TCS Daily

WHO's Inconsistent and Anti-Patent?

By Roger Bate - February 13, 2004 12:00 AM

In a recent letter to the Wall Street Journal, representatives of the World Health Organization (WHO) and the Global Fund for AIDS Tuberculosis and Malaria (the Fund) claimed that "The Global Fund, based on WHO guidance, is financing one of the fastest shifts to new and better [malaria] treatment regimens ever implemented in the developing world."

The WHO and Fund officials were responding to allegations made in the British medical journal, Lancet, and discussed on these pages, that they were guilty of medical malpractice in supplying ineffectual malaria drugs in Africa. Their defense was that although the drugs were failing, the agencies were doing the best job they could given uncooperative health bureaucracies in poor countries. The immediate reaction (especially from the original Lancet authors) was that this was an inadequate response from these premier health bodies. But on reflection, perhaps they have a point. Maybe operating in the poorest African countries makes fast policy changes impossible.

The letter went on to say that:

"...changes in the use of first-line medicines often take five to fifteen years. Propelled by the dual impact of Global Fund financing which started less than two years ago, and WHO assistance in providing clear and up-to-the-minute treatment policies, countries in Africa are already changing to the new, more effective artemisinin-based combination therapy (ACT)."

So, let's assume that the WHO and Global Fund are correct, and it will take at least five years to switch from using failing anti-malarials, (such as chloroquine and SPs) to the newer, better ACTs. But where does that leave us with the claims, made by these two agencies, that it will be possible to treat 3 million AIDS patients within the same time period?

AIDS Easier to Treat Than Malaria?

Malaria is an easy disease to diagnose. To experienced doctors blood tests are almost unnecessary and are done as a precaution in case of rare, but potentially fatal, mistaken diagnoses. Malaria is also easy to treat. If you know the age and body weight of your patient, it is easy to prescribe from one pill to at most, five or six pills over the next week. Given how sick malaria makes you feel, patients are likely to see through an entire course of medicine, especially given that a course lasts for such a short period. Patients are, therefore, likely to get better very quickly -- unless they are prescribed failing drugs.

HIV/AIDS on the other hand, is hard to diagnose, and many doctors are generally unfamiliar with it compared with an age-old disease like malaria. There are actually numerous definitions of the syndrome, and only blood tests can determine the presence and strength of viral loads. Presence of HIV does not lead to automatic treatment, since there is not much point until one's immunity starts to suffer.

Immunity is usually measured by the CD4 count. Healthy adults have counts over 800. CD4 cells are a type of lymphocyte that co-ordinate the immune system's response to HIV. When the CD4 count falls below a certain level treatment is started and in poor African settings the threshold is 200. Then a carefully designed drug regime, usually triple drug therapy, will be applied, often consisting of several pills/injections, several times a day. This regime will need to be altered but, in principle, has to last forever since it is not a cure. Regular check-ups on viral loads and dosing changes will be required. Furthermore, as the patient becomes sicker he may be subject to opportunistic infections that require further, sometimes complex, drug therapy.

All in all, treating AIDS is far harder than treating malaria. So why are we to believe that the WHO finds it impossible to change first line treatment for anti-malarials in under five years, yet will be able to treat millions of Africans with AIDS over the same time period?

The WHO and the Fund cannot have it both ways. They're either incompetent in dragging their feet over malaria drug policy, and are killing African children in droves, or their desire to garner US taxpayer dollars for AIDS drug delivery means they are ignoring the realities of treatment in an African setting. In fact, it's a mix of both. Ironically they are being both incompetent and money-grabbing.

Is WHO Anti-Patent?

A secondary but equally important point raised by the letter to the Wall Street Journal is about WHO's position on patents. The WSJ claimed that the WHO was anti-patent and implicitly anti-western-drug companies. The letter in response states:

"The assertion that WHO's and the Global Fund's treatment guidelines and policies are linked to patents is wrong. WHO, an international organization governed by rules collectively agreed upon by its 192 member states, has a straightforward policy regarding its recommendations on which medicines to use for a disease or condition: It matters most that medicines are safe, effective and affordable, rather than who manufactures them."

But the reality is that the best and most easily accessible anti-malarial ACT, Coartem, is on patent to Novartis, a Swiss pharmaceutical company. Yet the WHO and the Fund have not successfully promoted this first class drug, while they have, albeit in a limited way, promoted alternative ACTs. Furthermore, WHO recently hired Paulo Teixeira to be its new head of AIDS policy, which sent shudders through the research-based industry. Dr Teixiera formerly ran the Brazilian AIDS program, which routinely threatened the patents of western pharmaceutical companies. Threats of compulsory licensing, in Brazil (but also in Korea, South Africa, Argentina and elsewhere), have driven some companies away from HIV research (there are 27% fewer companies working on HIV than there were 6 years ago). Dr Teixeira has continued to make anti-patent noises while at the WHO. So the notion that WHO is patent-neutral is false. WHO dislikes the power of western pharmaceutical companies, and its practice has been to buy drugs from copycat manufacturers where and when possible.

Anti-drug company zeal and general incompetence means that the WHO and Global Fund are losing their reputations as health authorities of high standing. They only have themselves to blame.

Roger Bate writes frequently for TCS where he last wrote about Greenpeace founder Patrick Moore.


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