Pharmacy
7 min

Updated: The CAMR debate ramps up over the weekend

Following the walkout by the Grandmothers to Grandmothers campaign from the Industry Committee on Thursday, they put the following video online. (My story on the bill at committee so far is here).

The Canadian HIV/AIDS Legal Network also put out an urgent action alert for people to contact MPs over the weekend.

Additionally, people like K'naan and Margaret Atwood are also urging people to contact MPs on the weekend.

On the flip side, Liberal MP Keith Martin put out an op-ed saying that CAMR is not the answer.

A lack of access to drugs and other essential medical supplies in Low Income Countries (LICs) is a major global health challenge. Millions of people perish because they lack access to effective diagnostics, medications, health care workers, education, and sanitation. Canada’s Access to Medicines Regime (CAMR) was introduced in 2005 to increase the availability of essential drugs by allowing generic drug makers to create one-time versions of essential brand-name medicines for sale to LICs. However, neither this bill, nor the proposed changes to CAMR currently before the House of Commons, will address the core issues behind this chronic international health challenge.

Currently, 120 of the 130 medications on the World Health Organization’s (WHO) list of essential medicines are already off-patent (i.e. generic), including many anti-retroviral medications, pain medications, and antibiotics. Yet these drugs are not widely available in many LICs because their governments simply do not have the money to purchase them, nor the basic health infrastructure to disperse them. As a result, people are left untreated and die. Changing CAMR will have no effect on the ability of LICs to acquire medicines and medical supplies that are beyond their means to purchase or administer. Instead of debating CAMR, we should focus on helping LICs to identify the medical supplies and equipment they need, acquire adequate financial resources to purchase those supplies, and build the capacity to deploy and use them effectively. The primary hurdles LICs face in caring for their people are not legislative; they are economic.

Unfortunately, changing CAMR would also decrease the flow of donated medications that LICs receive from Research and Development (Rx&D) firms. Ninety per cent of donations for Health Partners International Canada (HPIC), which is the philanthropic arm of the pharmaceutical industry, come from Rx&D corporations. Just 10 per cent come from generic firms.

Changing CAMR could also reduce investments in research for new medications, including those for HIV, Malaria, and Tuberculosis. There will be no incentive to invest in Rx&D if intellectual property is not respected. It is the poor who will suffer most under this scenario.

A better solution is for CIDA to create and manage a $50 million essential drug fund to help LICs purchase medical supplies for their citizens. CIDA could also help LICs identify their needs (i.e. help them develop a statement of requirement) and tender a request for proposals to purchase these essential medications and supplies.

Additionally, Canada can do much more to help LICs train and retain qualified health care professionals. Currently, Africa has a deficit of one million health care workers, which means that many health care systems cannot function because they lack adequate human resources. CIDA should work with those countries to develop programs that help train health care workers and encourage them to remain in the country. As well, Canada should immediately sign an international agreement banning the poaching of health care workers from LICs.

In the end, the debate over CAMR is a well-intentioned but ineffective attempt to help save the lives of the world’s most vulnerable citizens. We all have a common objective: to enable people in LICs to access essential medical supplies and to ensure that they are used efficiently for patient care. However, CAMR will do little to achieve this because, in too many cases, LICs still will not have the resources to purchase medications, nor the ability to use them effectively.

While the opinion seems to leave out a lot of the facts in the case, it is nevertheless one of the sentiments currently at play in this debate.

UPDATED: Richard Elliott of the HIV/AIDS Legal Network responds to Keith Martin's op-ed.

Bill C-393, aimed at fixing Canada’s broken Access to Medicines Regime (CAMR) and help developing countries get affordable medicines, is up before the Industry, Science and Technology Committee today for clause-by-clause debate.  The Conservative government has to date opposed the bill as has the brand-name pharmaceutical industry.  Yesterday evening, Liberal MP Marc Garneau filed proposed amendments that would effectively gut Bill C-393 of its core reforms.  While C-393’s reforms would cut the red tape in the current access to medicines  regime, Mr. Garneau’s amendments maintain the status quo, which, in more than 6 years, has yielded exactly one instance of one medicine being supplied to one country – a failure by any measure.   

This morning, Liberal MP Keith Martin has distributed yet again a bizarre and illogical set of claims about CAMR and Bill C-393 aimed at derailing the proposed reforms and preserving the status quo for the brand-name pharmaceutical industry, which is perfectly happy with a law on the books that doesn’t work. 

One such argument advanced by Mr. Martin and others is that most of the medicines on the WHO’s list of essential medicines are already off-patent, but still are not widely available in many low-income countries because of a lack of funds or infrastructure to distribute them.  In fact, these claims of lack of infrastructure have been debunked time and again, including most recently this week and last by medical experts working in Africa, including from Doctors Without Borders.   Furthermore, where resources are scarce, it becomes all the more critical to have lower-priced medicines – and this has only come about because of generic competition to supply developing countries.

