Author Archives: David Ng

Passing drug bill imperative: AIDS in Africa could be stopped in its tracks if medications were available

Here is a recent op-ed written by Craig and Marc Kielburger of the non-profit Free the Children. Reprinted from the Edmonton Journal. Definitely worth a read…

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We build schools in Kenyan villages where teachers die, but their students refuse to name the cause because of its potent stigma, even as coffins are lowered into graves.

We’ve seen husbands, mothers, and then their children, wither away from a mysterious illness rather than be ostracized with a diagnosis.

In North America, access to treatment makes it possible for people with HIV/AIDS to lead relatively comfortable lives. In developing countries, where antiretroviral drugs (ARVs) are prohibitively expensive, AIDS is a curse.

There’s still no cure, but Canada has a chance to save potentially millions of lives with a single legislation. Bill C-393 would reform Canada’s Access to Medicines Regime, a system so flawed it’s only been used to ship a single drug to Rwanda since it was first introduced six years ago.

Bill C-393 allows Canadian companies to manufacture generic versions of patented drugs, like ARVs, making it easier to deliver affordable medicine to developing countries. It passed the House of Commons on March 9, but stalled in the Senate, and then died on the order paper when the government fell.

When Parliament resumes June 2 there will be numerous pleas for the attention of Stephen Harper’s majority government. But this is more than a plea. Finally passing this bill is a moral imperative, and research released since its initial passing has made it an urgent one.

A few weeks ago, a major clinical trial found that treating HIV-positive people with ARVs led to 96 per cent reduction of transmission for the 1,763 participating couples in 13 sites all over the world, including Kenya.

The breakthrough was so great that results were released four years earlier than scheduled.

“We have a new vaccine and it’s called treatment,” Dr. Jennifer Cohn from Medecins sans frontieres, a medical relief organization with offices in Kenya, recently told the Nairobi Star. Advocacy organizations also predicted the virus could be eradicated in Kenya in just a few years.

Kenya is our second home -we’ve spent the past 15 summers there. We love the untouched beauty of its landscapes and the warmth of its people, but we’re sick with the knowledge that AIDS devastates the country.

Mary was a nurse in Kenya’s Rift Valley. She knew her husband had been unfaithful, and that she was in danger. But he refused to wear condoms -he’d paid her dowry, she was his property. When Mary was diagnosed with HIV, her husband abandoned her while she was pregnant with their second child. Women are more likely to be identified as carriers because of prenatal testing. Her child, who we will call Abby, was born HIV-positive.

Mary couldn’t afford proper treatment. When she died, none of her close relatives would adopt Abby for fear of “catching” the virus. The now two-year-old has little hope of receiving the medicine she desperately needs to survive.

Canadian pharmaceutical company Apotex Inc. has promised to make a generic duplicate of a pediatric ARV should bill C-393 pass. Dr. James Orbinski, founder of the medical humanitarian organization Dignitas International and staunch supporter of C-393, has said this alone would save millions of lives, since generic drugs reduce treatment costs from $10,000 to $100 a year -even less for children, like Abby.

We wonder how many people were infected while Canada’s unelected Senate stalled a bill that passed in the House of Commons with a vote 172 to 111 -including support from the Bloc and NDP, all but two Liberals and a handful of Conservatives.

But not a single Conservative cabinet minister supported the bill, and brand-name drug companies, threatened by the prospect of lost business, lobbied against it.

Ideally, competition on the global market would increase with added competition from generic companies better able to compete on price, driving costs down for poor people dying preventable deaths. This is a humanitarian aid bill meant to save lives, not money.
After years battling opposition and regulatory quirks in the House, only to be stalled to death in the Senate, Bill C-393 isn’t guaranteed a swift pass through this Parliament.

Canada’s political landscape has changed. The NDP say they will reintroduce the private member’s bill that was first passed in the minority Parliament.

Canada has two choices.

The Conservative government could bolster the country’s reputation on the world stage at no cost to taxpayers. In fact, passing the bill would make Canada’s foreign aid dollars go further because we, and developing countries, could purchase more medicine for less.

Or, our government could fail to act, leaving countless people to die needless deaths.

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Back to the grind. Now… where were we? Ah right, we want to host a carnival!

