Access to Medicines (Part 1) This Week in Global Health

okay hello everybody welcome to all the global health enthusiasts out there this is twig trick stands for this week in global health today is Wednesday the 5th of November and we're going to be using the whole month of November to focus on access to medicines this is actually access to medicines week here in Europe and we're gonna be talking about that but there's so much to talk about in this on the subject of access to medicines we're gonna use the next four episodes deal to deal with that we're also of course as always we're going to be giving news updates and telling you what's happening in the global health space of course just reminder this is a live show so if you're watching this live either on Google Plus on youtube or on our web page please tweet ask your questions you can tweet us at hashtag twig Twi ogh or you can send a message straight through our web page at Trent org will get that message we're going to answer questions and comments at the end of the show also a reminder that of course those of you that aren't watching this live you might be watching it on YouTube at a later date or listening to the audio podcast of the show welcome to the show we love you guys don't ever change don't do drugs if you're listening to the show and there are references made to webpages or parts of the show that you think wow I'd like to read more about that subscribe to our newsletter we send out the show notes to everyone that subscribes so you can click on the links and you'll get all of those URLs ok Oh importantly we're now going to have the show notes available in multiple languages so if you go to our web page you'll notice when you subscribe to the newsletter you've got an option for choosing a language and we've got a couple of languages that we're going to have more so you know please use that option ok very exciting stuff I'm gonna start off by introducing ourselves and we'll start with me my name is Greg Martin during the show I'm gonna be talking giving you a short overview of what I think is necessary to be in place in order for access to medicines work to work next I'd like to introduce you to Brian Brian over to you sure hi everybody I'm Brian Simpson I'm editor in chief of global health now a daily aggregate enewsletter that goes out from the Johns Hopkins Bloomberg School of Public Health please subscribe you can subscribe for free right here there we are and a nice smiley face too we will include that in notes and will include the link to the subscription in the description below the YouTube channel let me just jump in right now that this newsletter is fantastic we use it all the time all of the twig members make reference to it all the time we read it we love it we're very excited to have Brian on the show so thanks for coming and joining us Brian great thanks so much Greg yeah I really appreciate it today I'll be talking about the three top global health stories from the past week and we'll kind of be updating you on those and so look forward to talking more okay thanks Brian next Jessica tell us who are you weigh are you and what are you gonna talk about today hey everyone I'm Jessica's half and I'm coming to you from the Washington DC metro area it is 2:00 p.m. here like it's 2 p.m. in Baltimore and today I'm gonna be giving you some updates from the current a is th meeting that's going on in New Orleans right now and I'll be telling you about the university's allied four essential medicines conference that's coming up this weekend and yeah that's us that's what I'll be telling you about oh and I will also be telling you about the ASU Macy's campaign do you one forget that one okay brilliant excellent thanks very much next Christie Christie talk to us hi everyone I'm Chris Ronson it is 11:00 a.m. here in San Francisco California and today I'm going to be going over FTAs or free trade agreements and what they mean for access to medicines as well as where you can learn more about them thanks very much Christy and over to Suzanne Suzanne where are you what are you going to talk about today hey everybody I'm souls in Bali I'm speaking to you from North Carolina and it is 2 p.m. here I'll be talking to you I'll be introducing the topic of trips or intellectual property rights and its impact on access to medicines okay and last but not least we've got a special guest andrea andrea is from Switzerland Switzerland will talk to us Andrea who are you where are you what are you gonna tell us about today hi so exactly my name is Andrea my rocker and I'm coming to you from Zurich Switzerland and I'll be talking to you about the a2m week that you mentioned at the beginning of the show and then also pediatric antiretrovirals and hepatitis C medication okay brilliant so we've got an exciting show launch to get through we're gonna jump right in with Brian Brian can you give us a that news roundup that you were talking about sure absolutely we'll start off today with mixed messages that we're seeing on the Ebola outbreak we had some encouraging news late last week from from Liberia that there seems to be a drop in terms of number of cases that w-h-o is reporting they're basing that on in terms of empty beds in clinics fewer positive confirmations and lab tests and a drop in burials I think we you know we can't assume too much from that but it does it is definitely an encouraging sign for sure yeah and I heard people