People Living with HIV and Marginalized Communities must be at the centre of all Universal Health Coverage (UHC) related policies, programmes and Discussions

Bangkok, 12 December 2019 – On the International day on Universal Health Coverage (UHC), Asia Pacific Network of People Living with HIV (APN+) calls on all governments in the Asia pacific region to make full use of all flexibilities provided in the WTO TRIPS Agreement to increase access to affordable medicines. APN+ also urge governments to reform patent laws to include these flexibilities and reject TRIPS-Plus provisions in Free Trade Agreements that will delay in accessing cheaper medicines. 

“UHC commitments require our governments to ensure access to essential medicines,” said Shiba Phurailatpam, Regional Coordinator of APN+. “Many of the medicines on the WHO’s Essential Medicines List for HIV, TB and Hepatitis C are patented in many of the countries in the Asia-Pacific region. Using flexibilities in the TRIPS agreement to ensure access to safe, effective and affordable generic medicines will contribute immensely in achieving UHC and funds being used for expensive patented medicines can be used to improve other health care related service. The use of TRIPS flexibilities has been clearly recognized in the Political Declaration signed by all our governments at the UN High Level Meeting on UHC in September 2019,” he added. 

Today, the cost of patented medicines takes up a large chunk of the healthcare budget in many countries and guarantees the profit of big multi national pharmaceutical companies at the cost of lives of millions of people in the developing countries. The pricing, patenting and licensing policies of multi national pharmaceutical companies are resulting in fractured access in Asia-Pacific countries. 

“For the Asia-Pacific region, this is of utmost importance as we contribute large chunk of HIV, HCV, TB epidemic to the global burden, and middle income countries in our region are routinely excluded from price discounts and licensing deals,” said Edward Low of Positive Malaysian Treatment Access and Advocacy Group (MTAAG+). “In Malaysia for instance we have used compulsory licensing to ensure access to affordable Sofosbuvir (HCV drug) in 2017 which has been critical to the rollout of HCV treatment in our hospitals and to help in the research being conducted by DNDI on a new treatment for HCV. The effectiveness of this approach has saved many lives and we call on our government to extend the compulsory license and continue using TRIPS flexibilities to improve our health care programmes,” he said. 

“Countries in the Asia-Pacific region have been global leaders in the use of TRIPS flexibilities,” added Loon Gangte of the Delhi Network of Positive People (DNP+). “In India we have successfully challenged many patent applications on essential medicines ensuring generic availability of these medicines at lower prices. We call on all countries 

in the region to adopt stricter patent criteria to prevent ever-greening patents on medicines and for the use of compulsory licensing to improve availability and affordability. Improved availability and far lower prices of medicines can be achieved through proper, unrestricted generic competition leading to a sustainable price for all kinds of therapy,” he said. 

“Thailand has been a tremendous example for the region in using TRIPS flexibilities to support its Universal Coverage (UC) programme,” said Chalermsak Kittitrakul of AIDS Access Foundation. “Our government issued compulsory licenses on medicines for treating HIV, heart disease and cancer between 2006 and 2008 making savings of millions of dollars for the UC programme that were then used to introduce additional programmes and treatments in our healthcare programme. The use of TRIPS flexibilities is essential to the sustainability of any UHC programme,” he said. 

However, there is also great concern that many countries in the region are negotiating Free Trade Agreements (FTA) that will undermine the ability of the governments in the region to use TRIPS flexibilities. “In Vietnam the FTA with the European Union (EU) has introduced TRIPS-plus measures and we are extremely concerned that these will undermine access to affordable medicines in our country,” said Do Dang Dong of Vietnam Network of People Living with HIV (VNP+). “The Regional Comprehensive Economic Partnership Agreement (RCEP) also has TRIPS-plus demands made by Japan and South Korea. We call on the ASEAN governments to release the text of the RCEP negotiations and reject all TRIPS-plus provisions in the text,” he added. 

“As the regional network of People Living with HIV working for and by people who are most marginalized we urge our governments to put people living with HIV, people with TB, people with hepatitis C and marginalized groups like people who use drugs, sex workers and the LGBTQI communities at the centre of all UHC related policies, programmes and discussions,” added Shiba Phurailatpam of APN+. “The experience with the successful scale up of HIV prevention and treatment programmes has demonstrated that people living with HIV and marginalized communities have the most important expertise in the design and rollout of health programmes and in the use of TRIPS flexibilities to ensure access to medicines for all. Our participation and involvement will contribute in bringing our region one step closer to achieving UHC for all,” he said. 

