine candidates, and funnel money to researchers with novel ideas. There is little doubt that a vaccine would be the most effective and cheapest way to shrink the AIDS epidemic.
Wednesday, April 2, 2008
Tropical Disease "Experts" Call For A "Global Fund To Fight Neglected Tropical Diseases"
PLoS NTD (Mar. 26, 2008)
An international team of tropical disease control experts has urged the global health and development community, and particularly the G8 leaders, to establish a new financing mechanism to combat the neglected tropical diseases (NTDs) of poverty.
A "Global Fund to Fight Neglected Tropical Diseases," say Professor Hotez (Sabin Vaccine Institute and George Washington University, Washington, DC, USA) and colleagues, would "satisfy an urgent need to support NTD control and elimination."
The NTDs, such as intestinal worms, schistosomiasis, elephantiasis, and river blindness, represent the most common infections of the world's poorest--the bottom billion. They are a major reason, say the authors, why the world's poorest people cannot escape a vicious, downward spiral of poverty.
Fortunately, they say, "we are now in a unique position to control or eliminate some of the highest burden NTDs through integrated use of donated drugs." The mass administration of such drugs just once a year has been the cornerstone of global projects aimed at tackling several of the NTDs, and the launch of a dedicated fund to scale up these activities would be "one of the most cost-effective and urgently needed approaches for sustainable poverty reduction."
A blueprint for such a funding mechanism already exists: the Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, has attracted $4.7 billion in financing for these three diseases. Professor Hotez and colleagues argue that the mandate of this fund could easily be expanded to include the NTDs.
Thus a new fund for NTDs could be established that uses a similar mechanism to that of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Countries burdened by NTDs would apply to the new fund for financing for NTD control efforts, and an expert board (supported by the expertise of the World Health Organization) could vet the applications.
"An important next step," say the authors, "would be to address global NTD control at the annual G8 leaders summit." The summit will be held in Hokkaido Toyako, Japan, later this year. "While gathered in Japan, the development community needs a robust discussion about the importance of the NTDs as global health, educational, and economic threats."
The G8 summit, they say, presents an opportunity for G8 leaders to consider earmarking specific funds for NTD control. "A comparatively modest amount of funds--in the range of $2 billion in total over 5 years--should be deposited and earmarked for treatment programs targeting the poorest populations in the poorest countries."
The proposal to establish a "Global Fund to Fight Neglected Tropical Diseases" is co-authored by Professor David Molyneux (Liverpool School of Tropical Medicine, UK), Professor Alan Fenwick (Schistosomiasis Control Initiative, Imperial College London, UK), Dr Lorenzo Savioli (Director, Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland), and Professor Tsutomu Takeuchi (Department of Tropical Medicine and Parasitology, Keio University, Tokyo, Japan).
Journal reference: Hotez PJ, Molyneux DH, Fenwick A, Savioli L, Takeuchi T (2008) A Global Fund to Fight Neglected Tropical Diseases: Is the G8 Hokkaido Toyako 2008 Summit Ready? PLoS Negl Trop Dis 2(3): e220. doi:10.1371/journal.pntd.0000220
An international team of tropical disease control experts has urged the global health and development community, and particularly the G8 leaders, to establish a new financing mechanism to combat the neglected tropical diseases (NTDs) of poverty.
A "Global Fund to Fight Neglected Tropical Diseases," say Professor Hotez (Sabin Vaccine Institute and George Washington University, Washington, DC, USA) and colleagues, would "satisfy an urgent need to support NTD control and elimination."
The NTDs, such as intestinal worms, schistosomiasis, elephantiasis, and river blindness, represent the most common infections of the world's poorest--the bottom billion. They are a major reason, say the authors, why the world's poorest people cannot escape a vicious, downward spiral of poverty.
Fortunately, they say, "we are now in a unique position to control or eliminate some of the highest burden NTDs through integrated use of donated drugs." The mass administration of such drugs just once a year has been the cornerstone of global projects aimed at tackling several of the NTDs, and the launch of a dedicated fund to scale up these activities would be "one of the most cost-effective and urgently needed approaches for sustainable poverty reduction."
A blueprint for such a funding mechanism already exists: the Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, has attracted $4.7 billion in financing for these three diseases. Professor Hotez and colleagues argue that the mandate of this fund could easily be expanded to include the NTDs.
Thus a new fund for NTDs could be established that uses a similar mechanism to that of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Countries burdened by NTDs would apply to the new fund for financing for NTD control efforts, and an expert board (supported by the expertise of the World Health Organization) could vet the applications.
"An important next step," say the authors, "would be to address global NTD control at the annual G8 leaders summit." The summit will be held in Hokkaido Toyako, Japan, later this year. "While gathered in Japan, the development community needs a robust discussion about the importance of the NTDs as global health, educational, and economic threats."
The G8 summit, they say, presents an opportunity for G8 leaders to consider earmarking specific funds for NTD control. "A comparatively modest amount of funds--in the range of $2 billion in total over 5 years--should be deposited and earmarked for treatment programs targeting the poorest populations in the poorest countries."
The proposal to establish a "Global Fund to Fight Neglected Tropical Diseases" is co-authored by Professor David Molyneux (Liverpool School of Tropical Medicine, UK), Professor Alan Fenwick (Schistosomiasis Control Initiative, Imperial College London, UK), Dr Lorenzo Savioli (Director, Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland), and Professor Tsutomu Takeuchi (Department of Tropical Medicine and Parasitology, Keio University, Tokyo, Japan).
Journal reference: Hotez PJ, Molyneux DH, Fenwick A, Savioli L, Takeuchi T (2008) A Global Fund to Fight Neglected Tropical Diseases: Is the G8 Hokkaido Toyako 2008 Summit Ready? PLoS Negl Trop Dis 2(3): e220. doi:10.1371/journal.pntd.0000220
Sally Pipes - Patent enforcer and President of the Pacific Research Institute
The mission of the Pacific Research Institute (PRI) is to champion freedom, opportunity, and personal responsibility for all individuals by advancing free-market policy solutions... enough said.
--------------
Sanction nations selling generic versions of drugs?
YES: Thailand used `compulsory licensing' as economic boost
SALLY PIPES
Charlotte Observer
When it comes to public health, Thailand's former government leaders would like the world to think that they're a collection of 21st-century Robin Hoods.
Last year, the unelected military-backed government gave Thailand's state-run pharmaceutical firm, the Government Pharmaceutical Organization (GPO), permission to manufacture generic versions of drugs that fight heart disease and AIDS, even though the medicines were still patented by Western firms.
Robbing the rich to give to the poor? Not really. Sick Thai citizens have yet to see any benefits and the move has set a dangerous precedent that will stifle medical innovation and endanger the health of millions.
Thai officials broke the patents by using "compulsory licenses," a legal maneuver afforded to poor countries by the World Trade Organization (WTO) in the event of a public health crisis. If a local government can't afford a pertinent patented drug, it can issue a compulsory license to produce it before the patent has expired.
