Tobacco control in Africa and the challenge of a colonial political economy

Public health advocates scarcely appreciate how entrenched the tobacco industry is in Africa given its colonial political economy. An analysis of the leading tobacco companies in Africa will reveal a colonial hang over. The leading tobacco company in most of Anglophone Africa is actually British American Tobacco (BAT) and the leading Tobacco companies in Franco phone Africa are actually French. In Kenya,Uganda, South Africa,Zambia and Zimbabwe, for instance, BAT has dominant market leadership. In Burkina Faso, Mali and Senegal, the leading tobacco companies have French-ties. Using economic history lenses we would need to appreciate that the tobacco crop is actually not native to Africa. In Uganda, for instance, it was introduced in the 1920s by the British. The British were majorly interested in a colonial empire in Africa partly because they wanted a base for raw materials for their budgeoning industries and here cash crops like coffee, cotton, etc come to mind. Public health advocates need to appreciate how deeply entrenched the colonial political economy in Africa in many respects is still intact. BAT of course is no longer wholly British-owned, indigenous Ugandans for example can freely buy shares on the stock exchange in Kampala reflecting the hybridization of the colonial economy by marrying it with narrow elite African interests. The Board Chairmen of BAT Uganda have in the past ten years been very carefully selected representing the most foremost indigenous Ugandans even when all they do is really serve as fronts for complex multinational interests. By offering Ugandans shares in BAT Uganda, multinational commercial interests are diversified by co-opting a narrow African middle class thereby spreading the risk of regulatory oversight in African markets. In Uganda, UMEME, the local power company was bought by a British consortium. After getting market intelligence that the Ugandan state was growing weary of its efficiency standards and protracted grambling over a badly negotiated sale, UMEME about two years hastily sold some shares to native Ugandans. Recently, the Ugandan government threatened to reverse its power deal with UMEME which has wisely pre-empted this by hastily selling its shares to Ugandans. Today the Energy Minister announced Government will not go ahead with its threat.

Why Uganda is in the throes of an NCDs epidemic: A bullet-point analysis

Uganda already has AIDS, malaria and Tuberculosis to worry about-infectious diseases Another tier of diseases (non communicable diseases) has been added on to the disease. EVOLUTIONARY PHYSIOLOGY AND NUTRITION REGIME CHANGES • Physiological inability of body to adapt from physically-active rural backgrounds to sedentary middle class lifestyles. • Recreational diets typically comprising roast pork and beef • Westernization and change in nutritional regimes (from low to high- cholesterol diets) INCOME AND LIFESTYLES • Urbanization (excessive sedentary use of motorized transport) • Occupation-associated inactivity; hours spent in meetings and air travel. • Epidemiological transition from infectious (e.g. AIDS) to non- communicable diseases( e.g. CVDs) DIAGNOSTIC FACTORS • Late detection, low diagnostic capacity and ignorance of family history risk factor GENDER, SOCIO-CULTURAL AND POLITICAL ECONOMY FACTORS • Males more affected by heart disease due to biology (& African race)and socio-cultural male privileges (disproportionate resource access). • African culture associates being overweight with affluence. (148 words)

Are poor African countries net creditors to rich western countries?

