PHA-Exchange> access to essential medicines also for women

[claudio at hcmc.netnam.vn]

>From Nadia 
WGNRR Women's Global Network for Reproductive Rights 
e-mail office at wgnrr.nl 
website www.wgnrr.org 

______________________________________________________________

1) What are the recent debates about access to essential medicines and
should this be an issue of priority for gender equality advocates?

This article looks at access to essential medicines including the
imbalances in research and development priorities. It also looks at how
research and policy decisions affect poor people in developing
countries who require affordable essential medicines.  

By Kristy Evans


The recent battles by the Treatment Action Campaign (TAC) in South
Africa as well as other activists around the world for access to
antiretrovirals (ARVs) for people living with HIV/AIDS has put the
spotlight back on the debates around access to essential medicines.
This time, the agenda comes with an explicit gender perspective because
within the highest prevalence countries, young women are the fast
growing group to contract the HIV virus(1) and will eventually require
medications (ARVs) to treat AIDS-related illnesses. However, for the
majority of these young women, essential medicines cannot be accessed.

The World Health Organization (WHO) began its work on essential
medicines in the mid- 1970s and launched its Action Programme on
Essential Drugs in 1981. Although much progress has been made in terms
of global health in general, access to essential medicines for many
still remains shocking as "close to one third of the world's population
still does not have regular access to the most basic essential drugs
and medicines." (Bisilliat, 2001, p.21)

In their campaign on Access to Essential Medicines, Medecins Sans
Frontieres (MSF) explain that the debates around accessing essential
medications center around three pillars:

1. Overcoming access barriers- Many drugs are too expensive for those
in the developing world to buy. Other life-saving treatments are not
available because manufacturers have abandoned their production because
they were not considered profitable enough.

2. Globalization- The emerging global trade system, which sets the
rules for how products are sold within and between countries, treats
medicines like all other products. This is unacceptable. The patenting
of medicines confers a market monopoly to pharmaceutical companies who
often charge the same high price worldwide. The result is that people
in the developing world cannot afford the medicines that could extend,
improve, or save their lives. 

Access to essential medicines is a political issue that will take
public involvement and change of government policy to solve. 

3. Stimulating research and development for neglected diseases-
Research into new and adapted treatments for communicable diseases such
as tuberculosis, malaria, sleeping sickness or leishmaniasis has ground
to a halt. Between 1975 and 1999, of 1,393 new drugs developed only 13
(1%) were to treat tropical diseases, which together account for over
9% of the worldwide disease burden. The reason is clear: drugs for
tropical diseases are not profitable for drug companies. Instead, the
pharmaceutical industry is focusing Research & Development (R&D) to
meet the needs of people living in wealthy countries, and is
increasingly dedicating research to address "lifestyle" diseases. It is
clear that the market has failed, and will continue to fail, the
diseases of the poor. Compounding with this market failure, there is a
failure of public policy to redress this fatal imbalance.(2)

Many of the access issues for essential medicines come down to the fact
that there is simply not enough monetary incentive for pharmaceutical
companies to research or develop drugs for diseases affecting the poor.
In terms of global pharmaceutical sales, only 20% are from developing
countries although 90% of illnesses globally occur within developing
countries (MSF, 2001, p. 8 and 9). There are many perspectives,
predominantly from gender and human rights activists, stating that it
is essentially immoral to make profits through patenting and unequal
trade agreements pertaining to drug development and sales. The debates
center around the well-used mantra of "people before profits." However,
pharmaceutical companies maintain that it is in their rights to make
profits from drug sales as they argue that it takes between 300-500
million dollars to develop a new drug. Barton Gellman, in 2000 article
in the Washington Post, explains that "it is a matter of simple
economics: potential return on investment, not global health needs,
determines how companies decide to allocate R&D funds. According to the
drug industry, the low purchasing power of developing countries-
coupled with the high cost of R&D and drug registration -rationalizes
their focus on wealthy country markets." These claims have been viewed
as highly contentious, with people questioning the validity of drug
development costs as well as the idea that they are profiting from
collective knowledge in terms of scientific discoveries that have been
funded by public means. 

The fact remains that as poor people in developing countries continue
to die from treatable diseases such as malaria, tuberculosis, and
HIV/AIDS, the pharmaceutical industry is more interested in putting
money into health priorities of developed countries. For example, an
analysis of drug development outcomes over the past 25 years shows that
only 15 new drugs were indicated for tropical disease and tuberculosis.
These diseases primarily affect poor populations and account for 12% of
the global disease burden. In comparison, 179 new drugs were developed
for cardiovascular diseases, which represent 11% of the global disease
burden. (MSF, 2001, p.10) 

There are many respects in which the availability of essential
medicines adversely affects the lives of women. In terms of access to
these drugs, women are the majority of the poor people in the world and
therefore are drastically affected by the pricing and availability of
essential medicines. With the advent of HIV/AIDS, the burden of care
for the sick and elderly, as well as the rise in orphans, have
increased drastically and have fallen on women who have little to no
access to the essential medicines needed to treat sick people both in
their homes and in their communities. Very little research has been
done into the extent to which women can access drugs in developing
countries and this has been put forth as an area which needs to be
studied in order to determine the extent of the situation. This is also
of concern as the rise of HIV prevalence has followed with an
increasing number of people who are becoming infected with
opportunistic infections of treatable diseases such as TB. However, if
these medications cannot be accessed and/or are not being developed,
this places more and more burden on caregivers who are predominantly
women.

In personal correspondence, a staff member from MSF stated that "there
is clearly a gender imbalance in research priorities. For instance, at
the recent Conference on Retroviruses and Opportunistic Infections in
February in San Francisco, new evidence was presented showing that
single-dose usage of the antiretroviral drug nevirapine (as given to
mothers and new-borns in Prevention of Mother-to-Child Transmission
programs) actually increases the chances of resistance developing later
to nevirapine when mothers are put into anti-retroviral treatment
programs. That is something which, we feel (but can't prove), would
have been discovered a lot earlier if the sample was men rather than
women" (Personal communication, April 13th, 2004). It is imperative
that women are involved in the clinical trials for all essential
medicines as women react to and metabolize drugs differently than men.

This highlights the urgency of the debates surrounding essential
medicines. With the rise of the HIV/AIDS epidemic and the fact that in
the highest prevalence region (Sub-Saharan Africa) women are not only
the group that is fast becoming the most infected, but are also the
ones who have the most barriers in terms of accessing essential
medicines. As women struggle with social, economic and political
disparities which are fueling and fuelled by gender imbalances, they
also struggle with their basic right to health-not only for themselves
but for the people that they are increasingly taking care of. It is
imperative that gender equality advocates realize the extent of the
problem. The availability and access to essential medicines is
imperative for people to realize their right to health which is
guaranteed "in article 25 (1) of the Universal Declaration of Human
Rights (UDHR), article 12 of the International Covenant on Economic,
Social and Cultural Rights (ICESCR), article 24 of the Convention on
the Rights of the Child (CRC) and article 12 of the Convention on the
Elimination of All Forms of Discrimination against Women (CEDAW), as
well as on the right to non-discrimination as reflected in article 5
(e) (iv) of the International Convention on the Elimination of All
Forms of Racial Discrimination (ICERD)" (Office of the United Nations
High Commissioner on Human Rights, 2004, p.1). We must be vigilant that
we advocate for access to essential medicines for those people who need
them and who also have the most difficulty accessing them- poor women
in developing countries. We must utilize the international human rights
treaties to assist us in our advocacy and realization of these rights-
at global, regional, national and local levels. 


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