But these provisions were never intended to be used by countries that could afford the medicines but are simply choosing to pay less in order to make other purchases -- like tanks for example. Since 2006, the nation has increased its defense budget by over 30 percent.
The reality is that the former government officials used compulsory licenses to pursue their own economic development. Their scheme is just protectionism by a different name.
Giving the GPO permission to manufacture patented drugs is part of the Thai government's plan to establish itself as a globally competitive producer of generics. Nothing is wrong with the government wanting to encourage its own industry -- but not when that's done at the expense of patients and other countries who abide by the law.
So far, the gambit has proven quite lucrative. In 2005, Thailand's GPO reaped $35 million in profits by copying medicines. Only 2 percent of that went toward research and development.
The billions of dollars in free medicines and development projects pouring into sub-Saharan Africa don't come for free. Those must be funded at least in part, from countries like Thailand that can afford to pay some of the cost -- even if not at the same scale the U.S. can afford.
Activists justify compulsory licenses by claiming that drug makers focus on diseases affecting only rich countries.
But that's simply not true. Over 100 drug-development projects that specifically target diseases plaguing the Third World are currently under way. Western pharmaceutical firms have already devised life-saving treatments for HIV/AIDS, tuberculosis, and malaria. And they often offer patented drugs to poor countries for free or at a steep discount.
The new Thai government is wisely examining this issue and appears more interested in pursuing a thoughtful, long-term policy of economic development. That will serve its citizens far better than quick-fix schemes that result in Thailand becoming a hero to anti-capitalist activists, but a pariah to the world economic community.
Sally C. Pipes is president and CEO of the Pacific Research Institute
--------------
Sanction nations selling generic versions of drugs?
YES: Thailand used `compulsory licensing' as economic boost
SALLY PIPES
Charlotte Observer
When it comes to public health, Thailand's former government leaders would like the world to think that they're a collection of 21st-century Robin Hoods.
Last year, the unelected military-backed government gave Thailand's state-run pharmaceutical firm, the Government Pharmaceutical Organization (GPO), permission to manufacture generic versions of drugs that fight heart disease and AIDS, even though the medicines were still patented by Western firms.
Robbing the rich to give to the poor? Not really. Sick Thai citizens have yet to see any benefits and the move has set a dangerous precedent that will stifle medical innovation and endanger the health of millions.
Thai officials broke the patents by using "compulsory licenses," a legal maneuver afforded to poor countries by the World Trade Organization (WTO) in the event of a public health crisis. If a local government can't afford a pertinent patented drug, it can issue a compulsory license to produce it before the patent has expired.
But these provisions were never intended to be used by countries that could afford the medicines but are simply choosing to pay less in order to make other purchases -- like tanks for example. Since 2006, the nation has increased its defense budget by over 30 percent.
The reality is that the former government officials used compulsory licenses to pursue their own economic development. Their scheme is just protectionism by a different name.
Giving the GPO permission to manufacture patented drugs is part of the Thai government's plan to establish itself as a globally competitive producer of generics. Nothing is wrong with the government wanting to encourage its own industry -- but not when that's done at the expense of patients and other countries who abide by the law.
So far, the gambit has proven quite lucrative. In 2005, Thailand's GPO reaped $35 million in profits by copying medicines. Only 2 percent of that went toward research and development.
The billions of dollars in free medicines and development projects pouring into sub-Saharan Africa don't come for free. Those must be funded at least in part, from countries like Thailand that can afford to pay some of the cost -- even if not at the same scale the U.S. can afford.
Activists justify compulsory licenses by claiming that drug makers focus on diseases affecting only rich countries.
But that's simply not true. Over 100 drug-development projects that specifically target diseases plaguing the Third World are currently under way. Western pharmaceutical firms have already devised life-saving treatments for HIV/AIDS, tuberculosis, and malaria. And they often offer patented drugs to poor countries for free or at a steep discount.
The new Thai government is wisely examining this issue and appears more interested in pursuing a thoughtful, long-term policy of economic development. That will serve its citizens far better than quick-fix schemes that result in Thailand becoming a hero to anti-capitalist activists, but a pariah to the world economic community.
Sally C. Pipes is president and CEO of the Pacific Research Institute
Turner, Lutherans and Methodists Churches propose $200 m to Fight Malaria
By RACHEL ZOLL – 22 hours ago
NEW YORK (AP) — Ted Turner formed a $200 million partnership Tuesday with Lutherans and Methodists to fight malaria, apologizing for his past criticism of religion as he announced the effort.
Turner, 69, said he had only made a few disparaging comments a long time ago and that he is "always developing" his thinking as he grows older.
"I regret anything I said about religion that was negative," he said in a brief interview with The Associated Press.
Years ago, the CNN founder called Christianity a "religion for losers." He also wrote his own version of the 10 Commandments and asked CNN employees who commemorated Ash Wednesday whether they were "Jesus freaks," saying they should work for Fox. He apologized at the time.
Turner now says he does not considering himself agnostic or atheist, as he had sometimes described himself previously. He prays for sick friends because "it doesn't hurt," he said, and maintains several churches on his properties for his employees and others who live nearby.
He said he has attended the churches a few times, but isn't a regular.
"I find it really hard to believe I'm going to hell," Turner said.
Turner said he had read the Bible "cover to cover twice" even though some of it is "pretty tedious" and considered becoming a missionary as a boy. But he rejected religion after his younger sister died of a form of lupus when they were both young.
On Tuesday, Turner's United Nations Foundation, which he started in 1997 with a $1 billion donation, launched the malaria project with the Evangelical Lutheran Church in America, the Lutheran Church-Missouri Synod and the United Methodist Church. The Protestant groups have been working overseas to fight poverty and prevent disease for more than a century.
"Religion is one of the bright spots as far as I'm concerned, even though there are some areas, like everything else, where they've gone over the top a little, in my opinion, " Turner said. "But I'm sure God, wherever he is, wants to see us get along with one another and love one another."
The Bill & Melinda Gates Foundation also provided a $10 million grant that will help promote the campaign in churches. The Protestant groups together have more than 15 million U.S. members.
Turner's foundation had been working with many groups, including the Methodists, on the Nothing But Nets campaign, which provides insecticide-treated bed nets in needy communities. Lutheran World Relief also had been helping malaria-infected communities.
But their new joint project has an even more ambitious goal: to stop deaths from malaria.
The United Methodist Church will raise $100 million for the project. The Evangelical Lutheran Church in America and the Lutheran Church-Missouri Synod, with their humanitarian arm Lutheran World Relief, will raise between $75 million and $100 million.
"This will be the largest campaign of its type ever for Lutherans," said the Rev. John Nunes, president and chief executive of Lutheran World Relief.
Turner has not completely embraced faith.
He said he continues to subscribe to his alternative commandments, which he called the "Ten Voluntary Initiatives." They include caring for people and the earth, promising not to have more than two children and contributing to the less fortunate.
