Written evidence submitted by the American
Pharmaceutical Group
The American Pharmaceutical Group (APG) welcomes
the continued and influential interest by the Committee in the
implementation of DFID's strategy on HIV/AIDS. This submission
sets out the APG's views on:
— monitoring and evaluation of DFID's Strategy;
— systems strengthening; and
— the impact of the commitment to universal
access to anti-retroviral treatment on the effectiveness of care
and treatment for women.
The Appendix has a short note about the APG,
which has focussed mainly on sub-Saharan Africa, where some 7
million people are estimated to need antiretroviral therapy.
MONITORING AND
EVALUATION OF
DFID'S STRATEGY
1. The strategy set out in 2005 was a commitment
to universal access to comprehensive HIV prevention, treatment,
care and support by 2010.
2. This strategy has been seen by many as
an aspiration rather than a realistic target. By end-2007 just
31% of those needing HIV treatment were receiving it (Source:
AVERT, Sept 2009), and some countries are re-defining what is
meant by universal access. A modified approach by the Government
is something that the Committee may wish to consider.
3. A key issue in providing medicines to
large numbers of people is whether the drugs prescribed are effective
and achieving the desired outcomes. Issues such as inadequate
supplies, irregular compliance and (often arising from these factors)
drug-resistance, are just some of the reasons why drugs may aggravate
rather than improve the conditions of sufferers.
4. The Committee touched on these matters
in its November 2008 Report when it referred to the lack of outcome
indicators in DFID's programme. In response, the Government stated
that it was not feasible, practical or desirable for the strategy
to set out specific budget allocations, targets and outcome indicators.
We understand the difficulties with so many countries involved,
but we would suggest that the use of sample surveys should be
considered. This would indicate whether there is a real problem
and its extent.
5. The Committee also referred to the Monitoring
and Evaluation Framework, which had not then been published. The
Government issued a document soon after, with a template of questions
for DFID country offices. Again, it would be helpful to have an
update from DFID on the progress of this work.
SYSTEMS STRENGTHENING
6. The APG strongly supports health systems
strengthening.
7. The research-based pharmaceutical industry's
ability to contribute to enhanced access to medicines in poorer
countries depends entirely on the environments in which it operates.
8. Self-evidently, the pharmaceutical industry
can best (and sometimes only) operate in the absence of civil
war and with politically stable and effective governments.
9. However the need for a proper infrastructure
goes deeper. The role of the pharmaceutical industry in the provision
of medicines depends upon:
— Quality-assured manufacturing.
— The proper collection and storage of
medicines on arrival.
— The reliability of governments, and the
absence of any corruption.
— Good transport distribution and regular
re-supply.
— Healthcare professionals to administer
the medicines and to monitor outcomes. Many see the inadequate
numbers of healthcare professionals as the single most important
obstacle to proper treatment.
10. To maximise the industry's current contribution
to improving access to medicines, the APG has given its support
to the UK Government in its commitments to:
— Build and strengthen healthcare capacity
and infrastructure, especially in Low Income Countries.
— Ensure appropriate incentives are put
in place to encourage the development of new medicines for neglected
diseases.
— Promote patient health by establishing
reliable intellectual property infrastructures in middle income
countries (the private sector and public research institutions
depend on such rights).
— Reinforce efforts to combat illicit diversion
and counterfeit drugs in both humanitarian and commercial markets.
11. We understand the point made by others
to the Committee that the tangible effect of health system strengthening
on combating HIV/AIDS is difficult to judge, but this should not
be a reason for failing to press ahead with this policy. The Committee
may wish to consider asking for more evidence from the Government
on how health system strengthening is working out in practice.
12. We share the concern in the Committee's
Report that HIV/AIDS specific funding can distort priorities and
undermine systems strengthening. In some countries, wider health
needs are being neglected in order to give priority to HIV/AIDS,
although this is not seen in the countries as justified by the
scale of this disease compared to others. The Government response
to the Committee's Report showed that this problem "will
be worked out in detail over the coming months"; the Committee
may wish to request an update.
THE IMPACT
OF THE
COMMITMENT TO
UNIVERSAL ACCESS
TO ANTI-RETROVIRAL
TREATMENT ON
THE EFFECTIVENESS
OF CARE
AND TREATMENT
FOR WOMEN
13. The Committee estimated in its report
that some 1.8 million children in sub-Saharan Africa were infected
with HIV/AIDS and stated that 90% of paediatric HIV is due to
Mother to Child Transmission (MTCT).
14. Mother to Child Transmission (MTCT)
occurs when an HIV positive woman passes the virus to her baby.
This can occur during pregnancy, labour and delivery, and after
birth through breastfeeding.
15. We note that in most high-income countries,
new HIV infections among children has been virtually eliminated
by wide implementation of an evidence-based package of interventions.
This is built around the use of antiretroviral drugs, elective
caesarean section and the avoidance of breastfeeding.
16. We understand the reluctance of governments
and agencies to become involved in discouraging breast-feeding
in the developing world by HIV-positive mothers, because this
goes against cultural traditions. This widespread reluctance to
speak out means that one important way of tackling paediatric
HIV without the use of drugs is being forfeited. In addition,
some mothers switch between breastfeeding and other fluids of
foods in the early months, which produces a higher transmission
risk. We would welcome the Committee looking into this issue more
closely and making recommendations.
17. Drugs for adults can also secure healthier
children. Antiretroviral (ARV) therapy for the mother can reduce
the risk of transmission substantially. Where inadequate capacity
precludes long-term ARV therapy, single-dose therapy for the mother,
combined with short-term treatment for the infant can be highly
beneficial. However there are different challenges in treating
children as the typical antibody diagnosis cannot be used for
children under 18 months. A diagnosis for the virus itself is
difficult and expensive paediatric antiretroviral therapy requires
dosing by weight. Few healthcare workers in developing countries
are trained to provide paediatric ARV therapy many paediatric
formulations are still in syrup form, which require refrigeration
and tend to have a bitter taste.
We would welcome the Committee considering further
drug treatment to reduce with paediatric HIV.
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