Use genuine drugs, do not worry about origin

By Daniel Tumwine

LAST week, I found myself watching the compelling documentary Fire in the Blood, which is an account of how Western pharmaceutical companies thwarted access of potentially life-saving AIDS drugs in Africa and the opposing grassroots effort to bypass these obstacles.

The documentary focused mainly on anti-retroviral drugs (ARVs), but the key issues raised could well be replicated and applied to any other form of medical access in Africa.

If you have ever wondered why drugs from say Europe cost more than, say, drugs from India or Egypt, it may have less to do with the quality of the drug and more to do with the profit margins of the manufacturers.

The story of how we, Ugandans, got access to anti-retroviral drugs best illustrates this.

In the late 1990s and early 2000s, the 20 or so types of antiretroviral drugs on the market were all manufactured by four or five Western companies. Because of patents placed upon these drugs ostensibly to ‘protect intellectual property and recoup costs of research and development’, the cost of these lifesaving ARVs was placed at more than 10 to 20 times the manufacturing price to around $10,000, a year. Africans — Ugandans inclusive — where only 1% of the global pharmaceutical industry revenue comes from, were unable to afford this cost and many people died.

The pharmaceutical industry is the most profitable industry in the whole world. Uganda’s pharmaceutical market is worth about $300m and 90% of these medicines are imported.

Globally, the top five pharmaceutical companies make more profits than the next largest 10 companies in the world. And this includes companies like Apple, Google, Shell, Microsoft and Walmart combined.

So when requesting for a drug made in Europe vis a vis one made in India, you are, more often than not, buying a similar drug for much more.

Take the example of Cipla. Cipla, an Indian generics manufacturer, announced in the mid 2000s that it would sell a cocktail of three anti-HIV drugs — stavudine, lamivudine and nevirapine — for $350 per patient per year.

The price of this same triple combination was as high as $15,000 prior to this announcement due to the Western pharmaceutical hold on drug pricing.
The average price for ARVs is now down to about $115 dollars per patient per year, yet the Global Fund still spends about $20b procuring these ARVs.

Another myth is that these companies actually spend a lot on drug research and development, hence the need to have 20 or so years of monopoly to recoup these costs.

This is not true. Most of the drugs are developed using US  tax money through their National Institute of Health Programme.

Drug companies spend most of their money on marketing and buying up smaller companies that actually do the drug developing and file the patents. Most drug companies spend less than 3% percent on research and development.

Only three of the 20 ARV drugs on the market today were actually developed by the drug companies themselves. India is the largest supplier of generic ARVs to low- and middleincome countries, providing 80% of donor-funded ARVs to low- and middle-income countries.
 
These ARVs have saved countless lives. Yet, many patients still have a perception that because drugs are more expensive in the West, they must be of better quality.

Local pharmacies are also in on it. A few years ago, I went to buy paracetamol for a friend. On asking for the price of a dose of this over-the-counter drug, the dispenser informed me of the price tier in her shop. “Locallyproduced paracetamol is sh500 a dose; that from India is sh700, while that from Egypt is sh1,000 a dose. We also have paracetamol from Jordan, which costs sh2,000, a dose, while that from Europe costs sh5,000,” she said.

When I insisted on buying the locally and cheaply made paracetamol, she tried to discourage me by saying it was not good.

Suffice to say, my friend recovered on the Ugandan drug.
Many patients are also wont to use only expensive brands. I have had to explain to patients, on many occasions, that, yes, there are some counterfeit medicines on the market, however, there are also genuine drugs.

And using these genuine local or cheaply imported generic drugs from India and Asia affords one the same level of pharmaceutical potency as those drugs under patent.

The world of pharmaceuticals is one which does not necessarily follow the laws of economics. Use genuine drugs, whether they are from Europe, India or Uganda.

The writer is a paediatrician at The Children’s Clinic in Kansanga and executive director of the Uganda Paediatrics Association

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