Nunes said that while the new anti-malaria project will address the underlying poverty that contributes to the spread of the disease, it will not involve distributing contraception.
"The religious community is huge and has a very good reputation for being able to mobilize resources," Turner said. "Why not use them and be thankful?"
NEW YORK (AP) — Ted Turner formed a $200 million partnership Tuesday with Lutherans and Methodists to fight malaria, apologizing for his past criticism of religion as he announced the effort.
Turner, 69, said he had only made a few disparaging comments a long time ago and that he is "always developing" his thinking as he grows older.
"I regret anything I said about religion that was negative," he said in a brief interview with The Associated Press.
Years ago, the CNN founder called Christianity a "religion for losers." He also wrote his own version of the 10 Commandments and asked CNN employees who commemorated Ash Wednesday whether they were "Jesus freaks," saying they should work for Fox. He apologized at the time.
Turner now says he does not considering himself agnostic or atheist, as he had sometimes described himself previously. He prays for sick friends because "it doesn't hurt," he said, and maintains several churches on his properties for his employees and others who live nearby.
He said he has attended the churches a few times, but isn't a regular.
"I find it really hard to believe I'm going to hell," Turner said.
Turner said he had read the Bible "cover to cover twice" even though some of it is "pretty tedious" and considered becoming a missionary as a boy. But he rejected religion after his younger sister died of a form of lupus when they were both young.
On Tuesday, Turner's United Nations Foundation, which he started in 1997 with a $1 billion donation, launched the malaria project with the Evangelical Lutheran Church in America, the Lutheran Church-Missouri Synod and the United Methodist Church. The Protestant groups have been working overseas to fight poverty and prevent disease for more than a century.
"Religion is one of the bright spots as far as I'm concerned, even though there are some areas, like everything else, where they've gone over the top a little, in my opinion, " Turner said. "But I'm sure God, wherever he is, wants to see us get along with one another and love one another."
The Bill & Melinda Gates Foundation also provided a $10 million grant that will help promote the campaign in churches. The Protestant groups together have more than 15 million U.S. members.
Turner's foundation had been working with many groups, including the Methodists, on the Nothing But Nets campaign, which provides insecticide-treated bed nets in needy communities. Lutheran World Relief also had been helping malaria-infected communities.
But their new joint project has an even more ambitious goal: to stop deaths from malaria.
The United Methodist Church will raise $100 million for the project. The Evangelical Lutheran Church in America and the Lutheran Church-Missouri Synod, with their humanitarian arm Lutheran World Relief, will raise between $75 million and $100 million.
"This will be the largest campaign of its type ever for Lutherans," said the Rev. John Nunes, president and chief executive of Lutheran World Relief.
Turner has not completely embraced faith.
He said he continues to subscribe to his alternative commandments, which he called the "Ten Voluntary Initiatives." They include caring for people and the earth, promising not to have more than two children and contributing to the less fortunate.
Nunes said that while the new anti-malaria project will address the underlying poverty that contributes to the spread of the disease, it will not involve distributing contraception.
"The religious community is huge and has a very good reputation for being able to mobilize resources," Turner said. "Why not use them and be thankful?"
Village health teams get bicycles
Amref's distribution of bicycles and insecticide-treated bed nets to village health teams, leads to questions that do not have straightforward answers, reports Richard M Kavuma
By Richard M Kavuma
Guardian.co.uk,
Friday March 28 2008
John Michael Ekeu hands over a bicycle and bed-net to Janet Abieto. Photograph: Richard M Kavuma
The 66 men and women smiled broadly and joked with one another as they each received a bicycle from Amref at the NGO's office in Katine. Merok is one of the six parishes that make up Katine sub-county and it now has 66 village health team (VHT) members. They recently completed 10 days of training by Amref to strengthen their work as drug distributors, health educators and sanitation promoters at village level.
Amref has given them bicycles to overcome a key challenge – transport. The week before, each VHT also got an insecticide-treated bed net to keep away mosquitoes that cause malaria, the number one killer in Uganda.
First to emerge was Janet Abieto from Abari village. The 33-year-old smiled shyly as she noticed my camera, before stopping as if to mount the bicycle to check its height. Noticing that some parts of the bike were still wrapped in polythene, she began peeling it away with the impatience borne of excitement.
Bicycles are the major means of transport in Katine, and the Indian-made, $70 Hero and Roadmaster brands given out here are popular in Uganda. Bicycles are crucial for VHTs because their work involves collecting drugs from the main health centre (located as far as 10 kilometres away), attending meetings and mobilising scattered households for educational and other activities.
Handing over the items, the sub-county's secretary for health and education, John Michael Ekeu, acknowledged that being a VHT member was a very demanding task. He thanked Amref for the support and the VHTs for their dedication. "Since you have volunteered, please do it with one heart," Ekeu told them all. "And if you meet difficulties, please do not hesitate to report to us."
Dr Charles Luwaga, the Katine project officer for health, reminded the VHTs that the bicycles were given to them to do official work and not for personal business. In effect these bicycles belong to the villages for which the volunteers work.
"If you visit a friend riding this bicycle, do not forget to carry out health education: if you notice sanitation issues in your friend's home, talk about them," Luwaga explained.
Katine VHT bikes 220x260 A VHT walks away with her bicycle. Photograph: Richard M Kavuma
But the VHTs were full of questions. "If you say that the bicycle belongs to the village, then anyone in the village might come and say, 'lend me that bicycle that Amref gave you.'" one man complained.
Another one asked: "If you lend the bicycle to someone who wants to take a patient to hospital and it gets stolen from there, what happens?"
In the end Luwaga clarified that the VHTs were to use discretion, as they would do with their own bicycles. Only time will tell, however, whether these community resources will be safe in private hands. As Luwaga anticipated, some issues will remain tricky.
"Some of you ladies are married: these bicycles are not for your husbands. Please tell your husband that, 'this bicycle is for me to do VHT work'," he said, attracting a bemused murmur from the women's corner.
But there was no dampening the excitement. In fact, some VHTs took their bicycles before the assembly team had fully tightened all the screws.
Meanwhile the VHTs reported back on how the distribution of bed nets they received the previous week had gone. It was terrible. Why? Because the demand was high and there were not enough nets. After training, each VHT is given 15 bed nets to distribute, making it 30 nets per village. With some villages having as many as 130 households, it was always going to be difficult deciding who to give them to.
"We decided to give them to children under five," said Willy Ecau, a VHT from Omariai village in Katine parish. "There are many of those, but we chose one child from different households. We tried to balance that by taking one household from one end, another from the other end."
By Richard M Kavuma
Guardian.co.uk,
Friday March 28 2008
John Michael Ekeu hands over a bicycle and bed-net to Janet Abieto. Photograph: Richard M Kavuma
The 66 men and women smiled broadly and joked with one another as they each received a bicycle from Amref at the NGO's office in Katine. Merok is one of the six parishes that make up Katine sub-county and it now has 66 village health team (VHT) members. They recently completed 10 days of training by Amref to strengthen their work as drug distributors, health educators and sanitation promoters at village level.
