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As U.S. Balks on Medicine Deal, African Patients Feel the Pain

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  • bobutne
    Big Drug Firms, Protecting Their Patents, Seek Limits to a Global Trade Accord By ROGER THUROW and SCOTT MILLER Staff Reporters of THE WALL STREET JOURNAL
    Message 1 of 4 , Jun 2, 2003
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      Big Drug Firms, Protecting Their Patents, Seek Limits to a Global
      Trade Accord By ROGER THUROW and SCOTT MILLER Staff Reporters of THE
      WALL STREET JOURNAL


      N'DJAMENA, Chad -- At the central hospital in this decrepit capital,
      the lone cardiologist writes prescription after prescription for
      medicine to relieve hypertension. But he acknowledges that few of his
      patients will ever fill his orders.

      "They often can't find the medicine in Chad, and if they do, they
      can't afford it," says Dr. Mouanodji Mbaissouroum.

      By now, Dr. Mbaissouroum and many of his colleagues throughout the
      developing world had hoped that relief would be on the way for the
      chronic affliction of unavailable and unaffordable drugs. Wealthier
      countries, where the drugs are produced and patented, promised 18
      months ago at global trade talks in Doha, Qatar, to loosen patent
      restrictions in order to ease shortages and reduce prices. It was
      just after Sept. 11, 2001, and the U.S. led the rhetorical charge,
      eager to demonstrate its desire to battle suffering among the world's
      poor, while mounting a war on terrorism.

      But last December, when all of the other 143 countries in the World
      Trade Organization had lined up behind a new plan on the trade of
      medicines, the U.S. blocked the proposal. The Bush administration,
      under heavy lobbying from a pharmaceutical industry seeking to limit
      the scope of the deal, endorsed a list of some 20 infectious diseases
      that it was willing to address. These included HIV/AIDS, malaria,
      tuberculosis, typhus, haemorrhagic fever and others categorized as
      epidemics in developing countries -- but that was it. Drug
      manufacturers feared that without the limitation, the deal could lead
      to a broader undermining of their lucrative patent rights.

      Poor nations were outraged. Dr. Mbaissouroum and other doctors here
      point out that they treat more patients, combined, for heart-related
      problems, diabetes, cancer and chronic respiratory diseases -- which
      aren't on the U.S.-backed list -- than for AIDS. Many AIDS sufferers,
      they say, don't seek formal treatment out of ignorance or fear of
      stigma. Malaria kills one million Africans each year. Yet nearly
      twice as many, combined, die of heart or respiratory ailments,
      diabetes and cancer, according to the World Health Organization.

      In the crowded diabetes ward here, a floor above the cardiology wing,
      Bechir Soumaine is recovering after several days without insulin,
      which he couldn't find in any local pharmacies. "People in the
      developed world think AIDS and malaria and communicable diseases are
      the biggest problems in Africa," says Dr. Mbaissouroum. "But we also
      suffer the same illnesses as rich people do."

      Fifteen months before Doha became the central command post for the
      U.S. campaign to oust Saddam Hussein, it was the stage for a mission
      to effect potentially even bigger change: liberalizing global trade
      for the benefit of the developing world. While the military mission
      has been largely achieved, the grandly named Doha Development Round
      of trade talks has deteriorated into a major letdown for those it was
      supposed to help.

      "We're disappointed, extremely frustrated and very concerned that
      this round of negotiations won't achieve the vision it set out to
      achieve," says Faizel Ismail, South Africa's trade representative in
      Geneva.

      Asked to explain the U.S. position, Deputy Trade Representative Peter
      Allgeier cites the importance of zeroing in on AIDS and other
      epidemics: "As agreed by ministers in Doha, the WTO's efforts must
      focus on helping the poorest countries have access to medicines to
      fight infectious epidemics like HIV/AIDS, tuberculosis and malaria
      and those that may arise in the future." He adds that it is crucial
      not to stray from that focus by emphasizing other diseases, such as
      cancer and heart ailments. "We think the WTO needs to keep its eye on
      the ball to fulfill the Doha mandate," Mr. Allgeier says.

      The clamor for action has grown in recent days, as President Bush and
      the heads of the other largest industrialized countries, known as the
      G-8, have gathered in Evian, France, for their annual economic
      summit, which concludes Monday. Thousands of protesters, marching
      from Geneva toward Evian on Sunday, carried placards
      proclaiming "People before profit." The group Doctors Without
      Borders, pushing its campaign for cheap and accessible medicines,
      fervently handed out "Too poor to pay" stickers. At the WTO
      headquarters in Geneva, before it was ringed by police in riot gear
      over the weekend, demonstrators scrawled graffiti on the surrounding
      stone walls: "WTO kills" and "No justice, no peace."

      Since the breakdown in December, there has been no action on the
      medicines stalemate. Neither has there been much movement on scaling
      back the agriculture subsidies that keep U.S. and European Union
      farmers in business. By encouraging surplus production that drives
      down world prices, the farm subsidies undermine the economies of many
      agricultural-based developing countries.

