I attended an insightful intellectual property workshop in Kampala. It is amazing how much access to essential medicines such as ARVs has to do with intellectual property laws.
Would you believe for instance that come 2016, generic AIDS drugs which are consumed in Uganda (originally from India) will no longer be permitted owing to international trade agreements(TRIPS)?
The Ugandan parliament has shelved a bill(industrial properties bill) which would buy Uganda some time (under the flexibilities of TRIPS). Now Uganda faces the real possibility of having to buy ARVs from western pharmaceutical companies at prices beyond the reach of the overwhelming majority of Ugandans.
Generic drugs made AIDS treatment possible for millions in the developing world now that the grace period is running out for copy the formula of these drugs by pharmaceutical companies in low-income countries then the real prospect of drug stock outs becomes a real and present danger.
Can parliament wake up to its mandate before millions die out of their negliegnce?
Of course the whole international trade law is ranged against the poor world and serves 'big pharma' but our own negliegence may worsen matters.
Friday, August 19, 2011
Saturday, July 30, 2011
Is the US really flat broke?
With the political stalement in the U.S., it is hard to believe that the US of A is in such debt. How did the most financially successful country in the history of the mankind reach such a point where the state doesnt have enough money to run and needs foreign borrowing to survive?
These are very strange times indeed. For Greece,may be. But then the U.S,?
The United States was a country founded on the ideals of self-reliance, individualism, the free market and it's embarasing and humuliating that the US finds itself in this position in the first place. The founding fathers would have surely chided the current generation of Americans.
Many argue that the very idea of capitalism led the US, and subsquently the rest of the world, in this state of affairs.
The US is now heavily indebted to China(most of all), to Japan,the UK, Germany and city-nation of Singapore!
The economic decline of the US is very astonishing especially given the speed with which it is being manifested. Even ten years ago,no one really saw this coming. We all knew that Americans love to live beyond their means and that they love the credit card but flat broke? That would have been pure fiction.
And the trouble for the world is that the US's financial woes dont end in Washington DC but extend to the rest of the world. The U.S. is still such a central player in the global economy.
The global financial crisis which started in 2008/2009 was actually sparked off by events on Wall street. Remember Lehman Brothers,Freddie Mae, AIG and the 'too big too fail' talk?
Industrial production is declining in the US as is export perfomance and it is hard to see that the US will regain its economic predominance pre-global financial crisis.
Its a difficult situation that President Obama finds himself-politically. He cant borrow to run government and the republicans wont let him increase taxes to finance the budget deficit. How in the hell is one supposed to run a government in these circunstances?
President Obama shouldnt be blamed for economic times that the US finds itself. In all fairness the root causes of the American malaise go back many years.
These are very strange times indeed. For Greece,may be. But then the U.S,?
The United States was a country founded on the ideals of self-reliance, individualism, the free market and it's embarasing and humuliating that the US finds itself in this position in the first place. The founding fathers would have surely chided the current generation of Americans.
Many argue that the very idea of capitalism led the US, and subsquently the rest of the world, in this state of affairs.
The US is now heavily indebted to China(most of all), to Japan,the UK, Germany and city-nation of Singapore!
The economic decline of the US is very astonishing especially given the speed with which it is being manifested. Even ten years ago,no one really saw this coming. We all knew that Americans love to live beyond their means and that they love the credit card but flat broke? That would have been pure fiction.
And the trouble for the world is that the US's financial woes dont end in Washington DC but extend to the rest of the world. The U.S. is still such a central player in the global economy.
The global financial crisis which started in 2008/2009 was actually sparked off by events on Wall street. Remember Lehman Brothers,Freddie Mae, AIG and the 'too big too fail' talk?
Industrial production is declining in the US as is export perfomance and it is hard to see that the US will regain its economic predominance pre-global financial crisis.
Its a difficult situation that President Obama finds himself-politically. He cant borrow to run government and the republicans wont let him increase taxes to finance the budget deficit. How in the hell is one supposed to run a government in these circunstances?
President Obama shouldnt be blamed for economic times that the US finds itself. In all fairness the root causes of the American malaise go back many years.
Thursday, June 30, 2011
Can we treat our way out of the HIV epidemic?
Today afternoon I attended a very engaging and thoughtful debate. Can we treat our way out of the HIV epidemic?