Amref has given them bicycles to overcome a key challenge – transport. The week before, each VHT also got an insecticide-treated bed net to keep away mosquitoes that cause malaria, the number one killer in Uganda.
First to emerge was Janet Abieto from Abari village. The 33-year-old smiled shyly as she noticed my camera, before stopping as if to mount the bicycle to check its height. Noticing that some parts of the bike were still wrapped in polythene, she began peeling it away with the impatience borne of excitement.
Bicycles are the major means of transport in Katine, and the Indian-made, $70 Hero and Roadmaster brands given out here are popular in Uganda. Bicycles are crucial for VHTs because their work involves collecting drugs from the main health centre (located as far as 10 kilometres away), attending meetings and mobilising scattered households for educational and other activities.
Handing over the items, the sub-county's secretary for health and education, John Michael Ekeu, acknowledged that being a VHT member was a very demanding task. He thanked Amref for the support and the VHTs for their dedication. "Since you have volunteered, please do it with one heart," Ekeu told them all. "And if you meet difficulties, please do not hesitate to report to us."
Dr Charles Luwaga, the Katine project officer for health, reminded the VHTs that the bicycles were given to them to do official work and not for personal business. In effect these bicycles belong to the villages for which the volunteers work.
"If you visit a friend riding this bicycle, do not forget to carry out health education: if you notice sanitation issues in your friend's home, talk about them," Luwaga explained.
Katine VHT bikes 220x260 A VHT walks away with her bicycle. Photograph: Richard M Kavuma
But the VHTs were full of questions. "If you say that the bicycle belongs to the village, then anyone in the village might come and say, 'lend me that bicycle that Amref gave you.'" one man complained.
Another one asked: "If you lend the bicycle to someone who wants to take a patient to hospital and it gets stolen from there, what happens?"
In the end Luwaga clarified that the VHTs were to use discretion, as they would do with their own bicycles. Only time will tell, however, whether these community resources will be safe in private hands. As Luwaga anticipated, some issues will remain tricky.
"Some of you ladies are married: these bicycles are not for your husbands. Please tell your husband that, 'this bicycle is for me to do VHT work'," he said, attracting a bemused murmur from the women's corner.
But there was no dampening the excitement. In fact, some VHTs took their bicycles before the assembly team had fully tightened all the screws.
Meanwhile the VHTs reported back on how the distribution of bed nets they received the previous week had gone. It was terrible. Why? Because the demand was high and there were not enough nets. After training, each VHT is given 15 bed nets to distribute, making it 30 nets per village. With some villages having as many as 130 households, it was always going to be difficult deciding who to give them to.
"We decided to give them to children under five," said Willy Ecau, a VHT from Omariai village in Katine parish. "There are many of those, but we chose one child from different households. We tried to balance that by taking one household from one end, another from the other end."
The man who battled big pharma
Published: March 29 2008 02:00 | Last updated: March 29 2008 02:00
Financial Times
On a hot morning in a dusty suburb of Mumbai, Rajiv, a man in his thirties, carries out the brief monthly transaction that keeps him alive. He passes through an unmarked door, up the stairs to the first floor of a crumbling clinic and waits, his head bowed. In a scene repeated by hundreds of thousands of patients from Argentina to Zimbabwe, he receives a box of Triomune, an HIV medicine that has helped turn a death sentence into a chronic disease.
On a wall of the clinic, operated by the charity Medecins sans Frontieres, a poster bears the words ''Patent on Aids drugs'' inside a circle struck out by a thick red line. The phrase ''lives before profit'' is written below. ''Medicine is our main expenditure,'' says Freya Raddi, the director. ''With cheaper drugs, we can use whatever money we have to help more patients.''
Cheap drugs are big business in India, as well as a source of fierce debate. Among the country's manufacturers of cut-price generic ''copies'' of other pharmaceuticals' products, Cipla, which makes Triomune, has caused the greatest controversy. Its owner, Yusuf Hamied, makes his products by circumventing other companies' patents, a tactic that has turned Cipla into the largest supplier of antiretroviral drugs in the world.
The last two decades of the 20th century saw a scientific revolution in the development of antiretroviral drugs for Aids. But it is commercial savvy like Hamied's that has translated these clinical advances into accessible treatment for HIV patients across the developing world.
To his supporters, Hamied has saved countless lives by making medicines affordable. But to his critics - above all the large western pharmaceuticals who first developed the drugs - he is a ''pirate'', an opportunist who has exploited others' intellectual property to swell his own profits. In the process, they say, he is undermining investment in future medicines, including the next generation of HIV therapies.
As the debate about generic copies gained momentum, India introduced tougher patent rules in 2005, and Hamied's fellow generic producers have aligned themselves with western rivals to defend patents. Their aim now is to develop and safeguard their own innovative medicines. These changes are a threat to Cipla's business model - and to the cheaper drugs that help keep clinics such as Raddi's going. Hamied says: ''I am not against patents, but India cannot afford them. I am against monopolies.''
Yusuf Hamied's father, Khwaja Abdul Hamied, had just completed his studies in chemistry in Allahabad, northern India, in 1921 when he responded to a call from Mahatma Gandhi to join him in an ashram. Inspired by the Indian independence movement, he continued his studies in Berlin before returning to Bombay with licences to sell typewriters, sewing machines and Okasa, a tonic for male impotence. The drug set the stage for his new company, Chemical Industrial and Pharmaceutical Laboratories, in 1935.
Four years later, at the outbreak of the second world war, Gandhi visited Cipla's headquarters. ''He told my father that the British were offering independence if India would support the war effort. He needed supplies,'' Hamied recalls. As demand for medicines from the Indian army surged, and supplies from European manufacturers collapsed, Cipla provided quinine to treat malaria, emetine injections for dysentery and nikethamide tablets for trauma.
Hamied senior died in 1972, 12 years after his son had joined the family business as a researcher. Today, Hamied junior runs the company, which has become among the largest in India, giving him a personal fortune estimated at $1.3bn. In a bustling downtown quarter of Mumbai, he looks defiant. White haired and relaxed in a blue shirt, he bounds into a conference room at Cipla's headquarters. The room looks more like a pharmacy, lined with glass cabinets stocked with hundreds of packets of pills and syrups, each bearing the Cipla brand name.
Most western pharmaceutical companies have displays of their products. But their high-priced, patent-protected medicines usually fit into a small case in the reception hall. Cipla is different. ''We have more products than any [drug] company in the world,'' Hamied says. ''More than a thousand for humans, and a hundred for animals. That's because they are, in inverted commas, 'copy products'.''
