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Global Fund Launches Human Rights Complaints Procedure

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EUROPEAN PARLIAMENT TO VOTE ON A TTIP RESOLUTION

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7 Hopeful Climate Stories from around the Globe

WHO leadership admits failings over Ebola, promises reform

Ban urges ‘bold changes’ to aid action as States prepare for World Humanitarian Summit

Health Care Reform And The Trap Of The “Iron Law”

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Narrative Matters: On Our Reading List

The future of Land Matters for development

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EU states told to tackle health challenges of migrant emergency

Development MEPs urge EU countries to stick to foreign aid commitments

EU must pull its weight to help create a better global financial system

Canada creates a bilateral Development Finance Institution: will Australia follow suit?

Competition Analyses of Licensing Agreements: Considerations for Developing Countries under TRIPS

China and UHC in Africa

The Cost and Cost-Effectiveness of Alternative Strategies to Expand Treatment to HIV-Positive South Africans: Scale Economies and Outreach Costs

A Public Health Approach to Hepatitis C Control in Low- and Middle-Income Countries

UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age

World Malaria Day 2015: Progress at risk with spread of drug resistance

Substandard drugs, not fakes, undermine fight against malaria

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New website shows Swiss leadership in the fight against Malaria

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Human Rights Reader 360

Global Food Security Act brings parties together in committee markup

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From The WHO: Preventing The Next Ebola 

Ebola outbreak still a global emergency despite significant drop in cases – UN health agency 

World Bank must lead efforts to raise $1.7 billion to improve Ebola-hit countries’ health care 

New 2015 edition of World Development Indicators shows 25 years of progress, but much left to do 

Europe’s Biggest Economies Continue to Deny Aid to the World’s Poorest, Despite 2015 Deadline

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Richard Lugar: ‘Kudos’ on US food aid reform hearing 

World Bank and EIB chiefs call for greater financial engagement and technical cooperation to fight climate change 

AfDB fast tracks to join Green Climate Fund’s newly accredited agencies to channel more climate finance to the continent 

Health can tackle (and measure) inequities 

“Equity, sustainability, dignity”: a proposal for a tripartite post-2015 motto 

Human Rights Reader 359 

Wave Of Protests Against TTIP, CETA, TISA 

MSF response to Indian Prime Minister’s visit to Germany and EU India FTA negotiations 

Don’t Keep the Trans-Pacific Partnership Talks Secret 

Experts Debate Medicines Access In South Africa And Beyond 

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The Payment Reform Landscape: Impact On Consumers 

If The ACA Were Repealed, Just What Would Replace It? 

May The Era Of Medicare’s Doc Fix (1997-2015) Rest In Peace. Now What? 

The Quality Tower Of Babel 

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I medici inglesi dicono basta al mercato 

Breaking news: CROI 2015 Update 

How the Global Drug Facility (GDF) Works to Reduce Prices of MDR-TB Drugs

Stop TB Partnership’s Global Drug Facility (GDF) was established in 2001, with the aim of using donor funding to consolidate demand from different countries and negotiate affordable prices for quality-assured anti-tuberculosis drugs. 
Today, as one of the main players in the complex global market for TB drugs, the GDF plays a crucial role in not only shaping drug supply, but also in reducing the price of medicines

Kaspars Lunte jpeg

by  Kaspars Lunte

Team Leader Sourcing and Special Projects, Global TB Drug Facility
Stop TB Partnership Secretariat/UN Office for Project Services

How the Global Drug Facility (GDF) Works to Reduce Prices of MDR-TB Drugs

 

One of the central objectives of The Global Plan to Stop Tuberculosis, a strategy document launched by the Stop TB Partnership every five years, is universal access to high-quality care for all people with tuberculosis.

Affordable drugs to fight TB and effective systems to provide treatment are important to increase cure rates. However, disease control depends, not only on the existence of curative treatment, but also on sustainable drug supply, which is ultimately mediated by the pharmaceutical market.

Countries often have limited experience in securing the best possible prices for quality assured drugs and have little negotiating power since they are not able to consolidate drug purchases into large volumes. This is especially true of the medicines needed for multidrug-resistant tuberculosis (MDR-TB), where treatment is complex and can last two years or more. In addition, these medicines are much more expensive than those for drug-sensitive tuberculosis.

The importance of usage of quality assured medicines as opposed to usage of drugs of unknown quality, is also underestimated by some countries.