The debate was at Makerere University's School of Public health where the presenters were up and coming Ugandan Centers for Disease Control (CDC) fellows. And so, the perspectives were largely Ugandan.
It was a debate akin to a secondary school debate with proponents and opponents for the motion of the day. And a very topical one indeed, seeing as it is ,that its thirty years since the onset of the HIV/AIDS pandemic which started way back in early 1980s among American gay couples.
Well, it emerged at the debate that there is scientific proof to show that the HIV/AIDS epidemic can be eliminated through a universal 'test and treat' approach where all are tested for HIV and those found positive are put on AIDS drugs.
Scientists have shown ,through modelling, that universal access to voluntary counselling and testing for HIV and putting all eligible patients on antiretroviral therapy(ART)can end the HIV epidemic while controlling for behaviour change and prevention efforts. The recent National Institutes of Health study among HIV discordant couples shows that starting early on ART can reduce the HIV transmission risk by 96% proving that that ART is both a treatment and prevention tool. An observational study conducted in Rakai,Uganda by Steven Reynolds which followed 51 discordant couples showed than none of them contracted HIV while the positive partner was on AIDS drugs. In Botswana, 90% coverage of prevention of Mother to Child Transmission(PMTCT)eliminated mother to child transmission of HIV altogether.
Those arguing that we cant treat our way out of the HIV epidemic hard a far easier task of the afternoon.
They simply made the case that we dont have the resources to treat all those in need of ART in terms of the financial,human,pharmacuetical and laboratory and other associated resource needs. That we dont have the health systems in which to dispense the drugs in Sub Saharan Africa even if they were suddenly available , in Uganda for instance, and that many countries have showed limited capacity for absorbing AIDS aid. The Uganda treasury recently returned 50 billion shillings of unutilized funds for AIDS drugs. The latest Auditor General's report shows that many AIDS drugs have expired in our national medicine stores and will have to be destroyed.
That the socio-cultural and behavioural drivers of the epidemic will continue to spread HIV even if all those eligible are put on anti AIDS drugs. The proponents though showed that those on ART have shown a 78% reduction in risky sexual behaviour. That ART drug adherence would be problematic and lead to an even more complicated situation of drug resistance due to posible low drug adhrence necesitating the use of second line drugs which a lot more expensive and not widely available in Sub Saharan Africa. And that stigma is a barrier to testing and treatment for HIV in Africa and would be a huge hurdle for universal coverage efforts.
And where will the finances come for treating all those in need of ART? How sustainable can it be fiscally speaking? Simple: the usual donors will pay for it! And by usual donors is meant PEPFAR,Global Fund, World Bank etc. In short, the west. This was the response of Sarah Nakku one of the proponents. Of course it is alot more complicated than that. She however argued that the west has a direct self-interest in combating HIV in Africa given the globalised world we live in. A traveling Ugandan can have breakfast in Kampala, lunch in London and dinner in New York.
And do we have health sytems within which to deliver these drugs in Sub Saharan Africa or Uganda at least? According to the proponents, yes we do. That an infrastructural skeleton exists in Uganda and all we have to do is beef it up. Read, pay doctors better salaries,equip hospitals with labs and drugs and that you dont necessarily need medical degrees to treat HIV since lower cadre health workers can be trained to do the job etc. Again a little simplistic if only for arguments's sake. And 80% of the generic AIDS drugs are from India ,from where Uganda an mot AIDS-affected countries get the ARVs, which has now asked to stop the production of generic drugs whose patents are help by western pharmaceutical firms.
And then the mainly academic audience weighed in. What if we targeted
specific epidemic drivers such as sex workers,truck drivers and fishermen instead od the entire population came a thoughtful question.
At the 2000 international AIDS conference in Durban South Africa, the west was skeptical about the abillity of African health systems to scale up access to ART because of fears of
drug adherence and weak health systems(again!) but see where we are now. In Uganda more than a half of those in need of ART have it. In other words, the west may be skeptical about mass treatment like it was before the scaling up of ART but it was proven it can be done. That it took truly global efforts to eliminate small pox,river blindness, polio etc and the same can be done for HIV/AIDS. And what is the alternative anway? The risk of not treating AIDS is a lot worse than actually treating it and studies show expenditure on ART is actually an investment in future generations.