Among the medicines displayed in front of us are treatments for HIV, including Triomune. But there is also Hamied's Asthalin respiratory drug, and Silagra, his version of Viagra that sells in India for 5 per cent of the price of Pfizer's original. ''We have lots of fun with the names,'' he says mischievously.
Wherever big pharmaceutical companies' patented drugs have come to public attention, Cipla has been swift to follow. When the US demanded cheap treatments for anthrax in the aftermath of 9/11, Hamied proposed his own cut-price version of Bayer's Cipro, a powerful antibiotic. When human deaths from bird flu in Turkey sparked rich countries to stockpile Roche's antiviral drug Tamiflu, he offered his own far cheaper version, Antiflu.
In recent decades, the western drug industry has built its success on the back of the patent system. While academics with government funding have carried out the basic science behind most medical breakthroughs, companies have borne the costs of running expensive clinical trials to convert these discoveries into drugs tested for safety and efficacy in humans. In exchange, they have been granted exclusive rights through the patent system to make and sell the drugs that successfully pass regulatory scrutiny, recovering their costs by charging high prices for the remaining years of the patent. Only after its expiry can generic drug companies launch their own cut-price but chemically identical versions.
The system has worked reasonably well in the developed world, with national health systems and insurers picking up the price of patented medicines for most patients, allowing drug companies to reinvest the profits in future research. But it has run into difficulties in poor countries, where rising expectations for treatment clash with modest state support for health. Few individuals are able to pay for their own drugs.
Hamied argues that western drug companies should - at best in exchange for modest royalties - allow generic producers to compete by making their medicines available immediately at the lowest possible cost, giving access to many more patients who would not otherwise be able to buy them. But he stresses that he has abided by legislation, even where he disagrees with it. ''I don't break patents,'' he says. ''I live by the law of the land.''
Hamied is an unlikely pin-up for many of his cheerleaders in the developing world. Born in 1936 in Vilnius, Lithuania, he eschews any formal religious adherence, even though his father was a Muslim who knew the Koran by heart, and his mother Jewish. ''I believe in what's right and wrong,'' he says. Today, the money he makes from Cipla allows him to indulge a penchant for race horses and art collecting, and a peripatetic lifestyle split between luxurious homes in London, Marbella, Mauritius and Mumbai.
However much he divides the drug industry over his tactics, Hamied is recognised as a brilliant chemist. He shared his father's passion for the subject - completing a PhD at Cambridge - before returning to Bombay to join the family business. Denis Broun, who once worked with Hamied and now runs the UN Aids programme office in Delhi, says: ''He has the most incredible passion for chemistry, and he's a genius at reverse engineering,'' referring to the process of analysing other companies' patented medicines and working out ways to reproduce them more efficiently. ''He has an outstanding memory, and knows the price of the raw materials of any product.''
But when Hamied returned to India, he found that there was not much scope to apply his talents. ''When I came back in 1960, it hit me. I saw that every avenue was closed,'' he recalls. A restrictive patent law introduced by the British in 1911 held back local drug production. Imported medicines were often sold at higher prices in India than Europe. When Hamied lobbied the local representatives of the western drug companies for permission to make their products, ''they all said go to hell''.
The following year, Hamied helped form the Indian Drug Manufacturers' Association with the aim of weakening the patent regime to help local producers. The breakthrough came a decade later, when its members presented their case to Indira Gandhi, the prime minister. At the time, ICI's cardiac drug, Propranolol, was inaccessible to Indians. ''We said to her that this drug is life-saving, and why should millions be deprived of it just because the patent holder doesn't like the colour of our skin? She passed the bill within a week.''
India's patent law came into force in 1972. It signalled the start of a golden era for the country's generic companies, and above all for Cipla. While the new legislation protected ''process'' patents - covering the specific way a medicine was manufactured - it denied the more usual ''product'' patents on the drugs themselves. The stranglehold of multinational pharmaceutical companies in India was broken.
At his office, Hamied grabs a pile of chemistry journals for bedtime reading and ushers me out. He waves away his driver, gets into his BMW, and eases out into the Mumbai traffic, where mastery of the horn and rapid swerving are king. Just such unorthodox manoeuvring was necessary in Hamied's biggest battle: the launch of cheap antiretroviral medicines. At the start of the 1990s, the Indian Council on Medical Research asked him if he could make a version of Glaxo Wellcome's AZT, the first Aids medicine. Within two years, it was on sale at one-fifth of the western price. But even then few Indians could afford it, and, to his anger, the authorities said their budget would be spent on prevention. ''I lost my shirt, and closed down manufacturing,'' he says.
But within a few years, Hamied's interest in Aids treatments was rekindled. He read reports of far more effective drugs ''cocktails'' and was moved by the death of a friend from HIV in Uganda. Health activists in the US and Europe keen to expand treatment into the developing world approached him for help, and Triomune, launched in 2000, was the result.
Hamied reproduced the most important cocktail of three medicines - Stavudine, Lamivudine and Nevirapine - each to be taken twice a day. But he also innovated. He put the separate drugs, each made by a competing company, into a single ''fixed-dose combination'' tablet. Reducing the number of daily pills from six to two increased the chance that patients would take them as prescribed, boosting their chance of survival and reducing drug resistance.
With the Indian authorities still providing almost no funding for treatment, his second innovation was to offer cut-price Triomune to other countries with no patent protection, notably in Africa, where the impact of HIV was greatest. He offered to sell them to Medecins sans Frontieres clinics for $1 a day, less than one-thirtieth of the price of existing HIV medicines. ''The first six months were absolute hell, as big pharma tried to run us down,'' he says. Richard Sykes, head of Glaxo, denounced Hamied as a ''pirate'' and described the quality of Indian generic drugs as ''iffy''. Hamied fired back, saying that the company was a ''global serial killer'' for charging such high prices.
His actions helped trigger a revolution. Around the same time, political leaders called for substantial increases in funding. Litigation by the big drug companies to enforce their patents in South Africa collapsed and they began to offer bigger discounts on HIV medicines to poorer countries. ''Now the big boys have wised up. We have educated them,'' he says. Cipla continued to win orders, in the process helping create new international systems for drug procurement and regulation.
''We have provided a third-world solution for the whole world,'' says Hamied. ''It gives us tremendous satisfaction. Every year, I tell our shareholders they should be very happy they are contributing to a humanitarian cause.''
Hamied is helped in this cause by his family, who control 40 per cent of Cipla. And while Triomune offers lower margins than the company's other products, he concedes that it is profitable. With $110m sales to 500,000 patients in the developing world, HIV medicines have helped the company boost its profits and its reputation.
Ranjit Shahani shakes his head as he reflects on Hamied over dinner at Mumbai's elite Willingdon Sports Club, its musty colonial-era dining room populated more by retainers than customers. ''He's a great chemist. I just wish he'd used his scientific knowledge for fundamental research. He could have been equally if not more successful in the cause of innovation.''
