Evidence, Access and Sustainability from a Population Health Perspective

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Evidence, Access and Sustainability from a
Population Health Perspective

• Chan Chee Khoon
• Womens Development Research Center
• Universiti Sains Malaysia
• ckchan50_at_yahoo.com
• March 27, 2007

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Gro Harlem BrundtlandDirector-General, World
Health Organisation (July 5, 2003)

• SARS (Severe Acute Respiratory Syndrome) can
  be contained despite the absence of robust
  diagnostic tests, a vaccine, or any specific
  treatment. When awareness, commitment, and
  determination are high, even such traditional
  control tools as isolation, contact tracing, and
  quarantine can be sufficiently powerful to break
  the chain of transmission.

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(No Transcript)
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Simon Szreter Amer J Public Health 92722-725
(2002)

• The medical professions scientific leaders
  have, since McKeowns time, had to change their
  tack and concentrate on the future, rather than
  the past, as the field in which they can stake
  the claim that they can save humanity from all
  its ailments with science.

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Biomedical Science Human Health

• The ongoing campaigns for access to
  anti-retrovirals testify to the potential impact
  of treatment for the public health control of the
  HIV/AIDS pandemic. Access to lifesaving
  treatment for infected individuals is
  emphatically a moral and ethical imperative.
  Beyond that, the availability of effective
  therapy may also encourage those at high risk to
  come forward for voluntary testing, and hence
  reduce the pool of infected-but-unaware
  individuals who constitute one of the drivers of
  the pandemic.
• It is nonetheless noteworthy that, just as with
  the SARS epidemic, the Nipah outbreak in Malaysia
  (1998-1999) was rapidly brought under control
  without vaccines or efficacious therapies, once
  the modes of transmission were established. The
  knowledge that Nipah encephalitis was linked to a
  newly recognised paramyxovirus which could be
  transmitted through close proximity to live,
  infected pigs but not via insect vectors, fomites
  or suspended airborne particulates, or contact
  with raw or prepared meats (ascertained from
  virological studies, field epidemiology, and
  clinical medicine), allowed for its rapid control
  in humans.

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In appraising the contributions of modern
biomedical science to disease control and human
health, it may be useful to distinguish between
knowledge-based practices and coping responses,
as opposed to consumable commodities. This
distinction is especially pertinent when we
consider the strategic priorities of
market-driven research and product development,
in contrast to publicly funded, needs-driven
research in the biomedical sciences.
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Biomedical Advances Human HealthSome
pertinent questions

• how important are biomedical advances (incl.
  genomics) to population health and to patient
  care? what is the relative significance of
  genetics in the etiology (and social ecology) of
  health and disease?
• what are realistic expectations of the advances
  that genomics can contribute to disease control,
  diagnostic aids, and treatment? in what ways can
  pathogen genomics be most useful in epidemic
  control strategies?
• what are the likely trajectories of genomics RD
  in the foreseeable future, given the current
  modalities for funding of biomedical research,
  the associated regimes of patents, intellectual
  property rights, and market-driven product
  development, and the chronically unresolved
  problems of neglected diseases of the poor?
• what would be an enabling environment for the
  realization of the useful potential of genomics?
  for an equitable harvest of benefits and a humane
  deployment of genomic technologies that can avoid
  the emergence of a marginalized genetic
  underclass and the imposition of arbitrary,
  constructed norms?

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.drug research and development for diseases that
disproportionately affect poor people in
developing countries is at a virtual standstill.
According to a Lancet article by Patrice
Trouiller et al (June 22, 2002), of the 1,393 new
drugs approved between 1975 and 1999, only 16 (or
just over 1 percent) were specifically developed
for tropical diseases and tuberculosis, diseases
that account for 11.4 percent of the global
disease burden. Doctors Without Border (Médecins
Sans Frontiéres, 1999 Nobel Peace Prize) has
called attention to the problem of "neglected
diseases" -- seriously disabling or
life-threatening diseases such as malaria,
tuberculosis (TB), Human African trypanosomiasis
(sleeping sickness), American trypanosomiasis
(Chagas' disease), and visceral leishmaniasis
(kala azar) -- which mainly affect people in
developing countries, for which treatment options
are inadequate or do not exist, and for which RD
is insufficient or non-existent. Those stricken
with neglected diseases do not constitute a
valuable enough market to stimulate adequate RD
by the multinational pharmaceutical industry.
With a global system that relies on private
companies to bring drugs to market, this
situation has left much of the world without
prospect for treatment and cure of the diseases
that take a dreadful toll on their populations.