As Africans, we have been made to believe that African states are propped up by loans and foreign money from the west. That right from free HIV treatment to World Bank loans,to government budget support, western credit and philanthropy sustains Africa's 'failed' states. A bold recent book however challenges this widely-held perception by providing stunning economic evidence that African countries are actually net creditors to the rich industrialized world. Put in lay man terms, the book's central argument is that more money leaves Africa to the west than comes into Africa from the west. The book (recommended to me by Pelegrine Sebulime) is entitled 'Africa's odious debts: How foreign loans and capital flight bled a continent'' was authored by Ndikumana and Boyce, Economics professors at the University of Massachusetts at Amherst, the former is actually Burundian. The book is no idle polemic but provides hard economic data most of which has already been published in academic journals since 2001. One of the articles written on this precise argument won an Economics award. Leonce Ndikumana should know. He holds a doctorate in Economics from University of Washington at St Louis and was head of research at African Development Bank from 2008 to 2011.He was also Chief of Macroeconomic analysis at the United Nations Economic Commission for Africa from 2006 to 2008. In an article the authors published in the Journal of Development studies in 2001 titled’ Is Africa a net creditor?', the authors write ''We found that capital flight from 25 low-income African countries over the 1970-96 period amounted to $ 193 billion(and to $ 285 million including imputed interest earnings) comparing to this to the $178 billion in external debt to the same set of countries, we concluded that Africa is a net creditor to the rest of the world: the external assets of these countries exceeded their external debts'. Here is how Ngozi Okonjo-Iweala Nigeria's Finance Minister put it 2005 ''We make annual debt repayments of more than$1.7 billion,three times our education budget and nine times our health budget'' Compounding the outrage is the empirical fact that most of loans borrowed by African countries end up in private pockets while the loans of course, remain publically-held by African states-for generations. The book discusses compelling case studies of Mobutu Sseseko's Zaire and Fernando Marcos' Phillipines. In a memorable story from the Philippines, 2 billion US dollars was borrowed from US Export-Import Bank and a Citibank and American Express consortium to build a nuclear energy plant that never produced even an ounce of electricity yet Philippines went on to pay billions of dollars in loan repayments. The trouble, partly, was that the nuclear plant was built on a site prone to earth quakes! The book highlights the complex behind-the-scene dealings at multilateral lenders such as the IMF which was arm-twisted by the US government to lend to Mobutu's Zaire contrary to its' own assessment. Not altogether strange if you have read similar tales in the frame of'Confessions of an economic hit man'. The notion that the west has taken more out of Africa than the other way round is hardly original. It has been previously harped by economic historians and anti-colonialism African intellectuals. This book, however, is hard empirical proof of this contemporary African reality of a hemorrhaging continent. One mortgaged by its elites in lots of needless borrowing with many in the west on the take as well. ''Aid in reverse: how poor countries develop rich countries''is how one observer sums it up.

The reluctant president: Obama and the missed Syrian moment

I have been a loyal Obama supporter from the moment he delivered his ground-breaking speech at John Kerry's nomination at the Democrat's convention in 2004. I predicted on these very pages that Obama would win a second term before he was even sworn in for his first term. But over the years I have been underwhelmed. It's not that he has done nothing striking for Africa. I knew that first and foremost he was a President of USA. I hate to think that even George W Bush's PEPFAR program trumps anything Obama has done thus far for Africa. It is clear as well that Syria's conflict is complex drawing in many regional powers with Russia added in for good measure but surely Obama flanked the Syria chemical-use incident. Any mediocre President would still have ordered surgical strikes in retaliation against the Assad regime for gassing its own people. Not every decision has to have approval of congress surely. The element of suprise is lost and Assad has been given all the time in the world to prepare for a potential strike. Even the Bush-era 'Shock and awe' seems preferable in comparison. Clearly, Obama's reluctance is partly because of the Iraq-Afghanistan hangover and an American public wary of another endless and costly foray of foreign interventions and an economy that is slowly recovering from (partly) its effects but still.. As US president, Obama has the privilege of presidential discretion. He could have easily ordered a surgical strike against Assad without requiring approval of the legislature. Obama gets a daily intelligence briefing that requires his swift action at certain times that requires a decisive President. Now he set an unwelcome precedent for the next US presidents. This was, without doubt, one of Obama's lowest moments as US president-for me at least. May be I am not as unqualified for US president as I thought.

Why continued access to affordable HIV drugs hangs on a bill in the Ugandan parliament