As head of the Indian operations of Novartis, the Swiss pharmaceutical giant, Shahani has found himself on the other side of the courtroom to Hamied, in the first test case since India introduced tougher laws recognising product patents in 2005. Cipla was one of half a dozen generics companies that launched equivalents of Novartis's leukaemia drug, Glivec, at a fraction of the price. As the litigation continues, Hamied maintains that the version of the medicine on which Novartis sought protection represents only a modest ''incremental innovation'', outside the terms of the new patent law.
Shahani, like executives from other western pharmaceuticals, believes instead that Indian law should be still tougher, and that the old-style generic model represented by Cipla is coming to an end. ''Weak patents are not sustainable,'' he says. ''The solution to providing affordable drugs has to be via donation programmes, tiered pricing and partnerships. It can't be built on destroying patents. That destroys innovation and hope for the future.''
Shahani has gathered some unexpected allies. Malvinder Singh, who runs the pharmaceutical group Ranbaxy, compares Cipla with his company by saying: ''They are just two very different business models. Hamied has a good company doing very well. But his strength has been entirely because of weak intellectual property [protection]. We think you need to have patents. The focus for us is how to replicate our generics success on the innovative side.''
We are sitting in his recently completed marble-clad corporate headquarters, in Gurgaon, just outside Delhi. Ranbaxy - founded by Singh's father, a long-standing acquaintance of Hamied - has taken a different route in recent years, reaching compromises abroad, acquiring foreign companies wholesale and launching generic medicines in the US and Europe.
It has also forged alliances to try to develop innovative medicines with western companies, including GlaxoSmithKline. This summer, it will follow several of its Indian peers and spin off Ranbaxy Life Science Research, a subsidiary focused exclusively on new medicines. Like other Indian pharma companies with research interests, it now advocates tougher patent laws, which in a few years could protect its products from competition.
Meanwhile, Cipla has had a taste of its own medicine from HIV-treatment groups. Last August, the Aids Healthcare Foundation, a US-based charity with treatment centres in India, launched a campaign against the company, throwing its own corporate slogan ''none shall be denied'' back at it in newspaper advertisements. It criticised Cipla for proposing prices in India twice as high as in Africa for Viraday, its version of the latest HIV drugs cocktail, Atripla.
''Viraday would be our drug of choice, but it's too expensive,'' says Chinkholal Thangsing, head of the Foundation's regional office in Delhi. ''For the same price of one treatment, I'd rather treat five patients with something else. We always let the generics companies off, but they are taking advantage. Cipla has been blinded by all the kudos.''
Hamied has fought back, threatening legal action and retorting that the Foundation is funded by Gilead, the US pharmaceuticals company which markets Atripla and is attempting to defend its patents. As we share a final meal at Mumbai's exclusive Breach Candy Club, he expresses frustration that the Foundation, and others - from Medecins sans Frontieres to the Clinton Foundation - have taken advantage of him by seeking low-price quotes for high volumes of orders, and then buying far smaller volumes if any at all.
Hamied senses the pressure mounting on all sides. There is aggressive price competition from other generics companies, and he says Cipla's reputation as ''the bad boy'' means it cannot find foreign partners. He is pessimistic that his Indian peers can successfully diversify into developing new medicines, saying ''we won't exist in 20 years' time''.
As we nibble buttered lobster, he accuses his government of ''selective genocide'' for tightening the patent regime, which he believes will make drugs unaffordable in India again. ''Thirty years ago, there was a national spirit. That's missing today.''
Andrew Jack is the FT's pharmaceuticals correspondent.
Financial Times
On a hot morning in a dusty suburb of Mumbai, Rajiv, a man in his thirties, carries out the brief monthly transaction that keeps him alive. He passes through an unmarked door, up the stairs to the first floor of a crumbling clinic and waits, his head bowed. In a scene repeated by hundreds of thousands of patients from Argentina to Zimbabwe, he receives a box of Triomune, an HIV medicine that has helped turn a death sentence into a chronic disease.
On a wall of the clinic, operated by the charity Medecins sans Frontieres, a poster bears the words ''Patent on Aids drugs'' inside a circle struck out by a thick red line. The phrase ''lives before profit'' is written below. ''Medicine is our main expenditure,'' says Freya Raddi, the director. ''With cheaper drugs, we can use whatever money we have to help more patients.''
Cheap drugs are big business in India, as well as a source of fierce debate. Among the country's manufacturers of cut-price generic ''copies'' of other pharmaceuticals' products, Cipla, which makes Triomune, has caused the greatest controversy. Its owner, Yusuf Hamied, makes his products by circumventing other companies' patents, a tactic that has turned Cipla into the largest supplier of antiretroviral drugs in the world.
The last two decades of the 20th century saw a scientific revolution in the development of antiretroviral drugs for Aids. But it is commercial savvy like Hamied's that has translated these clinical advances into accessible treatment for HIV patients across the developing world.
To his supporters, Hamied has saved countless lives by making medicines affordable. But to his critics - above all the large western pharmaceuticals who first developed the drugs - he is a ''pirate'', an opportunist who has exploited others' intellectual property to swell his own profits. In the process, they say, he is undermining investment in future medicines, including the next generation of HIV therapies.
As the debate about generic copies gained momentum, India introduced tougher patent rules in 2005, and Hamied's fellow generic producers have aligned themselves with western rivals to defend patents. Their aim now is to develop and safeguard their own innovative medicines. These changes are a threat to Cipla's business model - and to the cheaper drugs that help keep clinics such as Raddi's going. Hamied says: ''I am not against patents, but India cannot afford them. I am against monopolies.''
Yusuf Hamied's father, Khwaja Abdul Hamied, had just completed his studies in chemistry in Allahabad, northern India, in 1921 when he responded to a call from Mahatma Gandhi to join him in an ashram. Inspired by the Indian independence movement, he continued his studies in Berlin before returning to Bombay with licences to sell typewriters, sewing machines and Okasa, a tonic for male impotence. The drug set the stage for his new company, Chemical Industrial and Pharmaceutical Laboratories, in 1935.
Four years later, at the outbreak of the second world war, Gandhi visited Cipla's headquarters. ''He told my father that the British were offering independence if India would support the war effort. He needed supplies,'' Hamied recalls. As demand for medicines from the Indian army surged, and supplies from European manufacturers collapsed, Cipla provided quinine to treat malaria, emetine injections for dysentery and nikethamide tablets for trauma.
Hamied senior died in 1972, 12 years after his son had joined the family business as a researcher. Today, Hamied junior runs the company, which has become among the largest in India, giving him a personal fortune estimated at $1.3bn. In a bustling downtown quarter of Mumbai, he looks defiant. White haired and relaxed in a blue shirt, he bounds into a conference room at Cipla's headquarters. The room looks more like a pharmacy, lined with glass cabinets stocked with hundreds of packets of pills and syrups, each bearing the Cipla brand name.
