This paper studies the relationship between patents and access to essential medicines. It finds that in sixty-five low- and middle-income countries, where four billion people live, patenting is rare ...for 319 products on the World Health Organization's Model List of Essential Medicines. Only seventeen essential medicines are patentable, although usually not actually patented, so that overall patent incidence is low (1.4 percent) and concentrated in larger markets. This and other results shed light on the policy dialogue among public health activists, the pharmaceutical industry, and governments that is often based on mistaken premises about how patents affect corporate revenues or the health of the world's poorest. Pragmatism and greater flexibility are urged, so that policy may better concentrate on the greater causes of epidemic mortality, which now pose unprecedented threats to global peace and security.
On March 13, the Commission on Narcotic Drugs will convene in Vienna, Austria, for an annual meeting on drug control. On the Commission's agenda is a proposal to place ketamine--the leading ...anaesthetic used in developing countries--under Schedule I of the 1971 Convention on Psychotropic Substances, the same sort of international control reserved for the most highly illicit psychotropic drugs, such as mescaline and LSD. If the proposal passes, it will be a catastrophe for access to ketamine and safe surgery in developing countries.
Adherence to antiretroviral therapy is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV) and AIDS. Concerns about incomplete adherence among patients ...living in poverty have been an important consideration in expanding the access to antiretroviral therapy in sub-Saharan Africa.
To evaluate estimates of antiretroviral therapy adherence in sub-Saharan Africa and North America.
Eleven electronic databases were searched along with major conference abstract databases (inclusion dates: inception of database up until April 18, 2006) for all English-language articles and abstracts; and researchers and treatment advocacy groups were contacted. Study Selection and Data Abstraction To best reflect the general population, studies of mixed populations in both North America and Africa were selected. Studies evaluating specific populations such as men only, homeless individuals, or drug users, were excluded. The data were abstracted in duplicate on study adherence outcomes, thresholds used to determine adherence, and characteristics of the populations. A random-effects meta-analysis was performed in which heterogeneity was examined using multivariable random-effects logistic regression. A sensitivity analysis was performed using Bayesian methods.
Thirty-one studies from North America (28 full-text articles and 3 abstracts) and 27 studies (9 full-text articles and 18 abstracts) from sub-Saharan Africa were included. African studies represented 12 sub-Saharan countries. Of the North American studies, 71% used patient self-report to assess adherence; this was true of 66% of the African assessments. Studies reported similar thresholds for adherence monitoring (eg, 100%, >95%, >90%, >80%). A pooled analysis of the North American studies (17,573 patients total) indicated a pooled estimate of 55% (95% confidence interval, 49%-62%; I2, 98.6%) of the populations achieving adequate levels of adherence. Our pooled analysis of African studies (12,116 patients total) indicated a pooled estimate of 77% (95% confidence interval, 68%-85%; I2, 98.4%). Study continent, adherence thresholds, and study quality were significant predictors of heterogeneity. Bayesian analysis was used as an alternative statistical method for combining adherence rates and provided similar findings.
Our findings indicate that favorable levels of adherence, much of which was assessed via patient self-report, can be achieved in sub-Saharan African settings and that adherence remains a concern in North America.
This Campbell systematic review assesses the effectiveness of economic and educational strategies for ownership and appropriate use of insecticide‐treated bednets (‘ITN’) in developing countries. The ...review also examines whether changes in ITN ownership and use affect malaria‐specific morbidity rates. The review summarises findings from 10 studies, nine of which were conducted in rural Africa and one in rural India.
Compared to providing ITNS at full market or a subsidized price, giving away ITNs for free increases the number of people owning an ITN. However, the provision of free ITNs increases their use only slightly or not at all.
Providing education in the appropriate use of ITNs increases the number of people sleeping under bednets compared to a control group which didn't receive the education.
Combining these strategies with unspecified incentives does not increase ITN ownership, leading to little or no differences in their appropriate use. Embedding the promotion of ITNs within specific health‐ or finance‐focused marketing messages only leads to small or no differences in bednet ownership and use.
There is some evidence of improved malaria‐specific morbidities among children and adults as a result of increased ITN ownership and use. However, the evidence supporting this finding is of low certainty and should be interpreted with caution.
BACKGROUND
Malaria is a life‐threatening parasitic disease and 40 percent of the world's population lives in areas affected by malaria. Insecticide‐treated bednets (ITNs) effectively prevent malaria, however, barriers to their use have been identified.
OBJECTIVES
To assess the evidence on the effectiveness of available strategies that focus on delivery and appropriate use of ITNs.
SEARCH METHODS
We searched the EPOC Register of Studies, CENTRAL, MEDLINE, EMBASE, HealthStar, CINAHL, PubMed, Science Citation Index, ProQuest Dissertations and Theses, African Index Medicus (AIM), World Health Organization Library and Information Networks for Knowledge (WHOLIS), LILACS, Virtual Health Library (VHL), and the World Health Organization Library Information System (WHOLIS). Initial searches were conducted in May 2011, updated in March 2012 and February 2013. Authors contacted organizations and individuals involved in ITN distribution programs or research to identify current initiatives, studies or unpublished data, and searched reference lists of relevant reviews and studies.
SELECTION CRITERIA
Randomized controlled trials (RCTs), non‐randomized controlled trials, controlled before‐after (CBA) studies, and interrupted time series evaluating interventions focused on increasing ITN ownership and use were considered. The populations of interest were individuals in malaria‐endemic areas.