Stop TB Partnership’s Global Drug Facility was established in 2001, with the aim of using donor funding to consolidate demand from different countries and negotiate affordable prices for quality-assured anti-tuberculosis drugs.

Over the last decade or more, the GDF has played a crucial role in not only shaping drug supply, but also in reducing the price of medicines. Today, as one of the main players in the complex global market for TB drugs, GDF occupies a unique position. In 2011, it supplied enough drugs to treat 35% of publicly notified cases of tuberculosis worldwide and an estimated 24% of all incident cases.

Today, access to quality-assured drugs is promoted by key stakeholders including WHO’s Medicines Prequalification Programme, by the Global Fund to Fight AIDS, Tuberculosis and Malaria, other donors and the GDF.

However, despite the existence of international quality-assurance standards, TB drugs are often either substandard or counterfeit. Unsurprisingly, recent studies show that the substandard and falsified drugs readily available on the private market have probably contributed to the development of drug-resistance in low- and middle-income countries.

Although patents have expired on many TB drugs, low-income countries with a high disease burden have limited power in negotiating on an individual basis for cheaper treatment. Disease control is therefore profoundly influenced by the functioning of the TB drug market, particularly in resource-poor settings with a high disease burden.

Further, second-line treatment for MDR-TB involves more protracted and complex chemotherapy and can cost a hundred times more than treating drug-sensitive tuberculosis.

In such an environment, a defining feature of the GDF model is role that international quality-assurance standards play in its operation. These are embedded in overall quality management so that stringent public procurement standards can be met.

However, some manufacturers concerned about quality, may find that the benefits of acquiring international quality-assurance certification do not necessarily outweigh the investments needed to meet these standards. However, by creating a large, stable market, a mechanism such as the GDF, provides clear incentives for a supply of drugs that meet international quality-assurance standards. In 2012, the value of this market for tuberculosis drugs exceeded 109 million United States dollars (US$).

In 2013, as in previous years, the GDF reduced the price of the second-line drugs it supplies for the treatment of MDR-TB. This has resulted in a significant decrease in the overall cost of treatment. Between 2011 and 2013, for a 24-month treatment course for one of the most expensive medicines combination to treat MDR-TB, the cost of treating one patient decreased by up to 26% – from US$ 7890 to US$ 5822. (Costs were calculated based on nominal prices obtained from the Global Drug Facility, without adjusting for either inflation or exchange rates.)

In 2015, GDF slashed the price of Cycloserine – a key medicine to treat multi-drug resistant TB (MDR-TB) – by 55% compared to the previous year. This price reduction is expected to save up to US$ 22 million annually, enabling treatment for more people living with MDR-TB for the global donors. (In fact, the new GDF price for cycloserine indicates a reduction of up to 68% compared to the price of five years ago.)

The price reductions obtained by the GDF were secured not only because of its continuing efforts to consolidate orders, but also creating true partnership spirit with our suppliers.

The expansion of the supplier base for internationally quality assured, second-line drugs for MDR-TB ensures competition in the drug market. This enabled the GDF to consistently secure low prices. The system of competitive and transparent bidding involving long-term agreements and the existence of the donor (UNITAID and USAID) -funded rotating stockpile also reduced prices. The MDR-TB medicines stockpile also helped decrease delivery times. Finally, the resulting drug cost savings led to an increase in the number of courses of treatment delivered for constant amount of allocated funds.

Over time, the number of suppliers of quality-assured drugs for MDR-TB has significantly increased. And previous capacity assessment has shown that production capacity can now be rapidly expanded to satisfy twice the current demand if required.

The GDF has also increased the number of courses of treatment for MDR-TB that have been delivered year on year. In 2014, the Facility delivered a sufficient quantity of various drug combinations to provide 35,000 courses of MDR-TB treatment.

GDF can indeed secure lower prices for quality assured drugs compared to those available for unregulated drugs of unknown quality on the private market. Importantly, according to published studies, GDF’s prices varied considerably less than those in the private market. This could greatly assist planning, both for countries procuring medicines and for manufacturers, who would be able to better anticipate future demand. The GDF can thus create and support identifiable, transparent markets for internationally quality-assured drugs.