The debate was at Makerere University's School of Public health where the presenters were up and coming Ugandan Centers for Disease Control (CDC) fellows. And so, the perspectives were largely Ugandan.
It was a debate akin to a secondary school debate with proponents and opponents for the motion of the day. And a very topical one indeed, seeing as it is ,that its thirty years since the onset of the HIV/AIDS pandemic which started way back in early 1980s among American gay couples.
Well, it emerged at the debate that there is scientific proof to show that the HIV/AIDS epidemic can be eliminated through a universal 'test and treat' approach where all are tested for HIV and those found positive are put on AIDS drugs.
Scientists have shown ,through modelling, that universal access to voluntary counselling and testing for HIV and putting all eligible patients on antiretroviral therapy(ART)can end the HIV epidemic while controlling for behaviour change and prevention efforts. The recent National Institutes of Health study among HIV discordant couples shows that starting early on ART can reduce the HIV transmission risk by 96% proving that that ART is both a treatment and prevention tool. An observational study conducted in Rakai,Uganda by Steven Reynolds which followed 51 discordant couples showed than none of them contracted HIV while the positive partner was on AIDS drugs. In Botswana, 90% coverage of prevention of Mother to Child Transmission(PMTCT)eliminated mother to child transmission of HIV altogether.
Those arguing that we cant treat our way out of the HIV epidemic hard a far easier task of the afternoon.
They simply made the case that we dont have the resources to treat all those in need of ART in terms of the financial,human,pharmacuetical and laboratory and other associated resource needs. That we dont have the health systems in which to dispense the drugs in Sub Saharan Africa even if they were suddenly available , in Uganda for instance, and that many countries have showed limited capacity for absorbing AIDS aid. The Uganda treasury recently returned 50 billion shillings of unutilized funds for AIDS drugs. The latest Auditor General's report shows that many AIDS drugs have expired in our national medicine stores and will have to be destroyed.
That the socio-cultural and behavioural drivers of the epidemic will continue to spread HIV even if all those eligible are put on anti AIDS drugs. The proponents though showed that those on ART have shown a 78% reduction in risky sexual behaviour. That ART drug adherence would be problematic and lead to an even more complicated situation of drug resistance due to posible low drug adhrence necesitating the use of second line drugs which a lot more expensive and not widely available in Sub Saharan Africa. And that stigma is a barrier to testing and treatment for HIV in Africa and would be a huge hurdle for universal coverage efforts.
And where will the finances come for treating all those in need of ART? How sustainable can it be fiscally speaking? Simple: the usual donors will pay for it! And by usual donors is meant PEPFAR,Global Fund, World Bank etc. In short, the west. This was the response of Sarah Nakku one of the proponents. Of course it is alot more complicated than that. She however argued that the west has a direct self-interest in combating HIV in Africa given the globalised world we live in. A traveling Ugandan can have breakfast in Kampala, lunch in London and dinner in New York.
And do we have health sytems within which to deliver these drugs in Sub Saharan Africa or Uganda at least? According to the proponents, yes we do. That an infrastructural skeleton exists in Uganda and all we have to do is beef it up. Read, pay doctors better salaries,equip hospitals with labs and drugs and that you dont necessarily need medical degrees to treat HIV since lower cadre health workers can be trained to do the job etc. Again a little simplistic if only for arguments's sake. And 80% of the generic AIDS drugs are from India ,from where Uganda an mot AIDS-affected countries get the ARVs, which has now asked to stop the production of generic drugs whose patents are help by western pharmaceutical firms.
And then the mainly academic audience weighed in. What if we targeted
specific epidemic drivers such as sex workers,truck drivers and fishermen instead od the entire population came a thoughtful question.
At the 2000 international AIDS conference in Durban South Africa, the west was skeptical about the abillity of African health systems to scale up access to ART because of fears of
drug adherence and weak health systems(again!) but see where we are now. In Uganda more than a half of those in need of ART have it. In other words, the west may be skeptical about mass treatment like it was before the scaling up of ART but it was proven it can be done. That it took truly global efforts to eliminate small pox,river blindness, polio etc and the same can be done for HIV/AIDS. And what is the alternative anway? The risk of not treating AIDS is a lot worse than actually treating it and studies show expenditure on ART is actually an investment in future generations.
Monday, June 27, 2011
The Chinese are coming!