O.K. O.K. We’ve been a little neglectful of this blog. The Canadian election sort of sucked the wind from us, but here we are, back again with renewed vigor.

First order of business – let’s ramp up the Global Health carnival. We had a few submissions, but we also really want to make the first one EPIC! In light of that desire, we’re going to push the dates forward a bit – let’s move the deadline to May 31st, so that we have a proper chance to showcase some great work around the internets.

Also:

For those of you unfamiliar with the “carnival” vernacular, this is where we seek out submissions whereby writers highlight their kick ass blog posts which tackle the many and various themes surrounding global health. Then, we concoct a one stop blog post to highlight all of this fine writing.

Possible topics can be humanities driven: i.e. access to medicines, big pharma corporations, development issues, politics and health, etc. Or, they can be science driven: i.e. new data or research on this or that disease, new therapeutics that are cool or working well (preferably both), general science geekery. Submissions can even be creative or a little goofy in nature. It’s all good.

Plus, as mentioned before, we get in a habit of making a lovely to look at pdf file amenable for downloading and reading on what e-book/tablet device you may have.

Anyway, leave a link to your remarkable piece of writing in the comments, or point us in the right direction using a tweet via @myrightsvsyours

Game on!

What Would You Say to your Children about the Canadian Government? (My two cents)

It’s election time again and, as is the norm, we see teachers using the opportunity to talk to their students about things such as Prime Ministers, parliaments, senates, and, well, basically – how this thing we call the “Canadian Government” is meant to work. My own daughter who is in Grade 4 is in such a class, and has been asking me all sorts of questions: the most prevalent of which is “Who is Alice Wong?” Not a surprising question, since her face is fairly ubiquitous in Richmond, BC where I live, being set against the many blue Conservative signs and placards (she is our incumbent MP).

Because we’ve had a few elections of late, I have a habit of how I deal with such questions from my kids – these opportunities to talk politics. So far, being an educator and scientist myself, my training forces me to be objective, focusing primarily on the different philosophies that each of our political parties represent, including the general pros and cons of each. I tell my children that who you choose is a personal decision driven by what you think is important. Above all, voting is a privilege, as is the act of receiving a vote if you are campaigning. I think it best to not indoctrinate your kids with your own views, but rather to succinctly tell them that voting is something special, and deserves some effort to be informed on the issues. If you take that view, the rest will happen naturally.

Unfortunately, this time around, and to my surprise, I found myself facing my daughter and uttering the following: “I’m not really a big fan of Alice Wong.” This was quite a shift of attitude, and here is why: I have no issue with Conservative ideas and values (I actually agree with some of them), but I am tremendously concerned with the actions of the current Canadian Government.

How I came to this conclusion is due to many issues, but the one that has lit the proverbial “fire in my belly,” is a law that would fix policy to allow life saving drugs to be made at lower cost. There’s merit in this because it permits individuals, desperate in places like Africa, to be able to afford them. HIV/AIDS has the most disconcerting narrative: if you are diagnosed with HIV, now considered a chronic disease with very effective medicines, the choice between living and dying is based on your income. It’s that cold.

This law was called Bill C-393. And it was a good one. It was aimed to be innovative and to fix the previous law, which wasn’t working at all. It took care to protect Canadian pharmaceutical companies so that such generic drugs could only be sold to markets that weren’t in the industry’s bottom line. It had a built in “let’s monitor” clause. It was backed up by robust expert peer review, involving economists, policy analysts, health experts. Cost to taxpayers: zero. Because of all of these facts, it was passed by the Parliament in March – even many Conservatives broke rank and voted for it.

However, in a truly frustrating string of events, it was left to die in Senate, when Tory Senators (a large portion of which were appointed by Harper) continually delayed voting on it, until it was killed by default with the call of the election. A mini screenplay to describe this would consist of four acts, each one with the same dialogue: “We’d like to adjourn because such and such would like to speak, but oh, he’s left for the day, can we do this tomorrow?”

Why were there these four days of delay? Apparently, it’s because the pharmaceutical industry would rather keep things as is, even going so far as to distribute misleading counter arguments, all of which have been firmly discredited by the aforementioned expert peer review process. All of which were delivered top down to the mailboxes of Conservative Senators, and the rest, as they say, is history.