Autosufficienti ‘National Food Economies’ contro la Fame nel Mondo

 Oltre 1 miliardo di persone nel mondo soffrono la fame, soprattutto in Africa. A scopo correttivo, ricostruire autosufficienza nelle 'national food economies' è l’ obiettivo finale. Ne sono strumenti l’aumento dei fondi per la ricerca e lo sviluppo agricolo, la diversificazione della produzione interna, la promozione della vendita diretta da produttore a consumatore, la realizzazione di riserve alimentari nazionali, la distribuzione equa e lo stop agli espropri dei terreni agricoli, il controllo sulle importazioni, l’abolizione dei dazi intra-Africa, la lotta alla corruzione. A livello internazionale, queste misure devono implementarsi con la realizzazione di riserve alimentari sovranazionali e di regolamenti per il controllo dei volumi alimentari esportabili in Africa da parte dei Paesi ricchi. Solo così sarà possibile contrastare gli effetti negativi delle politiche neo-liberali che minano l’autosufficienza alimentare, del neo-colonialismo agricolo e dello sfruttamento terriero per bio-carburanti, delle speculazioni sui titoli “future” delle materie prime alimentari, della monopolizzazione dei mercati da parte delle compagnie multinazionali occidentali

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by  Daniele Dionisio

PEAH – Policies for Equitable Access to Health 

Autosufficienti ‘National Food Economies’ contro la Fame nel Mondo

 

La salute costituisce obiettivo trasversale a tutti gli Obiettivi di Sviluppo del Millennio. L’Organizzazione Mondiale della Salute (WHO) definisce, infatti, la salute non solo come assenza di infermità e malattia, ma anche quale stato di benessere fisico, mentale e sociale.
Salute e sviluppo economico sono, pertanto, embricati e non può esservi salute senza eliminazione della fame che attanaglia i Paesi poveri ed impedisce l’ accesso a cure e terapie essenziali. Complici la recessione globale e l’instabilità climatica, nel 2008 il prezzo della farina aumentò del 120%, mentre il valore di mercato del riso cresceva del 75%. In Bangladesh un sacco di riso da 2 chili erodeva quasi la metà del reddito giornaliero di una famiglia povera, mentre la Banca Mondiale (WB) prevedeva che oltre 20 nazioni dell’Africa avrebbero visto peggiorare la loro bilancia commerciale per una cifra corrispondente ad almeno l’ 1% del PIL a causa dell’aumentato costo delle importazioni dei generi alimentari.
Oggi, seppure lontani dai record del 2008, i prezzi degli alimenti base spesso restano inaccessibili e le persone che nel mondo soffrono la fame sono oltre 1 miliardo, soprattutto in Africa.
Certo, occorrono più fondi per la fame nei Paesi poveri, ma non possono bastare perché, al di là dei volumi, qualsiasi soluzione monetaria resta di fatto limitata all’emergenza. Piuttosto, sono necessari cambiamenti drastici delle prassi internazionali e delle politiche commerciali e governative principalmente in causa:

Politiche neo-liberali che minano l’autosufficienza dei Paesi nel settore produttivo alimentare
Negli ultimi decenni Banca Mondiale (WB), Fondo Monetario Internazionale (IMF) e Organizzazione Mondiale del Commercio (WTO) hanno condotto politiche di disincentivazione alla autonomia produttiva dei Paesi in via di Sviluppo (PVS) e contratto il supporto monetario e gli investimenti nelle produzioni agricole locali. Contemporaneamente, le riserve alimentari nazionali sono state progressivamente dismesse perché “dispendiose”, mentre accordi WTO hanno forzato i PVS verso logiche di importazione alimentare, con ridotta tassazione degli ingressi e accettazione di volumi per almeno il 5% del consumo interno, indipendentemente dalle necessità reali. Le politiche neo-liberali hanno minato la capacità dei PVS all’auto-sostentamento, rendendoli vulnerabili alle fluttuazioni dei prezzi alimentari determinate dalle politiche dei Paesi esportatori.

Neo-colonialismo agricolo e sfruttamento terriero per bio-carburanti
Negli ultimi anni paesi come Cina, Arabia Saudita, Emirati Arabi, Corea del Sud, ma pure Gran Bretagna, Germania, India, Svezia,… insieme a gruppi di investitori privati, hanno fatto incetta di terre in Africa sub-sahariana per produrre bio-carburanti (da monocolture di palma da olio, granturco, colza, canna da zucchero, jatropha,…) e alimenti da esportare nei rispettivi paesi. In questo contesto, tecnici, amministratori, dirigenti, giungono dall’estero, mentre i locali sono spesso relegati a forza lavoro sottopagata.
Secondo la FAO, la quota di terra agricola destinata a bio-carburanti aumenterà al 2-3,5% entro il 2030 (dall’ 1% del 2006), ponendo a rischio la sorte di 60 milioni di persone nei Paesi Poveri.

