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Lifeline for patients in jeopardy [Ottawa Citizen]

Ottawa Citizen, October 28, 2010

By Rachel Kiddell-Monroe, James Orbinski and Richard Elliott

One week after failing to win a seat on the UN Security Council, can Canada do better on the international stage by fulfilling a promise made years ago to the developing world?

In 1994, staff of Médecins Sans Frontières watched AIDS patients die in Rwanda. The unconscionable delay before governments admitted there was a genocide was followed by another great injustice: the inability to treat Rwandans with life-saving medicines available to American, British or Canadian patients. As they died, all staff could do was hold their hands. There was a hospital, health staff, a pharmacy and equipment. What was missing was medicine — it was too expensive to bring to Africa.

Sixteen years later, the situation is improved, but far from resolved. While five million people in the developing world now have access to AIDS treatment that is available in rich countries like Canada, roughly 10 million more — including two million children — still do not.

We have a chance to make a difference. In 2004, Parliament unanimously created Canada’s Access to Medicines Regime (CAMR) to authorize exports of lower-cost, generic versions of expensive brand-name medicines to eligible developing countries. But what was supposed to be an example of Canadian leadership on the international stage resulted in an unworkable system which has allowed only one order of one AIDS medicine to be exported to one country: Rwanda. This one use took years of effort, largely because the system’s cumbersome process is at odds with the practical realities facing developing countries and generic pharmaceutical manufacturers.

But Parliament can fix CAMR. Private member’s Bill C-393 would allow a generic drug manufacturer to get a single compulsory licence to export lower-cost medicines to multiple developing countries already covered by the current law. This would replace the present system’s requirement of a separate process of negotiation and licensing for every drug order from every country, with all the associated transaction costs.

Bill C-393’s “one-licence solution” would clear the way for generic suppliers and developing countries to navigate the bidding and procuring process without multiple hurdles and uncertainty along the way. It would also make it easier for Canadian generic manufacturers to provide developing countries with medicines at even lower, competitive prices.

Opponents of Bill C-393, including the “big pharma” lobby, are spreading misinformation. Despite their claims to the contrary, there is ample evidence that medicines can be delivered even in very resource-constrained settings, and that putting millions on AIDS treatment has only been possible because global competition by generics has propelled a dramatic and sustained reduction in the prices of some first-line AIDS medicines. And despite opponents’ claims, Bill C-393 maintains safeguards aimed at preventing the diversion of medicines from intended recipients, and independent expert after expert has testified before Parliament that the bill would not violate WTO treaties on intellectual property.

Economists have also debunked the specious claim that streamlining CAMR would undermine incentives for brand-name pharmaceutical companies to invest in Canada in research and development. The countries that generate brand-name pharmaceutical companies’ profits — and hence affect these R&D decisions — are excluded from CAMR. In addition, generic manufacturers must pay brand-name companies royalties on any sales in developing countries. Bill C-393 changes none of this.

However, Bill C-393 would make the current system simpler to use — and, by making it possible to supply multiple countries with greater quantities of medicines under a single licence, its one-licence mechanism would enable generic manufacturers to achieve economies of scale that make competing in the global marketplace that much more feasible.

There is an urgent moral imperative to fix CAMR with Bill C-393. The economic and other scare tactics of big pharma are exactly what they appear to be: baseless.

Now yet another hurdle has arisen. We have been told repeatedly that some MPs will use a little-known procedural mechanism to kill Bill C-393 before the House of Commons even has a chance to vote on it. The idea that politicians would undermine the democratic process in order to destroy a possible lifeline for patients in developing countries is unconscionable — as unconscionable as leaving a room full of AIDS patients to die simply because they are poor and African. Canadians should take note if any MPs or parties engage in such indecent tactics to put patents and profits of big pharma ahead of saving lives through a mechanism that costs taxpayers nothing.

Rachel Kiddell-Monroe is a former head of mission for Médecins Sans Frontières in Rwanda. James Orbinski is co-founder of Dignitas International. Richard Elliott is executive director of the Canadian HIV/AIDS Legal Network.

Dignitas InternationalLifeline for patients in jeopardy [Ottawa Citizen]