talking about there being a few days of missing data so I think we got that maybe the jury is not out yet and we need to see really what you know what what the truth of the drop is but yeah hope it's the case because that'll be exciting to see us getting on top of this ability yeah that would be a great great sign and absolutely I think the missing data has been the biggest challenge one of the greatest challenges in terms of dealing with this outbreak there's just not enough information not enough accurate information out there so that's that was sort of an encouraging sign but also Bruce Aylward vho had a yeah he had like sort of the quote of the week if you will from this in terms of like you know like yeah it's a little bit encouraging but he says it's like saying your pet tiger is under control definitely definitely one like you know our chickens before they're hatched right now but in in Sierra Leone again we're seeing reports of surging cases there and some some areas nine times as many cases are being reported per day as there were a couple months ago in rural areas and it looks like it's probably six or more six times more cases per day in the capital of Freetown as well so very serious you know signs there and again it's you know it's not a lot of data but it's it's not trending in the right direction in Sierra Leone right right okay brilliant and the next news item the next one is the report that came out this week on climate change this is from the Intergovernmental Commission on reporting on climate change and again there's no good news there it says that we are sort of on to an irreversible course here with climate change even if we are going to make immediate changes in terms of our carbon output and everything like that that that we are headed in absolutely the wrong direction a serious concern there and of course there's all sorts of impacts for global health coming along with climate change from affecting our water safe water and scarcity of water as well as food increased temperatures also can exacerbate cardiovascular disease risk and we're also looking at you know in expanding areas in terms of infectious disease for malaria dengue and a whole host of other concerns too so yeah thanks for bringing it up Brian because we actually talked about that oh maybe a month ago so if anyone wants to find out more details if we definitely covered this in in more details and I'd remember which episode but people can go to our YouTube page or go to our Google+ page you look at our other episodes or our website and find out more information on it because you definitely covered all of those things so thanks for bringing that up yeah absolutely it's a huge issue and I think it's an under cover tissue as well it really is yeah yeah media should be looking at more especially looking down in the future in terms of impacts on health as well absolutely well we know market Tran definitely you know had some comments on that right yeah absolutely mm-hmm good and the final news item Brian the our final one is an update from FP 2020 the family planning initiative to expand access for women to contraceptives to more than 120 million women coming within by the year 2020 so they're reporting on and effects last year and that they were able to increase access to 8 million women which is eight I'm sorry 8.4 million women good sign the only downside is that they were really their target was nine point four million so falling fairly significantly short there although you have to score that as a success in terms of expanding access and that they are expecting for more synergies to kick in and a greater expansion as sort of the years go along toward FB 2020 okay thanks very much Brian if I could interject really briefly Greg I just wanted to say when we were talking about Ebola one of the I think it was two episodes ago we were saying there had been reports of lower or reduced body counts and a lot of what we see with the data in a bola is cases that have been diagnosed like people that have been checked into the Ebola treatment centers and things like that so when you hear people talking about reduced body counts I think that's more indicative and reflective of those undiagnosed cases as well are they the unrepresented ones so that's a good indication and then also to follow up on what Jessica and Brian were saying the episode on climate change is number five if you go to trick don't find episode number five if you're interested in climate change and health right next up Jessica Jessica's gonna talk to us about the ASTM H conference tell us what HTM H stands for tell us what conference Thanks gladly do that so ASTM H stands for the American Society of tropical medicine and hygiene and they're having their annual meeting this week in New Orleans and this is a really important meeting for global health researchers and clinicians and it's actually one of my favorite meetings I'm really sad that I'm not there this year but but I'll see you guys next year so it opened on Sunday and I'm gonna give you some highlights from the meeting well first of all bill gates opened the meeting on Sunday with a keynote address and he pledged 500 million dollars to the fight against malaria and other diseases and he also talked about seeing a malaria eradication in his lifetime he also pointed out how the Ebola crisis shows us how unprepared we are for a pandemics also there was a study from the London