Indian patent rules infuriate Big Pharma

A CLASH over India’s drug market was inevitable. Foreign drugmakers, facing paltry growth in the West, are eyeing India hungrily. Rising incomes and rates of chronic disease may push sales from $12 billion in 2010 to $74 billion in 2020, according to PwC, a consultancy. But tapping this growth means having patents that protect intellectual property. India is home to a thriving generics industry, whose copycat drugs make up about 90% of the market. India’s drug-patent laws are just seven years old. Its government is keen to encourage generics and keep prices down.

Now India’s patent rules are being put to the test. Novartis, a Swiss giant, is challenging India for denying a patent for Glivec, its blockbuster cancer drug. The fight is due to reach India’s Supreme Court on September 11th. Bayer, a German drugmaker, has a different problem: in March India’s patent controller ordered it to license a drug to a local manufacturer. Its appeal had its first hearing on September 3rd. The cases will help decide how quickly India’s 1.2 billion people get new drugs, and at what price.

India’s drug industry has a unique history. For more than 30 years, the country did not recognise pharmaceutical patents. Domestic firms became masters at copying medicine and making it cheaply. After joining the World Trade Organisation (WTO) in 1995, India had to change its patent policy. But its new system, in place since 2005, includes special protections for both patients and generic manufacturers.

For example, the law bars patents of minor changes to existing drugs, a practice known as “evergreening”. Drug reformulations are often used to extend patents elsewhere; they get no protection in India. The country also has broad criteria for “compulsory licensing”. A WTO agreement allows countries, in some instances, to force a firm to license a patented drug to a generic company. India’s rules give officials broad powers to do this.

Now both provisions are under attack. In 2006 India denied Novartis a patent for Glivec, calling it an unpatentable modification of an existing substance, imatinib. Novartis insists this is nonsense. Only by making it in salt form, imatinib mesylate, did Novartis have a proper drug: the body absorbed the medicine 30% more easily.

Paul Herrling, the chair of Novartis’s Institute for Tropical Diseases, says the case is a test of what is patentable in India. “We are being accused of evergreening,” he says. “Having that concept applied to Glivec, which was one of the major breakthroughs in cancer therapies, is completely ridiculous.” Michelle Childs of Médecins Sans Frontières, a non-profit, retorts that drug firms such as Novartis should not win patents for minor improvements. This would keep generics off the market, driving up prices.

Bayer’s case is equally heated. In 2008 it won an Indian patent for Nexavar, a kidney-cancer drug. But in March India’s patent controller issued the country’s first compulsory licence. He wrote that Bayer had not made Nexavar “reasonably affordable” (Bayer offered it for a whopping $5,000 a month), that the company failed to provide enough of the drug and, in a protectionist nod, reckoned that importing Nexavar further hurt Bayer’s case. The controller ordered an Indian company, Natco, to sell Nexavar for one-thirtieth of Bayer’s price. Bayer will receive a 6% royalty. Meanwhile Bayer is fending off another competitor, Cipla, which has sold generic Nexavar in India for years.

As these cases drag on, India’s government is considering other ways to get cheaper medicine. It plans to offer free generics in public hospitals, which would drive up sales of very cheap copies. It may also set price controls for patented drugs. However, generic companies are not immune to regulatory pressure. Ministers plan to expand price controls for a broader swathe of generics.

Cost versus innovation

 

 

“We realise the industry will take a hit,” explains D.G. Shah of the Indian Pharmaceutical Alliance, which represents big generic companies. “We’re trying to find a solution so that the government’s concerns on access and affordability are addressed without threatening the long-term growth of the pharmaceutical industry.” Nice work, if they can get it.

Source: http://www.economist.com/node/21562226

Health workers on silent strike

WRITTEN BY PATIENCE AKUMU

Overworked and underpaid, health workers in Uganda have for decades fought hard to persuade the government to improve their working conditions. However, many of them have over the years given up the struggle, opting to join other professions and sectors, or staying in the medical field but giving half-hearted service, Workers MP Dr Sam Lyomoki has observed.

Speaking at a press conference organised by the Uganda National Health Consumers Organisation (UNHCO), Lyomoki said although the government may think it has beaten health workers into submission, this “go-slow” strike is even more dangerous than overt strikes, as uncommitted health workers can have a devastating effect.