Speculazioni sui titoli “future” delle materie prime alimentari
La speculazione finanziaria internazionale ha un peso determinante sull’incremento dei prezzi degli alimenti sin dall’estate 2007, inizio della crisi finanziaria USA. Le compagnie transnazionali stabiliscono unilateralmente il prezzo di acquisto dei prodotti nei Paesi di origine e il prezzo di vendita nei Paesi di importazione. Ma anche se il cibo sui mercati dei PVS è di produzione locale, lauti guadagni vanno solo alle compagnie e agli intermediari che incettano dai contadini per un’ inezia e rivendono a prezzi assai superiori.
Nonostante la produzione rimanga elevata, analisti e multinazionali, basandosi su previsioni di contrazioni di offerta, cinicamente strumentalizzano i mercati: in Indonesia, al culmine del rialzo del prezzo della soia (gennaio 2008) la Compagnia PT Cargill tratteneva 13.000 tonnellate di soia nei magazzini di Surabaya in attesa di usufruire dell’ indotto record dei prezzi. Non è da meno il potere monopolistico di catene di supermercati gonfianti all’eccesso i prezzi dei prodotti agricoli.

Monopolizzazione dei mercati alimentari da parte delle compagnie multinazionali
Le multinazionali controllano i mercati. I loro sistematici acquisti di terre spesso si associano all’allontanamento degli originari lavoratori rurali, oppure all’obbligo imposto agli stessi di produrre monocolture (cacao, tè, canna da zucchero, caffè, palma da olio) destinate esclusivamente al mercato (invece che a sfamare le proprie famiglie). Il magro compenso monetario è poi insufficiente per i prefissati ed elevati prezzi di mercato del cibo sia di produzione locale che di importazione. Così il sistema perversamente genera ulteriore povertà e fame.

QUALI RISPOSTE?
I contesti analizzati richiamano alla necessità sia di riserve alimentari sovranazionali, sia di regolamenti internazionali per il controllo e limitazione dei volumi alimentari esportabili nei Paesi poveri da parte dei Paesi ricchi. Ma richiamano, altresì, all’urgenza di partenariati e strategie condivise per:

Aumentare i fondi per la ricerca e lo sviluppo agricolo
Negli ultimi decenni i fondi per la ricerca e lo sviluppo agricolo destinati ai PVS da WB e altre Agenzie per lo Sviluppo sono diminuiti drasticamente (International Food Policy Research Institute-IFPRI). Nonostante una attuale controtendenza, anche per merito di donatori privati, molto maggiore impegno occorre e l’aumento dei fondi potrebbe non bastare se i risultati di ricerca non si traducessero, a supporto e tutela degli agricoltori e consumatori, in autosufficienti produzioni alimentari nazionali.

Ricostruire autosufficienza nelle ‘national food economies’
L’ obiettivo implica percorsi simultanei e sinergici per piani governativi finalizzati ad equità e aumento di investimenti per la produzione domestica, con particolare attenzione alle imprese agricole a conduzione familiare e di piccola-media dimensione. Ciò costituirebbe argine contro la fame tenuto conto, ad esempio, che l’85% degli africani vive in comunità rurali principalmente dedite all’ agricoltura. Coerentemente occorrono:

Diversificata produzione interna
Significa consentire ai conduttori di fattorie di scala medio-piccola una produzione agricola non solo monocolturale per l’export, bensì mista con prodotti destinati a sfamare i produttori stessi oltre che alla vendita locale del surplus da parte dei medesimi.

Vendita diretta produttore → consumatore
L’effetto calmierante di questa misura sui prezzi al dettaglio, a vantaggio dei consumatori locali, appare scontato.

Realizzazione di riserve alimentari nazionali
Dovrebbero essere a gestione statale. Servirebbero a stabilizzare i mercati domestici, destinandosi, in periodi di fecondità, il surplus ai mercati, e invece utilizzando gli stocks per le necessità interne in caso di carestie.

Distribuzione equa e stop agli espropri dei terreni agricoli
Sono urgenti riforme agrarie per l’equa distribuzione delle terre ai contadini e per l’abolizione della pratica degli espropri, con il fine ultimo che l’equità coniughi con la necessità di realizzare piena autonomia produttiva nazionale e ridurre la dipendenza dagli aiuti.