Yesterday sunday evening I watched an insightful BBC documentary on China's rising interests in Africa. The reporter takes us on an intimate trip through Zambia,Tanzania and Congo DRC to see first-hand China's budgeoning interests in Africa.
From a large-scale chicken farmer in Zambia to a large scale mining concession in DRC Congo, Chinese businesses are becoming new economic players in Africa.
China's interests are driven by an insastiable apetite for raw materials for their industrial machine that has been described as 'super market to the world'.
China's interests in Africa provide a new lease of life economically to many destitute African countries which cant seem to refuse the irresistible Chinese offers.
In Zambia, the copper mines had been closed until the Chinese came calling. In DRC Congo, the mines were there for locals to exploit using stone-age era mining implements.
Clearly, China is giving a new lease of life to poor African countries. But it has not come without a price. The Chinese are not missionaries in Africa. Their interests are pragmatic. They need raw materials and markets for their products and alternatives for their billion-strong population.
There have been reports of human rights abuses at Chinese factories. There has been an influx of Chinese entreprenuers at scale that is attracting the ire of many small scale Zambian chicken farmers. Do the Chinese have to compete at this level as well in Africa?
The irony is not lost on a History major here. China a country branded as communist is beating the capitalists at their own game. It has outcompeted european industry on cost and now the small scale African trader is next.
From a large-scale chicken farmer in Zambia to a large scale mining concession in DRC Congo, Chinese businesses are becoming new economic players in Africa.
China's interests are driven by an insastiable apetite for raw materials for their industrial machine that has been described as 'super market to the world'.
China's interests in Africa provide a new lease of life economically to many destitute African countries which cant seem to refuse the irresistible Chinese offers.
In Zambia, the copper mines had been closed until the Chinese came calling. In DRC Congo, the mines were there for locals to exploit using stone-age era mining implements.
Clearly, China is giving a new lease of life to poor African countries. But it has not come without a price. The Chinese are not missionaries in Africa. Their interests are pragmatic. They need raw materials and markets for their products and alternatives for their billion-strong population.
There have been reports of human rights abuses at Chinese factories. There has been an influx of Chinese entreprenuers at scale that is attracting the ire of many small scale Zambian chicken farmers. Do the Chinese have to compete at this level as well in Africa?
The irony is not lost on a History major here. China a country branded as communist is beating the capitalists at their own game. It has outcompeted european industry on cost and now the small scale African trader is next.
Saturday, May 21, 2011
The ugly return of Uganda's Amin image
The 'walk to work' protests are having a more profound effect than the architects hoped for.
Uganda has returned in the international media and regained its former pariah status.
The Ugandan president is being called names reserved for Robert Mugabe by internation media houses such as Al jazeera and 'The New York Times'.
The governments brutal handling of riots against the rising fuel prices has earned it internation notriety and turned back the clock to the very darkest days of Uganda's history in the 1970s.
The savage arrest of Dr Kizza Besigye the opposition leader by police forces has gone viral on Youtube.Uganda is once again the headlines for all the wrong reasons.
The immediate casualities are a dip in foreign direct investment and tourism sales which had reportedly gone south. No one wants to take a vacation in a riotous and restless Kampala where foreign presidents are stoned on the way to the airport.
Uganda's international credit rating is set to suffer as fears of instability and turmoil gain currency.
There seems to be no end in sight as both the Museveni administration and the Dr Kizza Besigye camps dig in. The Ugandan government insists it will let the high fuel prices stay and the Dr Besigye camp insists it will continue the protests until government relents.
Uganda has returned in the international media and regained its former pariah status.
The Ugandan president is being called names reserved for Robert Mugabe by internation media houses such as Al jazeera and 'The New York Times'.
The governments brutal handling of riots against the rising fuel prices has earned it internation notriety and turned back the clock to the very darkest days of Uganda's history in the 1970s.
The savage arrest of Dr Kizza Besigye the opposition leader by police forces has gone viral on Youtube.Uganda is once again the headlines for all the wrong reasons.
The immediate casualities are a dip in foreign direct investment and tourism sales which had reportedly gone south. No one wants to take a vacation in a riotous and restless Kampala where foreign presidents are stoned on the way to the airport.
Uganda's international credit rating is set to suffer as fears of instability and turmoil gain currency.