UNHCO is a non-governmental organisation working to put pressure on Parliament not to pass the 2012/2013 health budget. Uganda is yet to meet the 15 per cent budget allocation required by the Abuja Declaration to which Uganda is signatory.

With a ratio of 1.8 health workers per 1,000 people, Uganda is also far below the World Health Organisation standard of at least 2.5 health workers per 1,000 people.
And yet, this financial year, the government slapped a ban on recruitment of health workers.

The government has also failed to retain health workers and many of them are seeking greener pastures outside the country. Health workers in Uganda remain the least paid in the East African region.

And with economic integration, Uganda is likely to lose even more health workers. Now, civil society has teamed up with parliamentarians and leaders in the health sector to demand that government recruits over 5,000 health workers this financial year, 2012/2013, if it is to meet the national health targets.

In particular, MPs have vowed not to pass the health budget until the 7.6 per cent allocation to the health sector is raised. This percentage is even lower than the 9.8 per cent of the previous financial year.

“We are not going to pass the budget because it affects us,” said Rosemary Nyakikongoro, vice chairperson of the Uganda Women Parliamentary Association.
Dr Margaret Mungherera, a consultant with the Uganda Medical Workers Association, says health workers “have fought this battle for too long.”

“As the highest-paid doctor, I receive Shs 1.9m after taxes,” she said. “There is too much money spent on newspapers, entertainment and ‘travel outward’ — I wonder what that is,” Dr Mungherera said.

She said the solution to the health sector crisis is not putting up new structures and buying more medical equipment, but utilising the already existing ones. This, she said, can only be done by recruiting proper personnel.

Source: http://www.observer.ug/index.php?option=com_content&view=article&id=20820:-health-workers-on-silent-strike&catid=34:news&Itemid=114

Court rules for Cipla against Roche in patent case

MUMBAI: A court has ruled in favour of local drugmaker Cipla in a patent infringement case filed by Switzerland’s Roche Holding AG over Cipla’s cancer drug Erlocip, a senior executive of the Indian company said.

The Delhi High Court made the ruling a week before India’s Supreme Court is due to begin hearing a patent plea by another Swiss drugmaker, Novartis AG, over its cancer drug Glivec. That case is expected to set a precedent for the Indian drug market, where major western companies are fighting to protect their intellectual property.

“The court judgement says we have not infringed any patent,” S. Radhakrishnan, a director on Cipla’s board, told Reuters late on Friday after the Delhi High Court’s ruling.

Roche accuses Cipla of infringing its patent on cancer drug Tarceva, which Cipla sells under the brand name Erlocip.

Roche could not immediately be reached for comment. The company has the option to challenge the judgement in India’s Supreme Court.

The ruling comes nearly four years after the court rejected Roche’s attempt to stop Cipla from selling Erlocip in India.

The court, however, said that Roche’s patent over Tarceva is valid in India, media reports said.

Source: http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/pharmaceuticals/court-rules-for-cipla-against-roche-in-patent-case/articleshow/16302523.cms

Recruit more health workers or face staffing crisis, MPs tell government

IN SUMMARY

Female MPs appeal for the lifting of a ban on staff recruitment for the health sector to address current nationwide shortage.

By Mudangha Kolyangha

Pallisa

Government should lift the ban on recruiting more health workers to address current country-wide shortages in hospitals and health centres, MPs have said. The MPs said the health sector risks running into a staffing crisis if government does not re-consider its ban on recruitment of staff before the end of this financial year.

Under the Uganda Women Parliamentary Association, the lawmakers made the appeal while on a fact-finding mission in Bukedi sub-region to ascertain whether government health units receive sufficient drugs, have adequate infrastructure and staffing. But the MPs discovered that inadequate staffing and dilapidated structures were some of the key factors hindering health services.

They notes that Pallisa and Butaleja hospitals are in the worst conditions, with patients staying in congested wards. Pallisa Woman MP Mary Judith Amoit said lifting the ban on recruitment should be done urgently. “… we also feel government should increase staff remuneration and remit more funding for patients’ food and renovations of the hospitals.”

Government banned recruitment of health workers effective this financial year, saying only those who retire or leave the profession will be replaced by new ones.

Butaleja Woman MP Cerinah Nebanda said: “There are health facilities in the country that have less than 30 per cent staffing level which is not good for the sector to operate at optimal level,” said Ms Nebanda.