Controllo sulle importazioni
Ai Paesi poveri deve essere garantita libertà di controllo sulle importazioni a tutela della produzione interna. Allo scopo, il mantenimento di una adeguata tassazione sugli imports dai Paesi ricchi sarebbe strumentale.

Abolizione dei dazi intra-Africa
Significa promozione di libero commercio tra i vari Stati africani ed è manovra attualmente in avanzato corso di implementazione per una molteplicità di Stati membri della Comunità di Sviluppo dell’Africa Australe (SADC), del Mercato Comune dell’Africa Orientale e Meridionale (COMESA), e della Comunità dell’Africa Orientale (EAC).

Lotta alla corruzione
Nel settore specifico, essa dovrebbe includere azioni di governo contro il radicato abusivismo interno al settore pubblico nei PVS, e contro l’accaparramento e ricircolo illecito, a prezzi gonfiati, di prodotti alimentari e fertilizzanti.

 

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FONTI
Via Campesina
Food and Agriculture Organization of the United Nations-FAO
International Energy Agency-IEA
International Food Policy Research Institute-IFPRI
GRAIN
International Centre for Trade and Sustainable Development-ICTSD
World Bank-WB
World Trade Organization-WTO
International Monetary Fund-IMF
World Health Organization-WHO

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WHO Issues Guideline For Manufacturers Of Generic Hepatitis C Medicine

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Human Rights Reader 358 

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Six Lessons From the Ebola Epidemic

America’s AIIB Disaster: Are There Lessons to be Learned?

Joining the club: How will the United States respond to AIIB’s expanding membership?

Stolen Goods: The EU’s complicity in illegal tropical deforestation

COP 21 national contributions behind schedule, France warns

Moving In Reverse? Potential Coverage Impacts For Children Of King v. Burwell, Medicaid And CHIP Eligibility Changes

I founded CIDA, but its death worries me less than Harper’s foreign-aid agenda

Why we must invest in girls and women in humanitarian crises

WHO calls on the world to “Gear up to End TB”

Fight TB 2015 Campaign

The Movement of Multidrug-Resistant Tuberculosis across Borders in East Africa Needs a Regional and Global Solution

MPP Welcomes World Health Organization’s First Guide for Hepatitis B Care, Prevention and Treatment (STATEMENT)

KEI, KEI Europe, and Essential Inventions ask five companies for licenses to HCV patents

Indian generic companies should reject Gilead’s controversial hepatitis C ‘Anti-Diversion’ programme

India’s New Health Policy: A Work in Progress

Breaking News: Link 134

Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

Breaking News: Link 134

Some reflections on International Women’s Day from one of the many dumb males on this globe

Seminar: Putting Women’s Global Status on the Map: The WomanStats Project

7 DATA GAPS IN WOMEN’S HEALTH THAT SHOW WHY WE’RE NOTTHERE YET

Measuring Maternal Health in a Post-MDG World

Zimbabwe Launches Film on Rape Survivors Plight

Tears from Inside – Documentary Trailer

What to watch for in U.S. climate plan for Paris

In TPP, USTR Seeks To Boost Criminal Remedies Against IP Infringement

TTIP ‘threat to people’s health in UK and across Europe’

EU ministers must shape overseas aid policy wisely

Towards AGOA 2.0

Industrial Policies for the Upper-Middle-Income Countries

Opinion: The World Sees Progress Against Undernutrition, but it’s Uneven

Will Indian generic pharma players live up to their billing?

Make in India: Modi Launches New Vaccine

Effective Public Engagement To Improve Palliative Care For Serious Illness

The youth holds the future of development

WHO strives to provide universal access to immunization in the African Region by 2020

View on Private Sector: Insurance for the next Ebola

6 experts tasked to assess WHO’s Ebola response

Don’t squander lessons learned from Ebola outbreak, say advocates

This smart ‘band-aid’ could help the world beat Ebola

WHO: Sugars intake for adult and children Guideline

Political leaders and economists to tackle corporate tax avoidance through new independent commission

“Almost all” developing countries now vulnerable to financial crisis: sobering new report

Enabling Dynamic Partnerships through Joint Degrees between Low- and High-Income Countries for Capacity Development in Global Health Research: Experience from the Karolinska Institutet/Makerere University Partnership

Surveillance Report: Measles and Rubella Monitoring