Make Vital Medicines Available for Poor People: Bangladesh | Pharmaceutical Drug | Trips Agreement

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The already failing health care system in Bangladesh is set to take a pounding from which it may never recover. Recent reports on the state of Bangladesh's hospitals are just the tip of the iceberg. Oxfam interviewed patients, government officials, doctors and nurses, hospital chiefs, and NGOs in Bangladesh and many of them said that, by and large, the health care system is in a bad way. Some statistics show marked improvement, but many doctors see these as signs of isolated rather than overall progress. Money is going into reforming the health system. The most ambitious project is a four-year health programme, led by the World Bank, to which the UK's Department of International Development is contributing ᆪ55m. One of the main aims of the programme is to improve people's access to medicines.
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  Bangladesh Make vital medicinesavailable for poor people    B  a  r   b  a  r  a   K   l  a  s  s   /   P  a  n  o  s   P   i  c   t  u  r  e  s CUT THECOST  Bangladesh A nurse at Dhaka ShishuHospital prepares a prescription for a cheaplocally-made medicine Recent reports on the state ofBangladesh's hospitals are  just the tip ofthe iceberg Bangladeshi journalists seized on a ‘scoop’recently that seemed to sum up thecountry’s health care system “that has beenin a mess,” said one, “for longer than anyonecan remember”. The Sir Salimullah MedicalCollege and Mitford Hospital, which has apotential catchment of millions of peoplein the old part of Dhaka city, had beenoperating without 200 essential medicinesfor eight weeks. It had run out of money. The media spotlight shone on the degenerative state of Bangladesh’s healthcare. A dentist had performed an appendec-tomy. Doctors at the Dhaka Medical College were performing 15 caesarian sections a day with one set of instruments. Anotherhospital’s 36-bed post-operative ward was a veranda where used needles and bandagesclogged blood-filled drains. Clinics wereturning away dying people because they had no money. Inefficiencies; shortages of specialists; scarcity of money, drugs, andequipment… the stories went on.Oxfam interviewed patients, governmentofficials, doctors and nurses, hospital chiefs,and NGOs in Bangladesh and many of themsaid that, by and large, the health caresystem is in a bad way. Some statistics show marked improvement, but many doctors seethese as signs of isolated rather than overallprogress. Money is going into reforming thehealth system. The most ambitious project is a four-year health programme, led by the World Bank, to which the UK’s Departmentof International Development iscontributing £55m. One of the main aims of the programme is to improve people’saccess to medicines.However, more and more people are worried that any attempt to improve thecountry’s health system will be undermined. The problem, they say, is that in a few yearsBangladesh will be tied to a new global traderule that gives monopoly control of all new medicines to foreign cartels, at prices thatlocal people won’t be able to afford. Bangladesh is particularly vulnerable. The Northern pharmaceutical lobby is now testing whether their competitors’ patentlaws comply with the WTO rule (called TRIPs, or trade related intellectual property rights). The “testing” is being followed withthreats of legal action and trade sanctions.Bangladesh – which is dependant on cheap The already failing health care system in Bangladesh isset to take a pounding from which it may never recover     M  a   t   t   h  e  w    G  r  a   i  n  g  e  r  Bangladesh         > 3 Asif's grandmother sold her one possessionto get her dyinggrandson to hospital.But the life-saving drugshe needs are expensiveand in short supply medicines imported from India, a country that has the industrial power to compete with the big drug firms – may soon findthat this cheap supply of new drugs willeventually dry up. Bangladesh is caught between theimperatives of world trade on the one handand the health of its people on the other.  