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The main conclusion of the FAIR investigation so far is that promises made at the 2001 DOHA World Trade Organisation conference, where member countries undertook to relax patent rules so that developing countries could import cheaper generic medication instead of expensive brands, have so far not materialized. Essential drugs are still not affordable and accessible for the people who need them. Instead, a mainly US-based lobby linked to the pharmaceutical industry continues to pressurize African governments to buy patented drugs. Zambia, for instance, still buys almost exclusively expensive brand medication with its limited means. Talks between the US and the Southern African Customs Union have so far not led to signed free trade agreements because, as some participants have remarked, the 'US refuses to remove the patented medicines issue off the table.'
Some multinational pharmaceutical companies claim that they wholeheartedly support affordable access to essential medicines, such as antiretrovirals,in Africa. Roche proudly advertises its Technology Transfer program assisting African local ARV manufacturing. South African Aspen has been licensed by various pharmaceutical companies to produce ARV's for the African market. However, Aspen's key generic Tenofovir is still too expensive and consequently not available in the public health sector. Other local manufacturers have not been and will most probably not be able to produce a viable quantity or quality of ARV medication compatible with WHO standards - for reasons of cost of importation of raw materials and own infrastructure.
Asked why Roche gives countries like the DRC and Zambia false hope in this regard, spokesperson Maria Vigneau in Basel responded that 'that is what the African governments want, and we can only assist them on the basis of what they want.'
US help: big pharma and abstinence
The main developmental medicinal programme from the United States in Africa is PEPFAR: the Presidential Emergency Plan for Aids Relief. Though PEPFAR spends a lot of money on the acquisition of ARV's, the bulk of medication bought by this fund is still sourced from the 'big five' pharmaceutical multinationals. The fact that those companies accounted for a substantial percentage of President Bush election campaign complicates the issue. PEPFAR's connection to US conservative governing circles has also materialized in a directive that no less than 30 % of its funds are spent on 'abstinence only' campaigns in Africa. PEPFAR continues to prescribe that funds may not be used for condoms and instead must be spent on abstinence campaigns in the face of a growing body of evidence that this approach is harmful to Aids prevention efforts.
Zambia finds itself in the strange situation that large sections of its health care infrastructure are virtually run by the Bush administration. In the words of Health Minister Brian Chituwo: "PEPFAR is a mini-ministry of health. It has set up its own parallel (American) structure, and it refuses to be monitored or to adhere to the Zambian donor harmonization process." None of the PEPFAR funds pass through government hands. Chituwo said that 90 percent of the money goes into paying American experts who came to run the American set up NGOs and purchasing services, material and medication more expensively than necessary from the US and Europe.'Whilst this situation is an indictment of the Zambian government itself, it also shows that Zambia's main western partner, the US, is not helping
as much as they could', summarizes Zambia's team investigator, Zarina Geloo.
Traditional herbal medicine
Africa has a traditional knowledge of medicinal plants and their effects. However, claims that any plant-derived substance can cure Aids are false. Unfortunately, the local production of malaria medication drawn from plants, is not yet at an acceptable level. The FAIR team found that lack of
technical infrastructure, measuring equipment, labs and expertise regarding dosages and measurement stand in the way of the plants providing a cure. 'Instead, if you give the wrong dosage, you merely increase resistance of the parasite to the medicine', one expert said.
Counterfeit pills and quack cures
The fact that essential medicines remain out of reach of most Africans, has created room for massive circulation and sale of counterfeit products and quack cure peddlers. The managing director of Kenya Laboratory Supply Centre Mr Narshibhai Ghedia said a significant number of medicines sold
locally are fake. Between 20 and 30 per cent of the medicines entering Kenya currently are either counterfeit or illegally imported from Asia, especially India, China and Pakistan, a small part comes from underhand dealers in Europe. Some are labeled in languages other than English, and users can therefore not follow the instructions.
The Chinese vitamin boosters giant Tianshi operates in several African countries in classic pyramid style, recruiting consumers as sellers of their products, and charging them considerable sums of money for the privilege to be part of the 'Tianshi family of love'. Other than nutrients that are normally found in a balanced diet, Chinese products such as Tianshi's have been found internationally as well as by local doctors to contain damaging chemicals. 'We had to treat many Chinese product users for kidney damage -some of them had been using Tianshi products', Dr Nazaire Nseka Mangani, director of the Kinshasa University Clinic told the FAIR team. Because the authorities responsible failed to act, the Clinics started a joined campaign offering free tests for people with kidney problems to investigate the dimension of the damage done. This has however not stopped DRC government officials to travel to China and bring Tianshi representatives back to the DRC in order to further establish their
operations.
Corruption
Why a government would promote companies like Tienshi instead of exerting their efforts towards health awareness campaigns and making available generic essential medication against HIV/AIDS, malaria and TB? The FAIR team in the DRC could not get access to the Health Ministry to get an answer, despite endless attempts. Sources in the periphery of the health department were adamant that the reason why there was no transparency was that 'pharmaceutical companies are goldmines for the government'.
Kept away from real treatment
Quack 'Aids cure' peddlers like Tianshi were found in all the countries investigated by the FAIR team: South Africa's Dr Rath, from Germany, and nurse Tine van der Maas, from the Netherlands, have counterparts everywhere. In Zambia, large doses of the vitamin Selenium are pushed as
an Aids cure by a Canadian swindler. And a partnership of an American 'health practitioner' and a local Zambian weekly editor promoted an injectable Aids cure that proved to contain pesticide. In Kenya, foreign and local herb sellers have become so powerful and well-to-do that they sponsor radio shows on illnesses and treatment, advertising their own products. In the case of the herbal Canova, it was found that the makers untruthfully claim that the remedy has been clinically tested in Brazil.
In order to sell them their own vitamin boosters, swindlers like this actively discourage people - especially the HIV positive - from seeking professional medical treatment.
Conclusion
In the view of confusion, despair, disinformation and continuing price and patent wars, experts agree that a massive effort, coordinating the expertise of the WHO, donor institutions and the pharmaceutical companies interested in growing the African market for essential medication, is necessary. Such an effort may however still take a long time to materialize. Asked if the pharmaceutical industry could not embark on a joint corporate social responsibility program with the WHO, African health departments, bona fide herbalists and other interested parties, so that expertise and well-equipped labs as well as generic medication could be increasingly made available to the African public, Maria Vigneau of Roche
said: 'We are a private company and rather a small player. Such efforts should be made by the WHO.'
Roche may have a point. With less than 5 % of the market, the company could not be expected to take the initiative in such a partnership. Sadly, the main other approached big pharmaceutical companies -Glaxo Smith Kline, Boehringer Ingelheim, Pfizer, Abbott and Gilead- did not respond to emails
and phone calls asking to explain their Corporate Social Responsibility programs in Africa.
The FAIR Transnational Investigation was supported by the Netherlands Institute on Southern Africa (NIZA).
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