Today Wednesday 21st August 2013, a bill critical to the lives of half a million Ugandans enrolled on HIV treatment comes up for debate in the plenary of the Ugandan parliament. Not many Ugandans have heard about the Industrial properties bill (2009) but here is why we should pay attention. Uganda’s national HIV prevalence rates have shot up from 6.4% in 2005 to 7.3% in 2012 with a clearly worrying upward trajectory. Uganda continues to register steady increases in annual HIV infection rates since 2010. Annual infection rates have risen from 100,000 in 2010 to 150,000 in 2011 according to statistics from the AIDS Information centre (AIC). Now, here is why the industrial properties bill (2009) can make or break not just the lives of Ugandans currently enrolled on HIV treatment but the Ugandan economy as a whole given that a 2008 UNDP study showed that continued access to HIV treatment offsets the negative economic growth rate of HIV by 5.3%. According to the 2013 Ministerial policy statement signed by Dr Ruhakana Rugunda, the Health Minister, there are 520,000 Ugandans currently enrolled on HIV treatment- and counting. Over 90% of these half a million Ugandans depend on Indian generic antiretroviral drugs (ARVs) for treatment- according to Denis Kibira, a Pharmacist and Medicines Advisor at HEPS-Uganda. The trouble is that the Indian generic ARVs, and yes, even those manufactured by Quality Chemicals at Luzira, are not brand drugs. Put another way, the generics consumed by Ugandan ARV users were not developed by Indian pharmaceutical companies. Indian companies copied the formulas for manufacturing these drugs by companies mostly from Western Europe and North America (without their authority). Almost all these Indian ARVs were originally developed after painstaking research and development by a pharmaceutical giant after investing literally millions of dollars of their own R&D funds to develop these drugs and have taken though rigorous animal and human trials and getting them approved from agencies such as the Food and Drug Administration (FDA) in the US. These pharmaceutical giants are then granted patents or exclusive right of use and distribution of say 30 years under international trade law relating to intellectual property rights. These patents imply that the ARVs are NOT to be copied by another manufacturer, in Uganda’s case, an Indian one. Of course this would not be a problem if Ugandans could afford to buy these drugs from Pfizer or Norvatis. The trouble is that these drugs are often priced at prices tailored to western markets yet a quarter of Ugandans live below the poverty line and Indian generics, which go about a tenth of the price of brand drugs is all they can afford. Even the US’s PEPFAR program in Uganda depends on generic ARVs for 96% of those treated under its numerous implementing partners-according to PEPFAR’s 2012 country operational plan. Because of these patent and international trade law barriers to access to essential medicines, poor countries met in Doha, Qatar in 2001 and made the Doha declaration which provided for poor countries to overcome these patent barriers by domesticating its provisions in their laws allowing poor countries to disregard these pharmaceutical patents on account of public health emergencies such as HIV/AIDS. The grace period for manufacturing generic pharmaceuticals expires on 1st January 2016 unless the Ugandan parliament sits today and calls for amendments to the Industrial properties bill (2009) to include ‘flexibilities’ that allow Uganda to lawfully extend this deadline or suspend international pharmaceutical patents with regard to some specific public health emergencies or import these drugs from India. These ‘flexibilities’ were agreed upon by the World Trade Organization (WTO) in 2005 and all the Ugandan parliament needs to do is include them in the industrial properties bill (2009). Short of this, come 2016, generic HIV drugs will become illegal under Uganda law and western pharmaceutical giants would successfully enforce patents for HIV drugs in Ugandan courts. According to CSOs involved in access to medicines issues in a joint statement issued on Monday 19th August 2013, the current bill does not include these ‘flexibilities’. ’’ Every Ugandan who has ever taken a tablet or a syrup to treat an ailment should pay attention to the Industrial properties bill’’says Primah Kwagala of Center for Health, Human Rights and Development’’

Ugandan housemaids a most at risk population for HIV infection-Daily Monitor

Ugandan housemaids are said to be an at most risk population for HIV infection according to the Daily Monitor newspaper of 5th August 2013.House maid are typically teenage girls who are ferried from a life of poverty and destitution in rural Uganda to urban middle class homes in Kampala to work as domestic servants engaged to do domestic chores like cooking, cleaning, looking after babies etc. Here is the article in its entirety: ''...The Ministry of Health has included house maids on the list of most at risk population in the spread of HIV/Aids. With a seven per cent prevalence rate, housemaids are feared to get infected and spread the virus at almost the same rate with prostitutes and fish mongers. According to junior Health minister (General Duties) Elioda Tumwesigye, the sexual network arising from housemaids is among the largest while their vulnerability puts the whole network at risk. “A housemaid may have sexual intercourse with the owner of the house, the male child, the home guard, the Shamba boy, the delivery boy and even neighbouring men, sometimes they have no power to dictate the use of condoms especially with their bosses,” Dr Tumwesigye told journalists at the Uganda Media Centre. Due to the nature of their jobs and lack of sensitisation, housemaids are also believed to be reluctant in seeking for medical help as well as finding out their status. The most recent UN Aids report indicates that Uganda is losing the fight against Aids given the increased prevalence rate, a fact the government blames on the reluctance of the population due to the presence of ARVs and low sensitisation on behavioural change as a tool against the virus. “The population has changed its mentality against the fight since they now know they can live with HIV/Aids,” said Dr Jane Aceng, the Director General Health Services.''