As people living with HIV, UHC is of particular concern for our lives and health. The Asia Pacific Network of People living with HIV/AIDS (APN+) calls on Governments to: 

  1. Use to the full extent flexibilities provided in the WTO TRIPS Agreement to increase access to medicines, diagnostics and vaccines.
  2. Reject all TRIPS-plus provisions in trade agreement negotiations and ensure that other provisions related to investment, government procurement, competition etc. do not undermine our access to health services and medicines
  3. Ensure that the enforcement of intellectual property does not create barriers to legitimate trade
  4. Ensure people living with HIV and all marginalized population are involved in all UHC related policies, programmes and discussions. 

APN+ also calls on developed countries to immediately cease putting pressure on developing countries when they use TRIPS flexibilities to improve access to medicines. 

***************** Contact:Mr. Shiba Phurailatpam,shiba@apnplus.org, +66 8660 00738 


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Universal Health Coverage Day 2019: Who’s being left behind and why?

Ending AIDS by 2030healthy lives and well-being for all, and the ambitious treatment target of 90-90-90, just three of the key commitments made to ensure that everyone has access to HIV treatment and other essential medicines.

Yet despite global and national commitments, along with scientific advancements, millions of people are being left behind. A lack of access is devastating, both on an individual and societal and moral basis. When the drug to save someone’s life exists, no-one should be dying.

The majority of people living with HIV reside in middle-income countries but this is also often where the treatment gap is the largest.

So why? Why are drugs not reaching everyone who needs them?
What stops universal health coverage being achieved?

Our partners, from middle-income countries around the world, share their perspectives and frustrations about what the barriers are; the consequences; and what needs to change:

“We appreciate the commitment made by governments to Universal Health Coverage but achieving it will be a distant dream as long as the cost of medicines remains unaffordable,” says Shiba Phurailatpam, Regional Coordinator of the Asia Pacific Network of People living with HIV (APN+).

“Health care programs in our region are already struggling with the high cost of patented medicines. Whether we achieve UHC now, soon, or after 100 years will depend on how soon our governments bring in affordable generic medicines,” says Phurailatpam.

Achieve UHC? Tackle price and prejudice

Phurailatpam believes a dual-response is required, one which tackles both price and prejudice.

“Though the commitment to UHC exists in theory, marginalized communities in our region continue to struggle to access health care programs. Bringing UHC one step closer will only happen when people who are highly marginalized are put at the centre of all UHC related policies, programs and discussions.”

“We have a lot to learn from the HIV epidemic. The same drugs which used to be more than 10,000 US dollars per patient per year are now less than $100 because of generic production and competition. If we are serious about achieving UHC then we have got to sort out the issue of patented drugs and their high cost.”

Alma de León, ITPC’s Regional Director for Latin America and the Caribbean, agrees: “If we want to achieve universal coverage, drug patents must be eliminated,” de León says. She takes a hard line: “No more patent registration on life-saving drugs.”

De Leon also believes there is not enough take up of TRIPS flexibilities in order to prevent or challenge unmerited monopolies or other intellectual property barriers, something she is working on with civil society organizations in the region, to build on and change the medicine landscape.

Mykyta Trofymenko, Intellectual Property Counsel at 100% LIFE affirms that unmerited patents is also what’s stretching the health budget to breaking point in Ukraine. 

“Evergreening patents seriously obstruct access to medicines in Ukraine. According to 2017 data, one medicine monopolized by two secondary (evergreening) patents takes up a staggering 40% of the HIV budget and more than 10% of the whole state budget for procuring medicine.”

‘Intellectual property’ can at first seem a daunting topic to people without a technical or legal background, but Aissam Hajji, ITPC-MENA’s Advocacy Officer, explains why it’s essential for all health advocates to engage with this issue: “Experience has shown that action taken by civil society has a direct impact on stimulating competition,” he says. “It’s really important for civil society to understand the impact of monopolies on medicines and the important role they can play. Medicines no longer benefit from a status of ‘public goods’ [as Alma would like to see happen], instead they are mere products to profit from. With an absence of competition, these profits are unrestricted.”

It is clear from our work on access to medicines, that the ambitious health targets set cannot be achieved unless we tackle the patent problem. 

The commitments to UHC are being undermined by intellectual property barriers, especially in middle-income countries which are frequently excluded from pricing deals and licenses due to their income classification. However, this can change. Partners of the Make Medicines Affordable campaign are removing barriers and setting precedents to create long-term change. 

Read more at : http://makemedicinesaffordable.org/en/universal-health-coverage-day-2019-whos-being-left-behind-and-why/