I know that critiquing Miss Wong in front of my daughter is somewhat unfair (despite being one of the few who voted against Bill C-393 in parliament), but she is representative of the bigger problem. She is a small cog in a remarkably unsettling machine. I know the value of strong leadership, but this should not trump ethical leadership. Can you imagine my daughter at school, learning not about how the “Canadian Government” works, but instead, the “Harper Government?”

MacGyver would be proud: Possible 3 cent HIV test.

Literally, an HIV diagnostic kit made from tape and paper.  Seriously, if there was also a mention of a paper clip in there, I’d haf expect MacGyver to be a co-author.

Anyway, here’s a quote from the blog post over at Discover Magazine:

A new device smaller and cheaper than a postage stamp could be used to diagnose diseases in developing countries, Harvard researchers report. The sophisticated microfluidic diagnostic devices, called microPADS, are made out of little more than paper and sticky tape and cost about three cents each. “The starting point with us was asking, ‘What’s the simplest, cheapest [material] we could think of?’ … And that was paper,” [The Scientist] said co-author George Whitesides. (read more)

For those who prefer the technical jargon, this was recently published at PNAS, but I’ve copied the abstract below:

“This article describes a method for fabricating 3D microfluidic devices by stacking layers of patterned paper and double-sided adhesive tape. Paper-based 3D microfluidic devices have capabilities in microfluidics that are difficult to achieve using conventional open-channel microsystems made from glass or polymers. In particular, 3D paper-based devices wick fluids and distribute microliter volumes of samples from single inlet points into arrays of detection zones (with numbers up to thousands). This capability makes it possible to carry out a range of new analytical protocols simply and inexpensively (all on a piece of paper) without external pumps. We demonstrate a prototype 3D device that tests 4 different samples for up to 4 different analytes and displays the results of the assays in a side-by-side configuration for easy comparison. Three-dimensional paper-based microfluidic devices are especially appropriate for use in distributed healthcare in the developing world and in environmental monitoring and water analysis.”

Donald Trump and Access to Medicine: My predictions.

I’m going to go out on a limb here and predict that Mr. Trump is not a big fan of compulsory licensing.

But it’s tougher call on his stance with Neglected Diseases. I mean what is up with his hair: that condition must be pretty rare right?

Just saying…

A chance for Canada to make good (for a change).

Here’s an interesting press release regarding Canada’s reputation as a do-gooder. It seems that it’s taken a hit over the last few years, but that there’s still opportunities to improve our image: a big one being our possible actions on the Access to Medicine front.

Anyway, here’s the just released press release. And don’t forget: If you’re a reader from Canada, don’t forget to check out aidsaction.ca. Here, you can look up your candidates and send off an email to support the Call to Action to reform Canada’s Access to Medicines Regime and help save lives!

For immediate release

NEW POLL SHOWS CANADIANS CONCERNED ABOUT GLOBAL REPUTATION, BUT CONFIDENT IT CAN BE IMPROVED BY MAKING AFFORDABLE MEDICINES AVAILABLE TO DEVELOPING COUNTRIES

Grassroots campaign begins to build support for quick passage of bill after election

Toronto, April 26, 2011 – A new public opinion poll shows twice as many Canadians (35%) believe the country’s international reputation has declined in the last few years rather than improved (17%), with a third (37%) believing it has just remained the same. But according to the same poll, seven in 10 Canadians (71%) feel that it would improve the country’s reputation if Canada were to pass a bill making it easier to supply less expensive, generic medicines to people in developing countries for diseases such as AIDS, tuberculosis and malaria. Canada was on the verge of passing such a law – Bill C-393 to reform Canada’s Access to Medicines Regime (CAMR) – before it was delayed in the Senate and thus died on the order paper when the election was called.

“This poll confirms the tremendous opportunity presented to Members of Parliament and Senators willing to fix Canada’s broken Access to Medicines Regime,” said Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network. “Not only will such a bill help get desperately needed medicines to people dying of treatable diseases, it will also improve Canada’s reputation as a good global citizen.”

With Canada’s foreign aid now frozen and the loss of a seat at the UN Security Council seen by some as a setback for the country’s international reputation, humanitarian initiatives such as legislation to fix CAMR – which will cost taxpayers nothing – presents a compelling rallying point.