      U.S. Trade Representative Robert Zoellick and Pascal Lamy, his EU
      counterpart, said earlier this spring that they wanted to start by
      finding an easier target and had decided to join forces on the
      relatively attainable goal of reducing tariffs on manufactured goods.
      Focusing their efforts on that, they said, might create some momentum
      at the WTO that could spill over into other areas, such as medicines
      or agriculture.

      The explosive spread of AIDS in Africa has drawn international
      attention to the issue of access to patented medicines readily
      available in the West but scarce and prohibitively expensive in most
      developing countries. At Doha, trade ministers agreed that poor
      countries should be able to override patent protections and use
      cheaper generic copies of drugs to attack mass health problems. Mr.
      Zoellick repeatedly stressed the need to reach out to struggling
      nations. "One of our primary objectives in launching a new global
      negotiation is to use trade and openness to bring new opportunities
      and new hope to the poorest among us," he said in a speech to the
      Council on Foreign Relations in October 2001.

      But the Doha agreement didn't spell out how poor countries, with no
      capability to manufacture generic drugs of their own, could import
      the generics from a third country. The pact also didn't specify
      precisely which diseases it covered. The key language referred
      to "public-health problems afflicting many developing and least
      developed countries, especially those resulting from HIV/AIDS,
      tuberculosis, malaria and other epidemics."

      The developing countries interpreted this as covering any disease
      they would identify as a public-health problem. But as the round-the-
      clock talks neared a final deal last December, U.S. negotiators
      argued that the patent exception should apply only to epidemics such
      as AIDS, tuberculosis and malaria.

      Drug companies, led by their trade group, the Pharmaceutical Research
      and Manufacturers of America, mounted an 11th-hour lobbying blitz
      aimed at the White House and members of Congress. The industry had
      spent more than $50 million to help Republicans gain control of
      Congress in November 2002.

      About three dozen lawmakers signed individual and group letters
      beseeching Mr. Zoellick to limit the scope of the deal. Chief
      executives of 19 drug companies signed a separate letter to the trade
      representative. And the White House kept "in very close contact" with
      Mr. Zoellick, as is standard practice in such negotiations, an
      administration spokeswoman said.

      The drug industry fears that relaxing patents beyond those for a
      limited list of epidemics would set a precedent leading to much
      broader erosion of their intellectual-property rights. That could
      spark an open season on lucrative drugs of little relevance to
      African public-health crises, the industry says, specifically citing
      Pfizer Inc.'s impotence remedy, Viagra, and products designed to
      prevent baldness. Without the exclusive right to produce innovative
      drugs -- and collect commensurate profits -- manufacturers say they
      won't have enough incentive to research new treatments. In the long
      run, that will undercut medical science and harm those who suffer,
      both rich and poor, the companies add.

      "We care a lot about people having access to our medicines," Raymond
      V. Gilmartin, Merck & Co.'s chairman and chief executive, said at a
      European Commission conference in Brussels in April. He pointed to
      Merck's distribution of reduced-cost drugs in the developing world,
      including antiretroviral medicines for HIV/AIDS and treatments for
      river blindness, an affliction transmitted by flies that breed on
      water. "Many of the medicines that have come from Merck laboratories
      have changed the way diseases are treated and changed millions of
      lives," the executive said. But Mr. Gilmartin also said that the
      original broad Doha declaration could lead to future pressure to
      relax patent protection of other products.

      U.S. trade representatives also bristle at the perception that they
      are keeping drugs out of the hands of those who need but can't afford
      them. At the Brussels conference, Grant Aldonas, under secretary for
      international trade at the U.S. Department of Commerce, deflected
      questions on the topic, stressing that drug prices are only a small
      part of the health problem facing developing countries. More
      important than prices, he said, are ineffective distribution systems
      and endemic corruption in developing countries, which make it hard
      for the needy to get their hands on any medicine that does arrive
      from abroad. "It's not just about intellectual property," he said.

      The U.S. tried to counter international critics late last year by
      announcing a temporary moratorium on export laws governing patented
      drugs for poor nations facing certain epidemics. And, several weeks
      later, in his State of the Union address, President Bush pledged that
      the U.S. would spend $15 billion over five years to fight AIDS around
      the world. The Bush plan, focused largely on African and Caribbean
      countries, aims to provide care for those already infected with the
      disease, as well as bolster programs designed to prevent its spread.

      Representatives of African countries praise the U.S. AIDS money and
      the temporary export-law moratorium, but they question why similar
      steps aren't taken for other diseases that are big killers. And, they
      ask, what about diseases that materialize in the future and medical
      breakthroughs? If new cures are patented and not included on the U.S.-
      favored list, they will be largely out of reach to the sick of Africa.

      "The development of science is so great, we must be up to date," says
      Dr. Mbaissouroum, the Chad cardiologist.