School of Tropical Medicine and hygiene and it showed that monkey malaria is now a dominant cause of human malaria hospitalizations in Malaysia and deforestation is to blame for this and finally there are scientists from Baylor College of Medicine that show that Jacques disease is emerging as a US public health threat for more information on these go into our show nets with the links and read more about it and if you want to keep up with what's going on at the conference right now you can follow the Twitter hashtag hashtag trop med 14 thanks very much is there not another Twitter hashtag that people need to be alerted to you yes yes there is so alt H is has the social media campaign calling I am trop Matt any idea is to give a human face to the people that are behind that our global health professionals people doing global health work so this applies for a scientist you know researchers clinicians nurses doctor every anyone that does administrators so if you're a global health professional show your support for a global health and Tropical Medicine by sending in a picture of yourself with a sign with the hashtag I am trop it you could use a sign just kind of like that right and we have gotten involved in this and we are going to show you how we are supporting this campaign because we are all global health professionals and from the communication side and communication and education is important so I think Suzanne has our has our composite quick photo there we are and though that will go up on Twitter and on our Facebook page and they're all those places so yeah a is teammate yeah so he'll be a topical medicine brilliant excellent a great great can I pop in with one one note from AST mhm that any of the researchers who are scientists who have been in West Africa investigating the Ebola virus have been expressly uninvited to ast mhm and the upcoming APHA conference as well III didn't really lose Anna to I knew about the ast that was a huge controversy but I did know them a APHA yeah exactly so they're exceeding CDC guidelines in the state of Louisiana and it's expressly uninviting a scientists or anybody who's been in West Africa lately because it's also and it's just angles Ben West Africa anyone that's had patient contact so it's a little extreme I would say so many had a bola okay all right we're gonna jump right into I mean we said that this episode and the rest of November we're gonna focus on the subject matter of access to medicines what I'm gonna do just quickly in about 30 second is give you what I think needs to be in place for people to be able to access medicines this is not a comprehensive exhaustive list of things this is just in my experience and in the sense that I've been working in this area for a little while this is what I think needs to be in place and other people on the panel might want to jump in with other stuff as well the first is of course the medicines and the diagnostics have to exist right and there's lots there lots of diseases out there for which either effective treatments and safe treatments for those diseases just aren't there and we're wanting the pharmaceutical industry to really step up and and and and invest money in R&D for those diseases and then I've mentioned Diagnostics as well and the reason for that is it's pointless having medicines that you can use to treat people if you can't diagnose them with the disease in the first place and it's all so pointless developing Diagnostics if it's the case that you don't have medicine to treat people that you diagnosed with the disease so medicines and Diagnostics have to be developed together and and obviously this is extremely important you know I mentioned that you know then of course pharmaceutical companies need to step up and do this R&D and of course it's not just pharmaceutical companies I think universities are doing a lot of work in this area and there's a lot of nonprofit organizations like D n di that are doing incredible work the TB the TB Alliance of course are doing incredible work in terms of developing medicines for TB there's lots of mmv they're doing stuff for malaria there's these these public-private partnerships so they're not happening that's not just Pharma but anyway this entire community of people need to kind of like really get medicines and diagnostics developed for neglected tropical diseases and others right so the first thing was it's very important even for access of medicines to have universities doing increasing research in in in research because the patenting system for pharmaceuticals and universities as different universities are more open to giving access to people with their with their findings so that's again like another reason why universities are really important absolutely no question about it that's that's exactly right so the first thing is the drugs have to exist the second thing is that these drugs have to be approved by a national regulatory authority like you know in the UK it's the MHRA in the u.s. it's the FTA but all countries have got a national regulatory authority we're not going to get into that now we'll we'll talk more about that in subsequent episodes but suffice to say that that's important to ensure that safe and effective medicines are available in these markets there's an important initiative that the world health organization called WH o pre-qualification and that's gone a long way to facilitate this process in developing