Ugandan activists decry patent barriers to accessing affordable generic HIV drugs

The World Trade Organization (WTO) last month extended the deadline for enforcement of patents and copyrights, mainly held by multinational companies, in the world’s least developed countries (LDCs) by a further eight years which elapse in 2021. The extension did not however include cheaper generic HIV drugs or pharmaceutical products in general whose deadline expires in 2016. Human rights organizations warn that the lives of half a million Ugandans enrolled on HIV treatment will hang in the balance if generic drugs are outlawed based on international trade law or the Trade Related Aspects of Intellectual Property Rights (TRIPS). According to Denis Kibira, medicines advisor for the non-governmental organisation HEPS-Uganda, over 90% of all HIV drugs in Uganda are generics manufactured in India. Generic drugs are identical copies of brand drugs manufactured by originator pharmaceutical companies, most of which are based in Western Europe and the US. HIV treatment was previously a preserve for patients in the west on account of the high prices of antiretroviral drugs (ARVs) and international patents which did not permit manufacture of ARVs at cheaper prices. HIV treatment became a possibility for millions in Sub Saharan Africa principally because of the introduction of generic ARVs in 2001. HIV drugs must be affordable Joshua Wamboga from The AIDS Support Organization, where over 100,000 people are enrolled on HIV treatment, said: "The ability to access cheap medicines on the market will be curtailed and the fight against HIV in Uganda may be lost if expansive trade laws are adopted without improving the incomes of Ugandans." According to the Ugandan Ministry of Health, there are over 500,000 antiretroviral users in the country. PEPFAR, the leading funder of HIV treatment in Uganda, indicated in its 2012 country operational plan that it depends on Indian generic drugs for 96% of those treated under its implementing partners. Generics drugs were a major factor in scaling up access to the over seven million who are currently on treatment in Africa according to a UNAIDS report of May 2013. Medicins San Frontiers reported this month the price of first line and second line antiretrovirals has fallen due to competition among generic drug manufacturers, further making antiretrovirals affordable by poor countries. The much more expensive second-line and third-line drugs, which are prescribed when a patient develops drug resistance to the first-line drugs are however, still patent protected. Putting lives at risk Outlawing generic antiretrovirals would jeopardize the lives of those already on treatment and be a crippling impediment to further scaling up access for those who become eligible for treatment. The demand for antiretrovirals in Uganda is set to increase given the increase in national prevalence of HIV from 6.4% in 2005 to 7.3% in 2012, according the Ugandan health ministry. The new World Health Organization HIV treatment guidelines issued on 30 June, recommend antiretroviral therapy now be initiated earlier before people’s CD4 counts get too low. So the demand for generic HIV pharmaceuticals is set to increase even further based on these recommendations. Professor Brook Baker of the US-based organisation Health GAP, in a joint statement with Uganda’s Centre for Health, Human Rights and Development (CEHURD), calls for least developed countries to start early in their quest for an unconditional extension to the grace period given by the World Trade Organization for manufacture and sale of generic antiretrovirals, which elapses in 2016. Uganda’s pharmaceutical industry Moses Mulumba, director at CEHURD, said: “Uganda has major technological and infrastructural deficiencies for its indigenous pharmaceutical industry to be able to develop its own original antiretrovirals. This would require millions of dollars in investment and highly qualified researchers.” He advised that Uganda could overcome these challenges through technology transfer arrangements with countries such as Brazil, China and India. Quality Chemicals is currently the only Ugandan pharmaceutical company manufacturing generic HIV drugs in a joint venture with Cipla of India.