Drugs for Africa: Is help on the way?

Rachel Kiddell-Monroe has seen firsthand the impact of a lack of affordable medicines in the developing world.

The Montreal-based physician, with Doctors Without Borders for 16 years, worked in a hospital ward in Rwanda full of AIDS patients, many within days of dying.

It was 1994 and there was no AIDS treatment available in Africa. She called pharmaceutical companies to try to get treatment for her patients, and was told the lifelong treatment would cost about $12,000 per patient each year, and that no one was willing to fund it.

Zodwa Hilda Ndlovu, a retired South African nurse who is HIV-positive and lost her son, daughter and only grandchild to AIDS, addresses a Parliament Hill rally.“I was just so horrified that we just had to watch these people die. And of course, they all died,” she recalls.

Sixteen years later, Canada now has legislation to get affordable medicines, like HIV/AIDS drugs, to people in the developing world. Canada’s Access to Medicines Regime, or CAMR, was passed in 2004, with Kiddell-Monroe playing a key role in championing the legislation.

But CAMR is “seriously flawed,” says Richard Elliott, executive director for the Canadian HIV/AIDS Legal Network.

The five-year-old legislation has only been used once, with an order of drugs shipped to Rwanda.

That’s why New Democrat MP Judy Wasylycia-Leis introduced Bill C-393. The private member’s bill aims to reform CAMR and streamline the process of getting patented pharmaceuticals to developing countries. The bill passed second reading in the House of Commons in December 2009, and is now at the committee stage.

Bill C-393: the solution to “flawed” legislation?

Jillian Köhler, University of Toronto pharmacy professor and co-author of a 2007 report on CAMR’s policy gaps, says CAMR was “designed to fail from the get go.”

“The legislation fails to give commercially-viable incentives for the generic drug industry, " Kohler says. "It was cumbersome for the developing countries to use, and it simply was too complex to get drugs to people quickly.”

An example, Köhler says, is the situation with Apotex. The Toronto-based company was the first and only generic drug manufacturer to use CAMR to ship an order of HIV/AIDS drugs to Rwanda in Sept. 2009.

Apotex says it faced so many hurdles using the legislation that it wouldn’t likely try it again, according to a Sept. 18, 2009 statement from Jack Kay, the company’s president.

“The bottom line is: we need to make [CAMR] easier to use,” says Köhler.

Tweaking [CAMR] wouldn’t cost Canadian taxpayers a single cent and could potentially save many, many lives.

“It risks becoming a one-hit wonder,” says Elliott.

Wasylycia-Leis says C-393 addresses those problems.

“It speeds up the process, takes out the bureaucracy and red tape, and becomes much more efficient,” she says.

Not everyone supports C-393. 

It passed second reading in the House of Commons by 143 to 127 votes, with most Conservatives opposing the bill along with a handful of Liberals.

CAMR not the only answer

One of the opposed is Liberal MP Marc Garneau, the party’s industry, science and technology critic. While Garneau says he supports getting medicines to developing nations, he doesn’t agree with C-393.

He says countries in need of medicines are already getting them at a lower cost from other countries, like India and South Africa. He also says there is a lack of infrastructure in place in developing countries to receive, store, transport, and administer medicines.

Garneau instead proposes a model where developing countries make their drug needs known to the Canadian International Development Agency. CIDA passes the order on to both big pharmaceutical companies and generic drug companies, who then bid for the order.

Also opposed to C-393 is Rx&D, a lobby group representing Canada’s research-based pharmaceutical companies.

Russell Williams, the group’s president, said in a March 29 statement that “C-393 would remove a number of critical safeguards that were consciously placed in CAMR by parliament.”

Williams also said pharmaceutical companies represented by Rx&D have provided more than $250 million in donated medicine to developing countries since 1990.

Opposition arguments don’t “hold water”

Wasylycia-Leis says “it makes no sense” for big pharmaceutical companies to oppose C-393.

“It’s power politics,” she says. “Anything that leads to generic drug companies playing a greater role is a threat to Big Pharma.”

The McGill Global AIDS Coalition staged a demonstration outside MP Marc Garneau's office in support of CAMR changes.

Elliott believes many of the MPs who opposed C-393 at second reading were “accepting misdirections” from big pharmaceutical companies.

He says this has led to a few MPs “caving to corporate pressure.”

Kiddell-Monroe, also president of the board of directors for Universities Allied for Essential Medicines, a global private non-profit organization, says none of the arguments against C-393 “hold water.”

“Tweaking [CAMR] wouldn’t cost Canadian taxpayers a single cent and could potentially save many, many lives,” she says.

Wasylycia-Leis is not opposed to Marc Garneau’s proposed model.

“It’s fine to pursue other additional ways of getting drugs to Africa, but that doesn’t negate the need for my bill,” she says.

Supporters know there are still many hurdles ahead for C-393 to become law.

“This is not smooth sailing by any means,” says Elliott. “There’s definitely going to be an effort from Big Pharma and its allied MPs to vote the bill down, or possibly even kill it.”

For now, the bill is waiting for an Industry committee meeting to be scheduled to be considered, which Wasylycia-Leis believes will take place sometime before June.

Grannies on the go

An estimated 13 million children have been orphaned by AIDS in Africa. Many are now being raised by their grandparents. The Grandmothers to Grandmothers Campaign aims to help African grandmothers raising their grandchildren – and it supports Bill C-393.