Finally, the claim that patents are not blocking access to medicines is simplistic and inaccurate, but another favourite talking point of big pharma.  In fact, the bulk of AIDS drugs are still blocked by patents, including the possibility of producing fixed-dose combination products (i.e., multiple medicines in one tablet), and this includes in countries such as Canada that would be a potential supplier if CAMR were to be made workable.  Even in Africa, key AIDS drugs, and combinations of AIDS drugs, are blocked by patents in key countries where there are millions of people living with HIV. 

Furthermore, while some important first-line AIDS drugs have been produced generically in countries like India – which is the only thing that has made scaling up to put 5 million people on treatment even possible – the applicability of patents is spreading globally, including to India, which has been a critically important supplier of generic medicines to developing countries.  As of January 1, 2005, Indian patent law (as a condition of WTO membership) now grants patents on pharmaceutical products, which it did not before (and which allowed the production of generic AIDS drugs for export to developing countries).  This means that all AIDS drugs that still had a potential portion of a 20-year patent term available to them as of 2005 are now in the process of being patented in India.  This development is on a collision course with the reality that more and more people currently receiving affordable treatment with first-line AIDS drugs will need to switch to second or third-line drugs as the first regimes begin to fail as their virus mutates and develops resistance, or toxicities of the older, less tolerable medicines builds up.

And of course, this will be the situation not just for AIDS drugs going forward, but for any pharmaceutical products.  This claim by Martin and others is a totally static – and hence misleading – view of the situation, which fails to recognize that the medicines needed – including those named on the WHO model list of essential medicines – evolves over time, and the patent barriers to those medicines are just getting higher over time.

Below we address a number of other common, but misinformed arguments, that the brand-name pharmaceutical industry and MPs such as Mr. Martin and Mr. Garneau like to repeat  over and over:

MYTH: Streamlining CAMR would undermine incentives for brand-name pharmaceutical companies to research and develop new medicines.

FACT: This claim makes no sense.  CAMR only allows compulsory licensing for the purpose of exporting lower-cost generic medicines to eligible countries, which represent a very small percentage of total global pharmaceutical sales and the profits of brand-name pharmaceutical companies.  For example, the entire continent of Africa, the hardest hit by the AIDS pandemic, represents less than 2 percent of global pharmaceutical sales.  As brand-name companies make little or no profit in developing countries, these markets have little or no impact on their investments in research and development (R&D).  Furthermore, the brand-name drug companies are entitled to receive royalties on sales of generic medicines supplied under CAMR – and Bill C-393 does not change this.  Exports to high-income countries, in which brand-name pharmaceutical companies make the vast majority of their profits and on which they base their decisions about R&D, are not authorized by CAMR – and Bill C-393 does not change this.  The countries that would benefit from a streamlined CAMR are the same as those agreed upon by all countries at the WTO, including Canada, years ago.

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MYTH: Canadian generic manufacturers will not be able to supply medicines at prices competitive with generic manufacturers elsewhere, such as India.

FACT: In the one case to date in which CAMR has been used, the Canadian generic drug company supplied the medicine to Rwanda at the same price being offered by Indian generic manufacturers and won the contract through this competitive bidding process.  Furthermore, the simpler it is for developing countries and generic manufacturers to use CAMR to supply multiple developing countries, the greater economies of scale and the lower the costs of production that can be achieved by generic manufacturers in Canada – which ultimately benefits purchasing countries and patients in those countries through even lower medicine prices.

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MYTH: The barrier to greater access is not the prices of medicines but rather widespread poverty and inadequate health systems.

FACT: There are multiple barriers to access to medicines in the developing world, which vary from country to country and even within a given country.  But major progress has been made in increasing access to treatment, including by strengthening health systems.  Every credible organization and expert recognizes the obvious fact that the price of medicines is a key factor affecting access to those medicines – and that the prices of medicines prevent many patients with HIV or numerous other conditions from accessing life-saving treatments.  Prices are higher when medicines are only available from brand-name pharmaceutical companies that hold patents (i.e., monopolies) on those medicines.  All the clinics, doctors and nurses in the world won’t be able to help patients if medicines are priced out of reach.  Streamlining CAMR could effectively assist developing countries in overcoming one of the major barriers to affordable treatment.  The lower the prices of medicines, the more people can be treated with limited resources – and the more resources are freed up for investing infrastructure and other aspects of health care that are also needed in some settings. 

As well, Elliott, Rachel Kiddell-Monroe and Dr. James Orbinksi penned an op-ed in the Ottawa Citizen

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