      Chad, one of the world's poorest countries, where the vast majority
      of the population lives on less than $1 a day, displays all the ills
      of African health systems: little capacity to manufacture its own
      drugs, broken-down distribution networks, no reliable record-keeping
      to gauge medical needs and a lack of money to import medicine.

      While the government has a list of over 400 drugs it considers
      essential for treating its citizens, it can't afford many of them,
      even in generic versions. Last year, according to the local WHO
      office, the Chad government relied on $2.3 million in funding from
      the EU and the World Bank to buy medicine for the country's eight
      million people.

      Shortages are common. Often, Chad patients have to cross into
      neighboring countries, such as Cameroon, to find the drugs they need.
      And when they do, they often find they can't afford them there.

      Consider Dr. Mbaissouroum's dilemma: For hypertension, he usually
      prescribes one of two drugs which sporadically make their way into
      the country. One, Loxen, sold by Switzerland's Novartis AG and
      patented in Europe, costs the equivalent of about $25 for a box of 60
      tablets. He prescribes one or two tablets a day, so the box can last
      for one or two months. Or he prescribes a generic version of the drug
      alphamethyldopa that costs about the same: $8 for a box of 20
      tablets. He prescribes several tablets a day, so this box lasts only
      one week. Most of the patients prefer the $8 box because it costs
      them less on the day of purchase, even though it lasts for a shorter
      time.

      "They can't afford a second box, so they interrupt their treatment,"
      the doctor says.

      Mr. Soumaine, the diabetic, often interrupts his treatment, too,
      because insulin supplies in Chad are spotty. Some pharmacies lack
      refrigerators to store it, so they keep a low supply. Other times, it
      isn't available at all. Most injected insulin is no longer under
      patent. But potential new treatments that are currently being
      researched and could be of particular benefit to Africans with
      diabetes, such as inhaled or oral insulin, would probably be patented
      if they ever come on the market.

      For 16 years, Mr. Soumaine has battled diabetes, taking insulin
      whenever he could to control his blood-sugar level. When he has a
      job -- most recently he managed inventory for a French contractor in
      Chad -- Mr. Soumaine can afford the monthly insulin purchases: $12 in
      local pharmacies, $25 over the border in Cameroon. But now that he
      has been out of work for eight months, the 42-year-old father of
      eight children says, "When I need more insulin, I rush to my parents
      or other relatives for money. It's embarrassing."

      Two months ago, he traveled eight hours by car to Moundou, the
      nation's commercial hub, to look for a job. The search dragged on,
      and he ran out of insulin. There was none to be found in Moundou, he
      says. Weak and woozy, he was rushed back to N'Djamena, to the
      diabetes ward at the central hospital.

      There, a medical student found that Mr. Soumaine's blood-sugar level
      was severely elevated. The patient was stabilized with insulin from
      the hospital's emergency supply while, for two days, friends and
      relatives scoured N'Djamena for insulin. Finally, they bought some in
      Cameroon.

      Preparing to leave the hospital, Mr. Soumaine says he is certain
      he'll be back. "As a diabetic in Chad," he says, "every day I don't
      know if I'll die."
    • bobutne
      Government Shuts Down Two Magazines, May 20, 2003, Abidjan http://allafrica.com/stories/200305210006.html The government of Gabon has suspended the publication
      Message 2 of 4 , Jun 2, 2003
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        Government Shuts Down Two Magazines, May 20, 2003, Abidjan

        http://allafrica.com/stories/200305210006.html

        The government of Gabon has suspended the publication of two
        magazines in a move which "looks like a campaign of intimidation
        against the privately owned press," the French-based campaign group
        for press freedom, Reporters sans Frontieres, said on Tuesday.

        It said that on 12 May the government's media watchdog, the National
        Communications Council, had ordered Misamu, which appears once every
        two months, to cease publication because of a dispute between the
        founder and current editor over who owned the magazine.

        However, Reporters sans Frontieres noted that this decision followed
        the magazine's publication of an article about the mysterious death
        of an aide to Pascaline Bongo, the eldest daughter of President Omar
        Bongo, who is also the head of the president's office. Misamu
        accused a sernior finance ministry official of murdering the
        deceased person.

        Reporters sans Frontieres said that three days later the govenment
        had ordered the suspension for three months of the weekly newspaper
        Le Temps. The government accused the newspaper of "besmirching the
        good name of the nation" by publishing an article which alleged that
        Bongo's government had "wasted more than 500 billion CFA (US $87
        million)in two nights" on lavish independence day celebrations, it
        added.

        Reporters sans Frontieres said these moves looked like "a campaign
        of intimidation against the privately owned press and is nothing
        more than a way of preventing the population from having access to
        more objective information and knowledge of different manoeuvres by
        the government."

        Reporters sans Frontieres said two other newspapers, Jeunnesse
        Action and L'Espoir, had received final warnings from the National
        Communications Council this month.
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