Most western pharmaceutical companies have displays of their products. But their high-priced, patent-protected medicines usually fit into a small case in the reception hall. Cipla is different. ''We have more products than any [drug] company in the world,'' Hamied says. ''More than a thousand for humans, and a hundred for animals. That's because they are, in inverted commas, 'copy products'.''
Among the medicines displayed in front of us are treatments for HIV, including Triomune. But there is also Hamied's Asthalin respiratory drug, and Silagra, his version of Viagra that sells in India for 5 per cent of the price of Pfizer's original. ''We have lots of fun with the names,'' he says mischievously.
Wherever big pharmaceutical companies' patented drugs have come to public attention, Cipla has been swift to follow. When the US demanded cheap treatments for anthrax in the aftermath of 9/11, Hamied proposed his own cut-price version of Bayer's Cipro, a powerful antibiotic. When human deaths from bird flu in Turkey sparked rich countries to stockpile Roche's antiviral drug Tamiflu, he offered his own far cheaper version, Antiflu.
In recent decades, the western drug industry has built its success on the back of the patent system. While academics with government funding have carried out the basic science behind most medical breakthroughs, companies have borne the costs of running expensive clinical trials to convert these discoveries into drugs tested for safety and efficacy in humans. In exchange, they have been granted exclusive rights through the patent system to make and sell the drugs that successfully pass regulatory scrutiny, recovering their costs by charging high prices for the remaining years of the patent. Only after its expiry can generic drug companies launch their own cut-price but chemically identical versions.
The system has worked reasonably well in the developed world, with national health systems and insurers picking up the price of patented medicines for most patients, allowing drug companies to reinvest the profits in future research. But it has run into difficulties in poor countries, where rising expectations for treatment clash with modest state support for health. Few individuals are able to pay for their own drugs.
Hamied argues that western drug companies should - at best in exchange for modest royalties - allow generic producers to compete by making their medicines available immediately at the lowest possible cost, giving access to many more patients who would not otherwise be able to buy them. But he stresses that he has abided by legislation, even where he disagrees with it. ''I don't break patents,'' he says. ''I live by the law of the land.''
Hamied is an unlikely pin-up for many of his cheerleaders in the developing world. Born in 1936 in Vilnius, Lithuania, he eschews any formal religious adherence, even though his father was a Muslim who knew the Koran by heart, and his mother Jewish. ''I believe in what's right and wrong,'' he says. Today, the money he makes from Cipla allows him to indulge a penchant for race horses and art collecting, and a peripatetic lifestyle split between luxurious homes in London, Marbella, Mauritius and Mumbai.
However much he divides the drug industry over his tactics, Hamied is recognised as a brilliant chemist. He shared his father's passion for the subject - completing a PhD at Cambridge - before returning to Bombay to join the family business. Denis Broun, who once worked with Hamied and now runs the UN Aids programme office in Delhi, says: ''He has the most incredible passion for chemistry, and he's a genius at reverse engineering,'' referring to the process of analysing other companies' patented medicines and working out ways to reproduce them more efficiently. ''He has an outstanding memory, and knows the price of the raw materials of any product.''
But when Hamied returned to India, he found that there was not much scope to apply his talents. ''When I came back in 1960, it hit me. I saw that every avenue was closed,'' he recalls. A restrictive patent law introduced by the British in 1911 held back local drug production. Imported medicines were often sold at higher prices in India than Europe. When Hamied lobbied the local representatives of the western drug companies for permission to make their products, ''they all said go to hell''.
The following year, Hamied helped form the Indian Drug Manufacturers' Association with the aim of weakening the patent regime to help local producers. The breakthrough came a decade later, when its members presented their case to Indira Gandhi, the prime minister. At the time, ICI's cardiac drug, Propranolol, was inaccessible to Indians. ''We said to her that this drug is life-saving, and why should millions be deprived of it just because the patent holder doesn't like the colour of our skin? She passed the bill within a week.''
India's patent law came into force in 1972. It signalled the start of a golden era for the country's generic companies, and above all for Cipla. While the new legislation protected ''process'' patents - covering the specific way a medicine was manufactured - it denied the more usual ''product'' patents on the drugs themselves. The stranglehold of multinational pharmaceutical companies in India was broken.
At his office, Hamied grabs a pile of chemistry journals for bedtime reading and ushers me out. He waves away his driver, gets into his BMW, and eases out into the Mumbai traffic, where mastery of the horn and rapid swerving are king. Just such unorthodox manoeuvring was necessary in Hamied's biggest battle: the launch of cheap antiretroviral medicines. At the start of the 1990s, the Indian Council on Medical Research asked him if he could make a version of Glaxo Wellcome's AZT, the first Aids medicine. Within two years, it was on sale at one-fifth of the western price. But even then few Indians could afford it, and, to his anger, the authorities said their budget would be spent on prevention. ''I lost my shirt, and closed down manufacturing,'' he says.
But within a few years, Hamied's interest in Aids treatments was rekindled. He read reports of far more effective drugs ''cocktails'' and was moved by the death of a friend from HIV in Uganda. Health activists in the US and Europe keen to expand treatment into the developing world approached him for help, and Triomune, launched in 2000, was the result.
Hamied reproduced the most important cocktail of three medicines - Stavudine, Lamivudine and Nevirapine - each to be taken twice a day. But he also innovated. He put the separate drugs, each made by a competing company, into a single ''fixed-dose combination'' tablet. Reducing the number of daily pills from six to two increased the chance that patients would take them as prescribed, boosting their chance of survival and reducing drug resistance.
With the Indian authorities still providing almost no funding for treatment, his second innovation was to offer cut-price Triomune to other countries with no patent protection, notably in Africa, where the impact of HIV was greatest. He offered to sell them to Medecins sans Frontieres clinics for $1 a day, less than one-thirtieth of the price of existing HIV medicines. ''The first six months were absolute hell, as big pharma tried to run us down,'' he says. Richard Sykes, head of Glaxo, denounced Hamied as a ''pirate'' and described the quality of Indian generic drugs as ''iffy''. Hamied fired back, saying that the company was a ''global serial killer'' for charging such high prices.
His actions helped trigger a revolution. Around the same time, political leaders called for substantial increases in funding. Litigation by the big drug companies to enforce their patents in South Africa collapsed and they began to offer bigger discounts on HIV medicines to poorer countries. ''Now the big boys have wised up. We have educated them,'' he says. Cipla continued to win orders, in the process helping create new international systems for drug procurement and regulation.
''We have provided a third-world solution for the whole world,'' says Hamied. ''It gives us tremendous satisfaction. Every year, I tell our shareholders they should be very happy they are contributing to a humanitarian cause.''
Hamied is helped in this cause by his family, who control 40 per cent of Cipla. And while Triomune offers lower margins than the company's other products, he concedes that it is profitable. With $110m sales to 500,000 patients in the developing world, HIV medicines have helped the company boost its profits and its reputation.