There seems to be no end in sight as both the Museveni administration and the Dr Kizza Besigye camps dig in. The Ugandan government insists it will let the high fuel prices stay and the Dr Besigye camp insists it will continue the protests until government relents.
Sunday, April 24, 2011
The changing face of the Libyan conflict
Is the situation in Libya a civil war or is it a case of a desparate leader dropping bombs on unarmed protestors?
Is the west foray into Libya still guided by the United Nations security council resolution?
We now hear that Britain has sent in military advisers near Benghazi and that the US has 'unmanned'drones which have already launched attacks against Gadhaffis' forces?
For starters this is no defence against Muammar Gadhafi,the world more than know what his ills have been as Libyan leader.
Are the international actors in Libya changing goal posts in Libya?
At first we were told the military strikes were there to forestall Gaddhafi from advancing rapidly against rebels and thereby preventing a sure bloodbath.
Strategically, the aims of the initial mission was to secure a 'no fly zone' and to build a buffer for the Libyan's opposition stronghold of Benghazi. It was to kind of enforce a ceasefire through military means. But character of the west's onslaught in Libya is changing very rapidly we need to be afraid,indeed, very afraid.
Arent we breaching international law by sponsoring an armed internal rebellion against a sitting government by providing them with direct military support?
Arent we setting a precedent?
Are we still within the UN security council mandate?
Is it legitimate for external forces to support a partisan party in a civil war?
We all know that the country that we know as Libya is actually a hotch potch of ethnic sects and tribes and that this a major part of the current conflict in Libya. Gadhafi is detested partly because he is from a different ethic group from the peoples of Benghazi.
How much support does international law accept in a conflict as peculiar as the one in Libya?
Initially, the libyan sage could be seen in black and white. A dictator using excessive force against his own people including peaceful demonstrators. Are we still at this stage of the conflict?
Arent we getting into Vietnam territory here?
Where is the worlds's rage?
Is the west foray into Libya still guided by the United Nations security council resolution?
We now hear that Britain has sent in military advisers near Benghazi and that the US has 'unmanned'drones which have already launched attacks against Gadhaffis' forces?
For starters this is no defence against Muammar Gadhafi,the world more than know what his ills have been as Libyan leader.
Are the international actors in Libya changing goal posts in Libya?
At first we were told the military strikes were there to forestall Gaddhafi from advancing rapidly against rebels and thereby preventing a sure bloodbath.
Strategically, the aims of the initial mission was to secure a 'no fly zone' and to build a buffer for the Libyan's opposition stronghold of Benghazi. It was to kind of enforce a ceasefire through military means. But character of the west's onslaught in Libya is changing very rapidly we need to be afraid,indeed, very afraid.
Arent we breaching international law by sponsoring an armed internal rebellion against a sitting government by providing them with direct military support?
Arent we setting a precedent?
Are we still within the UN security council mandate?
Is it legitimate for external forces to support a partisan party in a civil war?
We all know that the country that we know as Libya is actually a hotch potch of ethnic sects and tribes and that this a major part of the current conflict in Libya. Gadhafi is detested partly because he is from a different ethic group from the peoples of Benghazi.
How much support does international law accept in a conflict as peculiar as the one in Libya?
Initially, the libyan sage could be seen in black and white. A dictator using excessive force against his own people including peaceful demonstrators. Are we still at this stage of the conflict?
Arent we getting into Vietnam territory here?
Where is the worlds's rage?
Sunday, March 27, 2011
What I have learned from the Libyan saga
Abraham Maslow was right. Satisfaction of physiological needs gives rise to the need to satisfy higher needs. The people of Libya may have had good good health care,education and roads but they had unmet civil and political needs. The west will intervene in a crisis if the country in question has oil and the conflict is getting in the way of the world's supply of crude oil. The African Union is toothless in the face of the west's hand wringing. The United Nations' Security Council is a mouthpiece for western interests. Staying in power for over four decades makes conditions ripe for a revolution given the right spark. Do not shoot and drop bombs on unarmed street protesters no matter how much power you think you wield. Do not ignore events in your neighbourhood they have a bad habit of spreading to your backyard. All conflicts have underlying economic undertones. Air prowess and strikes dont win wars on their own. 'You need boots on the ground'. Getting direct international intervention in national conflicts takes more than three weeks.
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