DATA COLLECTION AND ANALYSIS
Two authors independently screened studies to be included. They extracted data from the selected studies and assessed the risk of bias. For RCTs, we used the Cochrane Collaboration's 'Risk of bias' tool and we used the risk of bias criteria suggested by EPOC for other study designs. When consensus was not reached, any disagreements were discussed with a third author. The magnitude of effect and quality of evidence for each outcome was assessed.
MAIN RESULTS
Of the 3,032 possibly relevant records identified, 10 studies were included in this review; eight cluster RCTs, one RCT, and one CBA study. Overall, three studies were assessed as having moderate risk of bias and seven studies were assessed as high risk of bias.
Effect of ITN cost on ownership:
Four studies including 4,566 households and another study comprising 424 participants evaluated the effect of ITN price on ownership. These studies suggest that providing free ITNs probably increases ITN ownership when compared to subsidized ITNs or ITNs offered at full market price.
Pooled data for two studies suggested that receiving an ITN at no cost probably increases ITN ownership, compared to purchasing an ITN at the market price (SMD 0.69, 95% confidence interval (CI) 0.39 to 0.99, moderate‐certainty evidence) or purchasing an ITN using a loan (SMD 0.37, 95% CI 0.27 to 0.47, moderate‐certainty evidence). There is probably little to no difference in ITN ownership when comparing groups in which ITNs were purchased using a loan and those in which ITNs were purchased at the market price (SMD 0.29, 95% CI ‐0.06 to 0.63, moderate‐certainty evidence).
Effect of ITN cost on appropriate use of ITNs:
Three studies including 9,968 households and another study comprising 259 individuals found that there is probably little or no difference in the use of ITNs when they are provided free, compared to providing subsidized ITNs or ITNs offered at full market price.
Effect of education interventions on use of ITNs:
Five studies, including 12,637 households, assessed educational interventions regarding ITN use and concluded that education may increase the number of adults and children using ITNs (sleeping under ITNs) compared to no education.
One study, including 519 households, assessed the effects of providing an incentive (an undisclosed prize) to promote ITN ownership and use, and found that incentives probably lead to little or no difference in ownership or use of ITNs, compared to not receiving an incentive.
None of the included studies reported on adverse effects.
IMPLICATIONS FOR POLICY AND RESEARCH
Five studies examined the effect of price on ITN ownership and found moderate‐certainty evidence that ownership was highest among the groups who received the ITN free versus those who purchased the ITN at any cost. In other words, demand for ITNs is elastic with regard to price and hence subsidies (providing full or partial cost recovery) will probably increase ownership. However, once the ITN is supplied, the price paid for the ITN probably has little to no effect on its use; the four studies addressing this outcome failed to confirm the hypothesis that people who purchase nets will use them more than those who receive them at no cost. Educational interventions for promoting ITN use have an additional positive effect. In other words, the evidence suggests that ITN use is highly inelastic with respect to price, and therefore additional encouragement (such as through education) is probably needed to promote appropriate use, over and above any subsidies to increase ownership. However, the impact of different types or intensities of education is unknown.
However, rather than put this invention in the public domain, Canada's Minister of Health applied to patent the vaccine. Canada subsequently granted Bioprotection Systems Corporation, a subsidiary of ...NewLink Genetics, a "sole, worldwide, revocable and royalty-bearing license" to develop and commercialise the vaccine "for the maximum commercial return to the Company and Canada". 4 This profit-driven arrangement does not put public health first.
Au cours des dernières années, notamment en 2003 lors de l'épidémie du syndrome respiratoire aigu sévère (SRAS), Taïwan a été autorisée à participer aux activités de l'OMS de façon ponctuelle, mais ...seulement avec l'aval de Beijing. Bien qu'il n'ait jamais véritablement été satisfaisant, cet arrangement est maintenant inapplicable. Au cours de l'épidémie du SRAS, cet accord a forcé le ministère de la Santé de Taïwan à avoir recours à un intermédiaire des plus invraisemblables - un Texan - pour communiquer avec l'OMS1. Le nouveau Règlement sanitaire international (RSI), en vertu duquel l'OMS doit être informée rapidement et de façon transparente de la survenue de toute urgence de portée internationale en matière de santé publique, exige un rapport moins lourd et plus "normal" avec Taïwan. Or, voilà que récemment, on note un dégel et des signes de compromis. Un gouvernement Kuomintang plus tempéré a été élu à Taipei (ce qui est positif). La Chine est aussi devenue moins ombrageuse et moins anxieuse qu'elle ne l'était avant la réussite de ses Jeux olympiques (ce qui est positif). Elle a même envoyé deux adorables pandas géants à Taïwan, geste interprété comme un présage de jours meilleurs (ce qui est positif, même si l'entente n'indiquait pas clairement si les deux pandas avaient besoin d'un passeport). Au moment de la rédaction de cet éditorial, les deux parties avaient ouvert la voie à un réchauffement diplomatique et avaient débattu de leurs positions respectives quant à la participation de Taïwan à l'OMS (ce qui est très positif). Les tierces parties doivent encourager cette tendance. Les efforts de l'OMS méritent également d'être soulignés : elle a discrètement négocié un accord pragmatique relativement au RSI. En janvier, l'OMS a proposé que Taïwan ait des "contacts directs" par l'intermédiaire de personnes-ressources à Taipei (proposition que Taïwan a acceptée); il n'est plus question d'intermédiaire texan. En d'autres mots, Taïwan a accès à une base de données sur les épidémies grâce à laquelle elle peut alerter l'OMS en cas de flambée de maladie menaçant la santé publique à l'échelle mondiale ainsi que recevoir de telles alertes. L'OMS tire aussi parti du fait que des experts médicaux et des laboratoires taïwanais se joindront à ses équipes spécialisées dans la lutte contre les épidémies de portée internationale.
PDF