Médecins Sans Frontières (2002)
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Michael Kremer Rachel Glannerste, Creating a
Market for Vaccines (New York Times, June 1,
2001).

• for 13 out of those 16 drugs, two were
  modifications of existing medicines, two were
  produced for the US military, and five came from
  veterinary research.
• Only 4 were developed by commercial
  pharmaceutical companies specifically for
  tropical diseases in humans.

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Abbott Backlash Activists push for global
boycott The Nation, March 20, 2007

• Bangkok-based health advocacy groups yesterday
  began a mass campaign to boycott giant US
  drug-maker Abbott Laboratories and vowed to bring
  the campaign to a global level. The company
  withdrew its applications for registration of its
  new drugs in Thailand in protest at the
  government's decision to use compulsory licensing
  for the company's blockbuster Aids medication.
• The health groups, including the powerful Rural
  Doctors Society which once brought down a public
  health minister, a group representing pharmacists
  around the country, the globally-respected
  Medicins Sans Frontieres (MSF) and various
  consumer networks vowed to boycott Abbott
  products until the company changed its mind.
• Kannikar Kitjiwatchakul, a campaigner at the MSF
  Bangkok office, said MSF offices around the world
  are now discussing whether to raise the boycott
  campaign to a global level. Saree Aongsomwang,
  (Foundation for Consumers), said more than 220
  members of Consumers International in 115
  countries would join the boycott. "Since Abbott
  has challenged Thailand and shown it doesn't care
  about Thai consumers, please stop using any of
  its products," she said. This act by Abbott is
  totally unacceptable.

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Flu virus samples not for profiteering, says
Jakarta The Nation, March 15, 2007

• Indonesia will not share bird flu samples with
  the World Health Organisation without a legally
  binding agreement promising the virus will not be
  used to develop an unaffordable commercial
  vaccine, the health minister said yesterday.
  Health Minister Siti Fadilah Supari said last
  months letter of guarantee from WHO
  Director-General Margaret Chan was not good
  enough. Thats just an agreement in principle
  Supari said.
• Supari said the system, which enables influenza
  virus samples to be freely passed throughout
  the global community for public health purposes,
  needs to be revised so it is fair for developing
  countries, poor countries, affected countries.
  We will not share our virus sample without a
  change in the rules. Indonesia is worried that
  large drug companies will use its H5N1 strain to
  make vaccines that will ultimately be
  unaffordable for developing nations. It stopped
  sending samples of its bird flu virus to WHO-
  affiliated laboratories at the start of this year.

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Lancet editorial (February 17, 2007)

• To protect the global population, 6.2 billion
  doses of pandemic vaccine will be needed, but
  current manufacturing capacity can only produce
  500 million doses. In November 2004, a WHO
  consultation reached the depressing conclusion
  that most developing countries would have no
  access to vaccine during the first wave of a
  pandemic and possibly throughout its
  durationIndonesias move to secure an affordable
  vaccine supply for its population is
  understandable the country has made a
  controversial decision not to share its H5N1
  virus samples with WHO. Indonesia is instead
  planning to provide a US pharmaceutical company
  Baxter with the strains in exchange for
  technology to manufacture a pandemic vaccine.
  This strategy is a marked departure from the
  existing WHO virus-sharing system, in which
  influenza viruses are donated by countries and
  flow freely to the global community for vaccine
  development. Indonesia fears that vaccines
  produced from their viruses via the WHO system
  will not be affordable to them. The fairest way
  forward would be for WHO to seek an international
  agreement that would ensure that developing
  countries have equal access to a pandemic
  vaccine, at an affordable price.

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Thank You