Ranjit Shahani shakes his head as he reflects on Hamied over dinner at Mumbai's elite Willingdon Sports Club, its musty colonial-era dining room populated more by retainers than customers. ''He's a great chemist. I just wish he'd used his scientific knowledge for fundamental research. He could have been equally if not more successful in the cause of innovation.''
As head of the Indian operations of Novartis, the Swiss pharmaceutical giant, Shahani has found himself on the other side of the courtroom to Hamied, in the first test case since India introduced tougher laws recognising product patents in 2005. Cipla was one of half a dozen generics companies that launched equivalents of Novartis's leukaemia drug, Glivec, at a fraction of the price. As the litigation continues, Hamied maintains that the version of the medicine on which Novartis sought protection represents only a modest ''incremental innovation'', outside the terms of the new patent law.
Shahani, like executives from other western pharmaceuticals, believes instead that Indian law should be still tougher, and that the old-style generic model represented by Cipla is coming to an end. ''Weak patents are not sustainable,'' he says. ''The solution to providing affordable drugs has to be via donation programmes, tiered pricing and partnerships. It can't be built on destroying patents. That destroys innovation and hope for the future.''
Shahani has gathered some unexpected allies. Malvinder Singh, who runs the pharmaceutical group Ranbaxy, compares Cipla with his company by saying: ''They are just two very different business models. Hamied has a good company doing very well. But his strength has been entirely because of weak intellectual property [protection]. We think you need to have patents. The focus for us is how to replicate our generics success on the innovative side.''
We are sitting in his recently completed marble-clad corporate headquarters, in Gurgaon, just outside Delhi. Ranbaxy - founded by Singh's father, a long-standing acquaintance of Hamied - has taken a different route in recent years, reaching compromises abroad, acquiring foreign companies wholesale and launching generic medicines in the US and Europe.
It has also forged alliances to try to develop innovative medicines with western companies, including GlaxoSmithKline. This summer, it will follow several of its Indian peers and spin off Ranbaxy Life Science Research, a subsidiary focused exclusively on new medicines. Like other Indian pharma companies with research interests, it now advocates tougher patent laws, which in a few years could protect its products from competition.
Meanwhile, Cipla has had a taste of its own medicine from HIV-treatment groups. Last August, the Aids Healthcare Foundation, a US-based charity with treatment centres in India, launched a campaign against the company, throwing its own corporate slogan ''none shall be denied'' back at it in newspaper advertisements. It criticised Cipla for proposing prices in India twice as high as in Africa for Viraday, its version of the latest HIV drugs cocktail, Atripla.
''Viraday would be our drug of choice, but it's too expensive,'' says Chinkholal Thangsing, head of the Foundation's regional office in Delhi. ''For the same price of one treatment, I'd rather treat five patients with something else. We always let the generics companies off, but they are taking advantage. Cipla has been blinded by all the kudos.''
Hamied has fought back, threatening legal action and retorting that the Foundation is funded by Gilead, the US pharmaceuticals company which markets Atripla and is attempting to defend its patents. As we share a final meal at Mumbai's exclusive Breach Candy Club, he expresses frustration that the Foundation, and others - from Medecins sans Frontieres to the Clinton Foundation - have taken advantage of him by seeking low-price quotes for high volumes of orders, and then buying far smaller volumes if any at all.
Hamied senses the pressure mounting on all sides. There is aggressive price competition from other generics companies, and he says Cipla's reputation as ''the bad boy'' means it cannot find foreign partners. He is pessimistic that his Indian peers can successfully diversify into developing new medicines, saying ''we won't exist in 20 years' time''.
As we nibble buttered lobster, he accuses his government of ''selective genocide'' for tightening the patent regime, which he believes will make drugs unaffordable in India again. ''Thirty years ago, there was a national spirit. That's missing today.''
Andrew Jack is the FT's pharmaceuticals correspondent.
$11bn fund to cut impact of malaria
By Andrew Jack in London,
FT.com site
Published: Jan 24, 2008
A group of government and business leaders will on Friday unveil a plan to raise and spend $11bn over five years in a fresh effort to sharply reduce the impact of malaria in the developing world.
The Malaria Implementation Support Task Force plans to rapidly boost prevention and treatment measures in the 30 African countries most hard hit by malaria, which causes more than a million deaths and very large numbers of hospital admissions each year.
The move marks a fresh effort to reinvigorate the fight to eradicate malaria, using a series of well-tested approaches including the distribution of bed nets, indoor spraying with pesticides and combination drug therapies.
It follows long-standing frustration that malaria continues to cause widespread personal and economic damage, despite frequent political pressure, growing funds and a number of existing organisations working to tackle the parasite.
The new task force, to be announced at the World Economic Forum in Davos, will be jointly chaired by the head of the World Health Organisation, Ethiopia's health minister, and Malaria No More, a business-led group.
It will work closely with Roll Back Malaria, the existing multi-lateral coordinating body, as well as the Global Fund to fight Aids, TB and Malaria, the World Bank, Unicef and the Bill & Melinda Gates Foundation.
Rajat Gupta from McKinsey, which drew up the new estimate of costs, and who also chairs the Global Fund, said that past efforts had failed because the groups involved "represented the interests and politics of the organisations they came from and were not answerable to the common task in hand."
He said: "We have pretty much all the tools to aggressively control the disease and reduce or eliminate mortality, but it has not been done."
The Gates Foundation last autumn offered fresh funding as part of a long-term objective to eradicate malaria.
FT.com site
Published: Jan 24, 2008
A group of government and business leaders will on Friday unveil a plan to raise and spend $11bn over five years in a fresh effort to sharply reduce the impact of malaria in the developing world.
The Malaria Implementation Support Task Force plans to rapidly boost prevention and treatment measures in the 30 African countries most hard hit by malaria, which causes more than a million deaths and very large numbers of hospital admissions each year.
The move marks a fresh effort to reinvigorate the fight to eradicate malaria, using a series of well-tested approaches including the distribution of bed nets, indoor spraying with pesticides and combination drug therapies.
It follows long-standing frustration that malaria continues to cause widespread personal and economic damage, despite frequent political pressure, growing funds and a number of existing organisations working to tackle the parasite.
The new task force, to be announced at the World Economic Forum in Davos, will be jointly chaired by the head of the World Health Organisation, Ethiopia's health minister, and Malaria No More, a business-led group.
It will work closely with Roll Back Malaria, the existing multi-lateral coordinating body, as well as the Global Fund to fight Aids, TB and Malaria, the World Bank, Unicef and the Bill & Melinda Gates Foundation.
Rajat Gupta from McKinsey, which drew up the new estimate of costs, and who also chairs the Global Fund, said that past efforts had failed because the groups involved "represented the interests and politics of the organisations they came from and were not answerable to the common task in hand."
He said: "We have pretty much all the tools to aggressively control the disease and reduce or eliminate mortality, but it has not been done."
The Gates Foundation last autumn offered fresh funding as part of a long-term objective to eradicate malaria.
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