Search

We discuss how corruption affects access to antiretroviral therapies (ARVs) globally. Recent cases of theft of ARVs, collusion, and manipulation in procurement found in countries such as Central African Republic, Bangladesh, Malawi, and Guinea, show there is still much work to be done to reduce the risk of corruption. This includes addressing the structural weaknesses in procurement mechanisms and supply chain management systems of health commodities and medicines., (© 2018 American Society for Clinical Pharmacology and Therapeutics.)

Background: In order to ensure their population's regular access to essential medicines, many least developed countries and developing countries are faced with the policy question of whether to import or manufacture drugs locally, in particular for life-saving antiretroviral medicines for HIV/AIDS patients. In order for domestic manufacturing to be viable and cost-effective, the local industry must be able to compete with international suppliers of medicines by producing sufficiently low cost ARVs., Methods: This paper considers the 'make-or-buy' dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania's imitation technology transfer agreement to locally manufacture a first-line ARV (3TC + d4T + NVP), reverse engineering the ARV., Results: Tanzania is limited by weak political support for the use of TRIPS flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to donor-financed tenders make it difficult to obtain economies of scale and provide competitive prices., Conclusions: Within the "make-or-buy" context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty of governments to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.

Pharmaceuticals are one of the cornerstones of human development as their rational consumption can reduce morbidity and mortality rates and enhance the quality of life. Pharmaceuticals have curative and therapeutic qualities, so they cannot be considered as ordinary products. In line with this, ensuring public policy fosters access to medicines demands thoughtful and careful consideration, as it is often about whether a patient lives or dies. Despite the flow of international aid for pharmaceuticals, particularly used for the treatment of HIV/AIDS, tuberculosis, and malaria, there is a morally concerning drug gap globally; the World Health Organization (WHO) notes that one-third of the global population lacks regular access to essential medicines and that in some parts of Asia and Africa these figures are even more severe.(1) But what is troubling is that, despite the knowledge that we live in a world with inequitable access to medicines, we have not examined how we need to put in place policies that not only support drug access but also do not undermine it, which will be addressed later. What is promising, is that slowly, a paradigm shift is taking place. Access to essential medicines is increasingly viewed as a fundamental human right, with international human rights laws placing attendant obligations on states to ensure access.(2, 3) But governments also have to ensure that the policy environment is supportive of access to medicines. And this includes making sure that social policy is not undercut by economic interests.