countries and we'll talk about that in subsequent episodes so we've got the drugs they registered in countries the next thing you need is you need country demand in other words you need the countries themselves to be saying we want to buy these drugs and for that you need government policy treatment guidelines and and national formulary is all to support the use of these medicines in countries and of course fourthly connected to that is the drugs have to be affordable and finances must be in place in order for these drugs to be procured and when we know and we're going to talk a lot about barriers that are that that often prevent that from being the case an important one of course is is that the TRIPS Agreement and intellectual property rights surrounding some of these drugs that aren't patent we're going to talk about that in tonight and other episodes we're also going to talk about that the patent pool the patent pool is at an initiative in Geneva it was financed by by unit aid and that's an exciting initiative that's got a long way to try and circumvent some of these these accesses the access to medicines okay so the foot so the fourth one is you need to have finances and the drugs need to be affordable and the final one is you need to have procurement mechanisms in place and supply chain mechanisms to make sure that the drugs get from where they're manufactured to the people that need them for that to happen you need a whole lot of things inflation need quantification at a national level you need procurement shipping warehousing distribution inventory control etc etc all to be in place we're not going to talk more about that right now but suffice to say that's going to be important part of the discussion going forwards okay so that was a really speedy overview of what's important in terms of access to medicines is of course other things as well does anyone else in the group have anything to add you know that my list of five that might not be comprehensive is there anything that you can think of that needs to be added to that list you know one thing I was thinking of Greg and you may have already addressed this but is a medicines that are already approved and okay you know using it for one use reusing for another another these or another condition or something like that right right right that's important and we've seen that we've seen that happen very successfully often with drugs like diseases like TB so for tuberculosis there's been very little in terms of novel treatments available over the last 40 years I think I can only think of one drug that's been developed but there's been lots of drugs that have been repurposed for the use of in in tuberculosis particularly drug-resistant TB etc etc so that's I think that's an important thing something I touched on and I maybe just want to reiterate this because it's quite important is when we talk about access to medicines we should always include the idea of access to safe medicines because there is so much there's so many counterfeit medicines out there I can't remember the data I had these figures the other day but the number of malaria tablets out there for example there are not malaria tablets at all being being sold and used under the guise of malaria treatment that our counter feed is phenomenal it just as one example and you know that's we really need to be talking about safe medicines and and in my opinion you know people have a right to human right to be able to access safe safe medicines that that aren't going to do them any harm on that point Greg in fact innovation is very important to make sure that safe medicines reach the target population and there are innovative companies such as super raxil which is a social innovation firm and what they have come out is actually a way of tracking malaria medicines in Africa so they've been able to actually track medicines not only stolen medicines but also like counterfeit medicines so you can know because they have this innovative system so I can definitely mention that in the show notes details about companies such as which are looking at – a social enterprise and innovation as a way to come to you let's get a link to that in the show notes I think that's interested like to read more about that that sounds fascinating and what I think is also always important to mention is that when we're talking about research going into medicine we always have to make sure that the research that is being done isn't bound to the met to the the diseases that affect the solely the the rich people in this world and bring financial incentive to do research that we always remember that research also has to be done in neglected diseases and we need to really delink the system of research and innovation from the price is paid for the drugs that end up on the market in the end absolutely very good point absolutely okay well I'm gonna ask Susan you're gonna talk a little bit about intellectual property rights the trips agreement and access to medicines why don't this is a good time why don't you jump right in right now with that absolutely so actually talking about access to medicine it was Jonas Salk the the guy who actually came up with polio vaccines birthday hundredth birthday of this week last week and when he was asked why didn't he so he never patented his vaccine and when he was asked by someone why didn't you pattern to your polio vaccine he said it's like patenting the Sun and so