Dr Jane Aceng, the director of health services, while appearing before the parliamentary committee on health services last month, said staffing level for Ministry of Health should be raised from the current 58 per cent to 70 per cent. However, if the ministry chooses to register 100 per cent staffing level, it will need to recruit an additional 24,609 personnel at Shs149b in annual wages.

http://www.monitor.co.ug/News/National/Recruit+more+health+workers+or+face+staffing+crisis/-/688334/1496416/-/5e584/-/index.html

350,000 abortions in Uganda are induced – experts

Article by Catherine Mwesigwa Kizza ( New Vision)

Infanticide, child abandonment and abuse — the Ugandan media is full of the stories. The missing story though is that the abused and murdered children are most probably survivors of induced abortion.

“There are over two million conceptions in Uganda every year. 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced,” said Dr. Charles Kiggundu an obstetrician and gynecologist at a breakfast meeting convened by the Center for Reproductive Rights and Centre for Human Rights and Development in Kampala Wednesday, to discuss the laws and policies on abortion in Uganda.

“90,000 of the induced abortions end up with severe complications but only a half of them access post abortion services,” he added.

“Only half of the women with complications seek medical care. A few survive but many others die,” he added.

Joy Asaasira of CEHURD said of the 20 women in Uganda who die due to pregnancy and childbirth-related complications every day, four to five of these are due to induced abortion.

Dr. Kiggundu says these are needless deaths. The policy environment allows women to receive healthcare for post- abortion complications, however, studies have shown that when they seek care, it takes about 44 hours for them to get attention compared to 35 to 45 minutes other women spend in hospital before getting a service.

“Health workers do not want to treat women with abortion complications because they do not want to be seen to be accomplices to the termination of pregnancy,” he said.

He also pointed out that phrases on hospital documents like “Police notify” worry health workers and are a deterrent to provision of care for women.

‘Health workers do not want to get involved with police. They want to do their work unencumbered,” he said.

Women induce abortions due to unwanted pregnancies due to wrong timing of pregnancy or economic and social hardships.

“Some men tell their wives to abort because ‘they stopped having children’ and yet did nothing about it,” Dr. Kiggundu said.

Those who survive death end up with chronic pain, anemia, and infertility among other complications.

He said safe abortion services were available but hidden to the poor.

“You must be connected and well-oiled to access the services. Some women fly to South Africa to terminate pregnancies and return,” he revealed.

The consequences for the majority who go to quacks or unskilled medical workers working undercover are dire.

“We recover forks, pens, knitting needles, bed springs, sticks, herbs from women who run to us with botched abortions. Some of these things kill the woman before they even kill the foetus,” he said.

Treatment for those who survive death is expensive. According to CEHURD, sh17.6bn is spent on treating abortion complications.

Not only can this money be saved and spent on worthwhile health causes but women’s lives can be saved as well.

According to Dr. Kiggundu, the Ministry of Health’s comprehensive abortion care includes sexuality education to promote safe sex practices, family planning use including access to emergency contraception, reducing fertility, providing safe abortion services and quality post-abortion care.

Government is also training nurses and giving them skills to perform manual evacuation procedures to attend to women with incomplete abortions.

“There are still many gaps,” said Dr. Kiggundu. “Uganda still produces health workers for export and retains only a few.”

He revealed that only 30% of the vacancies for skilled health personnel required to provide safe motherhood are filled.

It is no wonder that despite government commitments, advocacy efforts, plans and policies to reduce maternal deaths in the country, there has been no progress in this indicator in the past five years.

New data from the Uganda Demographic Health Survey report of 2011 show that the maternal mortality ratio increased from 435 deaths per 100,000 live births in 2006 to 438 deaths, though other international studies show a decline to 310 deaths per 100,000 live births.

“26% of these deaths are due to unsafe abortion,” said Elisa Slattery the Regional Director, Africa Program Center for Reproductive Rights.

Once addressed, reduction in unsafe abortion contributes to reduction in maternal death.

Slattery said studies on the law on abortion in Uganda have found that “abortion is permitted where a mother has severe illnesses threatening her health like cardiac disease, renal disease, eclampsia.”

The Centre for Reproductive Rights study also found that healthcare providers are not required under the Uganda law to consult one or more providers to get their consent before terminating pregnancy as has been previously believed.

The organization is calling on government to broaden access of information among healthcare professionals and the public as a means of stopping the tragedy.

source:http://www.newvision.co.ug/news/634689-350-000-abortions-in-Uganda-are-induced—experts.html