Daily Times (Malawi) Op-Ed: Response to Pharma-Connected Think Tank

The Daily Times (Malawi)

My Point of View -On neo-colonialist NGOs
By Robert Weissman,
07 May 2008

It would be easy to dismiss Temba Nolutshungu’s recent opinion — Neo-colonialist NGOs published in The Daily Times — if it were not part of an organised effort to spread confusion about vitally important policy debates with life-and-death consequences.

The author spins a fantasy story in which public health groups have wrested control of the World Health Organisation (WHO), and are seeking to undermine the efficient patent-based pharmaceutical research and development (R&D) system.

Perhaps readers might have been able to better understand the motivations for the author’s arguments if he had revealed his organisation’s financial entanglements with Big Pharma.

The author suggests that Africa has little reason to care about the price of medicines, because healthcare infrastructure is inadequate.

It is of course true that Africa’s healthcare systems are badly depleted and in need of massive investment. It is also the case that many of the public health advocacy groups that the author denounces are working to strengthen African healthcare systems.

But it is not a matter of choosing between improving healthcare systems and finding ways to lower the price of medicines so they are affordable.

Both are necessary, and both can be achieved.

Remarkably, the author highlights the case of HIV/Aids drugs. Ten years ago, before generic competition, brand-name companies charged roughly the same price for lifesaving HIV/Aids drugs in Africa as they did in rich countries — $10,000 a year per person, or more. An HIV diagnosis was a death sentence. Today, the price is as low as $100 per person — a price decline that leveraged a huge increase in donor money that otherwise would not have been made available. The severe problems with healthcare infrastructure notwithstanding, 2 million people living with HIV/Aids in Africa are today receiving treatment.

Much more needs to be done — and improving infrastructure is a top priority. Only about 30 percent of those in need are receiving treatment. But without the price reductions brought about by generic competition, almost all of the 2 million people in Africa now receiving treatment would be dead or would die soon.

The author also directs attention to important negotiations now underway at the World Health Organisation. These talks are designed to identify means to advance both innovation and access to the fruits of innovation. The idea is to explore reward systems that provide an incentive for the development of new medicines to meet priority health needs in developing countries, and to make those products available on an affordable basis.

The need for new arrangements is apparent. The patent monopoly system, the current means to ‘incentivise’ corporate sector R&D, is not working for developing countries.

Patents are not worth much if they offer monopolies on sales to a population that — no matter how large — has little buying power.

Developing countries comprise 80 percent of the world’s population but amount to only 13 percent of the global market for medical products. As a result, there is little corporate sector R&D devoted to the needs of developing countries. A review by Doctors Without Borders found that of 1,556 new drugs put on the market between 1975 and 2004, only 21 were for “neglected diseases” — diseases endemic to developing countries.

Pharmaceutical companies commonly price the new drugs that they do develop, intended for rich country markets, far out of reach of patients in Africa. Compounding the inequity, most important new drugs are developed with very substantial government support.

A system that fails to respond to key health needs — and then prices what it does develop out of reach — is not one that recommends itself.

Isn’t it worth exploring other ideas, like non-patent prizes to ‘incentivise’ R&D, with the resulting fruits of the innovation made available at competitive prices?

Perhaps readers might have been better able to assess the author’s views on these matters if he had identified his organisation’s ties to the pharmaceutical industry. A host of multinational drug companies are among the corporate members of the author’s Free Market Foundation in South Africa. These include GlaxoSmithKline, Johnson & Johnson Medical, Novo Nordisk, Roche and Wyeth.

Ideologues and those would prioritise the narrow commercial interests of Big Pharma over public health objectives have reason to reflexively defend a patent monopoly-based R&D system that is not working for the developing world.

For everyone else, the rising interest in new institutional arrangements to promote the complementary public health objectives of innovation and access is something to embrace.

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The author is director of Essential Action, a public health advocacy and corporate accountability group based in Washington, DC.

This op-ed responds to a previously published op-ed by Temba Nolutshungu. Here is the text of that piece:

The Daily Times (Malawi)
My Point of View- Neo-colonialist NGOs
By Temba Nolutshungu
30 April 2008

Soon after the real colonialists had left Africa, a new breed of Western colonialists emerged: the statist non-governmental organisations that want to save us from everything from genetically-modified food to globalisation–and growth.

These “consumer” and humanitarian groups and “development” charities are united in the belief that modern industrial civilisation, profit and competition are unethical. In their view, people, particularly in developing countries, would be better served by state control that puts “equity” and the redistribution of wealth ahead of the economic dynamism that has enriched the West and such eastern countries as Taiwan, Japan and South Korea.

But despite their claims to speak for the poor, only a few hundred of the several thousand NGOs registered at the United Nations come from developing countries. The vast majority are from the USA, with many from Britain, France and Germany.

These groups have influence way beyond their size. Many poor countries do not have the technical capacity to formulate their own policies for services such as health, so they consult NGOs or bodies such as the World Health Organisation (WHO), mandated with providing impartial scientific advice to governments.

The WHO has been colonised by these NGOs, acting as policy consultants and playing a big part in formulating the WHO’s technical and policy advice to members. But the NGO advisors consistently get things wrong.

Take Aids. Because there is no cure, the only way to tackle its spread is to prioritise prevention, to stop the number of infections increasing every year. Of course treatment is essential but the NGOs pushed hard for most public money to be spent on drugs for those already infected–even though the worst affected countries do not have the doctors and clinics to administer the drugs. The WHO gave in, so infections continue to rise and treatment is haphazard.

A similar thing happened with malaria. For years, countries from India to South Africa successfully controlled malaria by spraying the insides of houses with DDT.

Environmentalists and NGOs played up scientifically unsound scare stories from the USA to demonise the pesticide and pushed for a ban: the WHO stopped recommending it in the 1990s, malaria soared globally and millions died. Recently, South Africa reintroduced DDT spraying and cases plummeted but few other countries have dared upset their NGO advisors.

Western pressure groups have also scared European consumers away from buying GM crops grown in Africa: Uganda has been directly threatened by European Union representatives and Kenya avoids GM.

NGOs operate at national level too, directly feeding governments with statist policies. In their latest campaign they argue that, because very few drugs have been developed for a handful of tropical diseases that occur in the poorest countries, patents prevent this and are inherently unjust.

They want bureaucrats rather than markets to determine what diseases are researched and they want subsidies for setting up medicine factories in Africa, where ingredients, technicians and managers would have to be imported and where there are very, very few laboratories to test quality: bad copies are often worse than no medicine at all as they encourage drug-resistance and virus mutation.

All this in the hope that removing profit will usher us into a magical new age in which cheap new medicines will become freely available to the poor –- never mind the fact that market-led research and development has produced the vast majority of all treatments available.

The final stupidity is that you could give every African every drug for free, to no avail: without the infrastructure to monitor and administer them, many drugs are useless or dangerous.
The NGOs achieved this by lobbying African governments at the WHO: the similarities between the NGOs’ campaign literature and the official position of Kenya, a leading proponent of the R&D Treaty, are too many to be a coincidence.

Of course, many African governments like these schemes because they help protect their own pharmaceutical companies or transfer the blame for their own failures in health care onto foreigners such as multinational pharmaceutical companies. And these schemes are being aired in Geneva this week at the WHO’s Intergovernmental Working Group on Public Health, Innovation and Intellectual Property (IGWG): member states need to put the real needs of the poor first and kick out the counter-productive ideology.

Statist NGOs have enormous influence on public opinion, the UN and African governments even though their ideologies have been shown not to work in their own countries: before taking the neo-colonialists’ medicine, we must carefully read the label or suffer nasty side effects.