To prove it, local experts point to the way that the country’s drug policy has gradually moved in recent years, from one that had been heavily-regulated by the government to that of an unfettered free market.Existing drugs are already a struggle formillions of people to buy, they say, and now Bangladeshis are dying from new strains of disease that these drugs can’t cure.For six-year-old Asif Begum, it is literally a matter of life and death. Six-year-old AsifBegum needs life-saving drugs that his family will never be able to afford  Asif was born stunted and underweight –as are 65% of Bangladeshi babies – and withchronic kidney problems. “His legs wouldinflate and his eyes grow yellow,” says hisgrandmother, Hamina. Asif’s father, now unemployed, and his mother, who alsodoesn’t earn, couldn’t afford to keep buyingthe antibiotics Asif needed. They have twoother children to feed. At the beginning of December, Asif’skidneys failed again and his body beganpoisoning itself. Hamina sold her onepossession worth more than a few hundredtaka ($5-6)– a television set – and brought Asif by donkey, rickshaw, and on foot to theDhaka Shishu (Children’s) Hospital. “Wehave been able to save this boy for now but Idon’t know how long we can continue,” saysPaediatric Chief, Professor Naila ZamanKhan. The now bright-eyed, impish boy is“still in an extremely dangerous state”. “We have sold all our assets and we can just no longer afford the 220 taka ($4) for hisinjections,” cries Hamina. However, even if she had money, Hamina couldn’t buy Asif the help he needs because the germs in his body are now immune to all the medicinesthe hospital has to offer. “His kidneys willinflame, fluid will build up, his bloodpressure will rise and he will eventually     M  a   t   t   h  e  w    G  r  a   i  n  g  e  r  Bangladesh > 4 have renal failure. I’m just not sure about what to give him anymore. He has had allthe drugs available here,” Dr Zaman Khansays. “He needs new drugs.” Cases like Asif’sare becoming increasingly common.“We are finding more and moreresistance to existing drugs,” says Dr SamirSaha, Professor of Shishu’s Microbiology Department, whose work on drug-resistancehas been published in international medical journals. “Meningitis? According to ourresearch, resistance is going up. Tuber-culosis? Up! Pneumonia? Up! These are someof the biggest child killers in Bangladesh.”Dr Zaman Khan agrees: “We have recently lost four patients to multi-drug resistancedisease. Eventually there will be new drugs but they will be even more expensive thanthe antibiotics we use now, Cefrazidine fromGlaxo, for instance, at 450 taka ($8) a dose orCeftriazone from Roche, at 500 taka ($9).”“Very few people can even afford the drugs we have got,” continues Dr Zaman.“We ask patients about their economichistory and then we decide who can andcan’t afford drugs. But I would say 70% of the people we see cannot afford to buy medicines. Even the cheaper versions areoften beyond them.” Dr Khurshid Talukder of the Institute of Child and Mother Health says, “We just want the best possible answers to treat alldiseases. Simply, we must have the drugshere when they are available in developedcountries. And they have to be affordable for poorer people to buy.”People are often too poor to buy thecorrect drugs needed to cure an illness orcannot complete the full course of medicines, which in turn leads to moreresistance. “Is this the correct environmentfor Bangladesh to sign up to a globalagreement that gives monopoly control of new drugs to a handful of foreigncompanies?” asks Dr Chowdhury. “I think the people of Bangladesh could be very seriously affected. It is an alarming anddismal picture.” In five year's time,Bangladesh willbe manacled to an agreementwhich will cost thousands oflives Mohammed Shah Alam produces a folderfrom his desk entitled “TRIPS” in blue feltpen. Shah Alam heads the WTO Cell withinthe Ministry of Commerce, in charge of administering Bangladesh’s entry into thenew global order of common trade rules.“Was this agreement done for the benefitof multinational corporations?” he asks. “ Of course it was. If you ever read thenegotiating history it is very clear. There isno secret here, no hide-and-seek. No one  will deny it. This agreement is to protect theinterests of the multinational corporations. And a big chunk of these are of US srcin.”Bangladesh signed up to TRIPs in 1995and was given 11 years to change its patentand copyright laws to make them standard with all other members of the World TradeOrganisation. The agreement will bindcountries into granting commercial firms 20-year monopolies on their inventions –the most controversial being inventions of new medicines. The Geneva-based WorldIntellectual Property Office (WIPO) iscurrently “assisting” Bangladesh draft itsnew patent law, “but I’m not aware of any pressure being exerted on us,” Shah Alamsays. “We are just doing it under ourcontractual obligation.”Unlike countries such as India andDominican Republic, Bangladesh is not being pressured for various reasons. Firstly,it has five more years to comply with the TRIPs agreement and secondly, foreign firms – especially US firms – do not seeBangladesh as a competitive threat. Despitehaving 125 million people, the average wage,life expectancy and literacy rates are amongthe lowest in the world; Bangladesh is not acountry that promises vast profits. Nor is itspharmaceutical industry able to make theraw material for new drugs, much lessdiscover them. Bangladesh relies on beingable to buy cheaply from India – and India
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