In fact, a grassroots movement made up of grandmothers groups, student organizations, and health and human rights activists have launched www.AIDSaction.ca. It asks every candidate from the major federal parties in every riding to indicate whether they support fixing CAMR to help those most in need. The website will track candidates’ responses online in an interactive chart so voters across the country can see which candidates in their riding have already stated their support for fixing CAMR. It also makes it easy for voters to e-mail the candidates in their ridings to ask them where they stand if they haven’t yet replied.

“Canadians were strongly behind a bill that would have saved lives,” said Andrea Beal, co-chair of the National Advocacy Committee of the Grandmothers to Grandmothers Campaign. “We’re asking candidates to listen to the will of the people and support making affordable medicines accessible to developing countries. This new poll is just further evidence of why they should act.”

Created unanimously by Parliament in 2004, CAMR has been rendered practically useless because of red tape. Only one order of one medicine was ever filled, and to just a single country. The one generic drug company that did use CAMR has said it will not attempt to use the cumbersome process again, nor will any developing countries try. Critical to the goal of cutting through this red tape is the “one-license solution”, a key part of any CAMR-reform legislation.

Before Bill C-393 died in the Senate last month, public momentum was behind efforts to make affordable medicines available to people who need them. The legislation – which included the “one-license solution” – had the support of many prominent Canadians including international aid workers, human rights leaders, physicians and faith leaders. It was also supported by more than 70 000 Canadians who signed a petition or sent letters calling on Parliament to pass the bill into law. When the House voted on March 9, Bill C-393 passed by a strong majority – 172 to 111 – with support from MPs representing all parties.

“Canadians have shown over and over that they get it when it comes to the rights of all people to have access to medicines that will save their lives,” said Aria Ahmad, coordinator of the University of Toronto chapter of the international student group Universities Allied for Essential Medicines (UAEM). “We urge candidates for Parliament to listen to them.”

More background information on efforts to fix Canada’s Access to Medicines Regime including detailed arguments by international legal and health experts in favour of previous legislative attempts to do just that can be reviewed at www.aidslaw.ca/camr.
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A Primer on the Subject of Access to Medicines

Here’s a piece I wrote for online reading at Scientific American. It basically tries to cover the main ideas and main challenges in Access to Medicines issues. Not a bad place to start to get into the swing of things. Also, If you’re a reader from Canada, don’t forget to check out aidsaction.ca. Here, you can look up your candidates and send off an email to support the Call to Action to reform Canada’s Access to Medicines Regime and help save lives!

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30 minutes, 70 fates.

You don’t know it, but as I write this piece, there is some serious procrastination going on. My attention span is weak and sidetracked constantly by a variety of diversions, and if you must know, it’s taken me close to half an hour to write these first two sentences. Still, one could argue that none of us are strangers to procrastination, and 30 minutes is relatively short – only a minor instance of time in the grand scheme of things.

But a lot can happen in thirty minutes. Earlier, I had been looking over some 2009 UNAIDS statistics, and noting the numbers issued in the report. They are all very big, big enough certainly to require the pressing of buttons on calculators. More to the point, I learn that during my thirty minutes, approximately 70 people died from HIV/AIDS in Sub-Sahara Africa. That’s 1.3 million victims each year – in Sub-Sahara Africa alone. Many of these were parents leaving orphans, and many were young children just leaving. Most troubling, however, is the fact that all of them suffered their fate with a loss of dignity.

Why do I say this? I say this because people shouldn’t have to die from HIV/AIDS. There are good medicines out there, and they can control the disease. In fact, for those in the developed world, HIV/AIDS is now considered a chronic disorder, not a death sentence. If you are diagnosed, you are no longer forced to take a shortcut to demise. You can still have a long life, you can still be productive, and you can still live with dignity.

Unfortunately, this wasn’t an option for those who passed away. For them, the medicines were out of reach. They were simply too expensive. And from this, you come to realize a cold hard fact in this narrative: that the fate of a person living or dying from HIV/AIDS is determined by their income. This statement is fairly straightforward, with no mincing of words, or confused rhetoric. But for most, it feels fundamentally wrong, and yet, it is a simple reality of how the world works today. Why it works in this way, however, is complicated.
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