that's again he's like one of the access to medicine heroes here but then again no conversation on access to medicines is complete without the mention of intellectual property rights issue and World Trade organization's trade agreements that governed the intellectual property rights especially trips or trade-related aspects of intellectual property rights as its full-form is which has implications for price of medicines under parents especially new medicines and new generation vaccines and just to give a brief background to reviewers on trips according to trip trip agreement World Trade Organization members agree to comply to a minimum standard of intellectual property rights which requires patent for new drugs and a 20-year patent protection window now trip does has flexibilities within itself to safeguard public health such as lease development at least old country's provisions which exempt those countries from trips until 2016 and a compulsory license system by which a country can issue a compulsory license to enable local manufacturers to manufacture drugs in a generic way for domestic use but at the same time giving royalties to the patent holder so just keeping this in mind like you know trip has had a huge impact on global health and access to medicines and we must remember when we think about it that performance of health in lower middle-income countries influences health worldwide and these trade agreements are really important when it comes to access to medicines in those countries okay very good and I think related to the trips agreement so you know just to reiterate the trips agreement is one of the WTO's multilateral trade agreements and all the member states of the WTO are bound by these agreements but there are also a lot of bilateral and multilateral trade agreements out there what we call free trade agreements Chris could you perhaps just kind of give us a little overview in a nutshell what's happening in the world of free trade agreements absolutely so hot on the heels of what Susan was just talking about intellectual property we've got free trade agreements the activities of many international organizations such as MSF the Global Fund to fight AIDS tuberculosis malaria depend heavily on affordable generic drugs to treat people living with a number of diseases from HIV to malaria to a number of neglected diseases as well free trade agreements or FTAs can actually threaten access to those generic drugs trade pacts other international agreements can impact domestic regulations and in many cases resulting competition results in high monopoly prices and a lack of access to people who need them most we're gonna highlight one the MSF access campaign is really vying and discussing the trans-pacific partnership or the TPP looking and asking for more transparency in the goings-on with the TPP the government seems to be attempting to impose aggressive intellectual property standards and a trade agreement with developing countries means stronger intellectual property regimes which translates into higher medicine prices for people who need them the most and in developing countries where people rarely have health insurance it means I have to pay out of pocket and in most cases won't be able to get the drugs that they need and that could determine whether or not somebody lives or dies so in our show notes we're gonna have a list of some current FTAs from the TTIP the transatlantic trade and investment partnership as well as like the US Jordan FTA is a good example of what can happen with free trade agreements as well as the EU Thailand FTA and one between the EU and India okay brilliant thanks Chris very interesting stuff and more details will be available in the links that will be in the show notes right now over to Andrea Andrea is going to talk to us about pediatric Ares and also a little bit about some exciting stuff that's happening in Europe at the moment in access to medicines week okay over to you Andrea all right yeah so first off I just want to sort of advertise for the access to medicines week it's going on all across Europe right now and also in the US and just it's actually really easy to just figure out what's going on just type in a 2m week org and you're already there this will all be linked or just use the hashtag that you see in my lower third there and you'll just just by clicking on the hash I going on Instagram Twitter Facebook whatever it's mind-blowing what students are doing across Europe right now to raise awareness on access to medicines we've also got a little petition going so it's really really inspiring to see what students are up to okay we'll have links we'll have all of those links in the show notes as well so if you subscribe to the newsletter you're gonna get those links and we'll get those out to you so yeah and Greg let me just interject briefly since this is on top with with what students are doing there's also because that's what's going on in Europe in this weekend at Duke University there will be a conference with UAM students that are going on and you can find more about this conference going to this website but we can have that in our show notes as well but I just wanted to mention that so if you haven't signed up already and you can get down to Durham North Carolina this weekend and you're passionate about essential medicines check it out brilliant exactly perfect andrea carry on talk to us about pediatric arabes all right so pediatric arabes is a lovely topic because it's a perfect way of sort of looking at neglected diseases from a completely other side and so it's with pediatric antiretrovirals of one of the issues that they deal with is that there's or one of the huge issues is that there's no appropriate diagnostic materials for children under the age of 18 months because you need to actually measure the viral load which is a very very expensive test so that's one of the barriers you have with with pediatric HIV is that you already can't diagnose children of the young age also the medications available it's currently the syrups available that infants can swallow taste very very foul so there's no syrups that are easy for children to swallow and the tablets available are also not available in a child friendly form or dosage so you often have parents or doctors who have to chop down the tablets and estimate how much they're giving children and the reason for this is because pediatric HIV is an issue that has come is very no doctor there's very little money in it there's very little research incentives accordingly and I'm currently I mean the w-h-o has done quite a lot to sort of standardize the diagnosis etc etc but as long as we don't have more research incentives going into this we have children just dying from actually from a disease that is treatable and that's really really sad so pediatric HIV is a perfect example for a very neglected disease that in general and grown in adults is not necessarily neglected okay that's interesting and of course the over the last few years we've seen really important work being done between unit aid and the Clinton Health Access Initiative one of the problems they try to solve and I think they went a long way to dealing with us is and we've talked about this on Twitter before so I'll just reiterate because we're talking about it again now the pediatric drugs were unbelievably expensive to treat their children with HIV so much so that countries were unable to out of their own budget yeah be buying pediatric drugs which meant the market was small which meant the prices stayed high unit alien try it together put together a program where they spent about five hundred million dollars and they over about five years they spent this money and they worked with the countries to improve demand forecasting except for etcetera so that the prices of the drugs could be brought down at the expense of unit aid but once the prices were lower country programs could then afford to step up and include pediatric arabes in their own national budgets and that's more or less what's happened so that's been what you know in the discussion about pediatric arabes that's one of the big ones I think that's a you know there's that is one of the sort of highlights that we can a real success story that we can point to and it's hopefully there'll be more of that sort of thing another disease where we're seeing a big problem with respect to pediatric drugs is of course tuberculosis recently in the last couple years the guidelines for the dosages that children need to be given to be treated for TB changed and when they changed we all kind of realized that at these new dosages there weren't formulations that were available to give them to kids at those dosages again we had to have mothers and doctors kind of braking pulls up and it all became quite complicated I know a lot of works being done to kind of solve this problem but it's an ongoing issue so that's TB drugs as well and of course over the next couple of weeks we're going to talk about other diseases and other initiatives that have been put in place to try and circumvent some of these problems okay that's all we going to talk about in this episode we're gonna call it a night now if you're watching this on YouTube this this whole thing is gonna end any second now if you're watching this live don't go away the live show will continue and this is where we're going to just answer questions and comments that people have been sending in over twitter or by the web page and we'll have more of a sort of an informal conversation and and banter right now if you're watching this on youtube thanks for watching don't ever change don't do drugs waste your best we'll see you soon and and thanks for watching okay sweet Greg really quickly can we give it a quick shoutout that's not they have not ended stay with us we have not ended just a really quick shout out to Teresa majeski because she is a viewer that we have every single week yes if she is about watching us on her lunch break so we just want to say hello and thank you for your continued patronage and your lunch but you were yeah thank you modesta kya and we do and believe me when people send us emails and comments we really appreciate it we try to respond to everything that comes our way so please keep in touch with us interact send us emails you can email us at hello at twig org and we will definitely respond to that or get us on Twitter okay thanks very much speech see you next week same time same place okay


  1. Such a fun episode to do on such an important topic, and really enjoyed having Andrea and Brian on the panel with us- great insight and great work that they both do.  Hopefully they will be back soon for some future episodes!

  2. Watch last nights episode of This Week in Global Health that focussed on Access to Medicines.

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