Cheaper vaccines from India are forcing global giants to slash prices. GSK announced its rotavirus vaccines at $2.50 per dose — or $5 to fully immunise a child — in response to a current tender administered by UNICEF.The offer is a 67% reduction in the current lowest available public price.

Hindustan Times

This is good news for many reasons. Preventable diseases kill over a million people every year, and one of the biggest factors in getting vaccinated is cost. India’s healthcare spending was estimated at US$ 40 billion in 2008, going up to 300+ billion in 2023. Forty billion is less than $40 per person, so saving 7-8 dollars on vaccinations alone for every one of the 26 million children born every year is a huge deal.

Development costs of vaccines and drugs are high and success is often uncertain. Pharmaceutical companies have used this to justify government enforced monopolies and per dose prices that are sometimes a 1000 times higher than the incremental cost of production. While this makes for good profits, it means severe lack of access in India, many African countries, and many excess deaths that could have been prevented. For years, India had what was called a process patent, not a product patent, which meant that if you could make a drug with a slightly different process, it would not get patent protection any more. How did this help India?

  1. Affordable drugs – Indian companies could make and sell drugs at a fraction of the cost without paying for drug development.
  2. Pharmaceutical Industry – This enabled the industry to grow and mature.

Of course, this also meant that India was considered an outlaw, and Indian pharmaceutical industry came under great pressure from the WTO to tighten patent laws, which it did. At the time, the concern (rightly) was that tightening patent restrictions would harm India’s pharmaceutical industry and reduce access to drugs. Has this come to pass? In some ways, yes. But the Indian pharmaceutical industry has also matured, and with government help, has been able to do its own development, clinical trials and production (which it was always good at). The focus on tropical diseases like rotavirus also means that US, European Companies, which have since moved away to treating chronic conditions like high cholesterol, erectile dysfunction, etc., have much more competition in the tropical diseases area and cannot charge premium prices to poor people any more.

So dear Canada, while you are negotiating with Europe about “free trade”, and trying to give European companies much greater patent protection for their drugs, know that this will very surely raise costs in the short term. Two important questions:

  1. Will Canada’s drug companies benefit?
  2. Will Canada’s consumers benefit?

Um, let’s take a look at Canada’s top 10 in 2009:

 

Rank Leading Companies Country Market Share (%)
1 Pfizer US 13.4
2 Apotex Canada 7
3 AstraZeneca UK 6.6
9 Merck US 6
4 Johnson & Johnson US 5.3
6 Novopharm (Teva) Israel 4.2
7 Novartis Switzerland 4
5 GlaxoSmithKline UK 4
8 Abbott US 3.9
10 Roche Switzerland 3.1
Source: IMS Health

There is one Canadian company in the top 10, and four European companies. Our pharmaceutical industry is not well positioned to be independent, or work to reduce Canadian drug prices, especially if laws strengthening patent protections for European companies come into effect. This will serve to weaken Apotex, and Canada does not have a big independent pharmaceutical company network born out of years of “isolation” to take advantage of any competition, or competitive advantages. So, while patent “reform” seems to not have hurt Indian industry as much as feared, it sure will hurt Canadian consumers.

 

The bill approved Wednesday falls short of how it began: a total and sweeping ban on smoking in all public places. But the House's original bill left a wide loophole for bars, an exemption that worried restaurant owners who feared bars would steal late-night customers.

via House approves smoking ban for N.C. – Politics – News & Observer.

The bill (soon to become law) still contains the giant “private club” loophole I had mentioned earlier, so, 1.5 cheers. And strange exemption for cigar bars (where smoke is emitted), but not for hookah bars (where water filters quite a bit of the smoke).

Critically, as Laura Leslie pointed out, the law will allow local health officials to go above and beyond state law. So, a floor was established, not a ceiling, which is good. They were previously forbidden to enact any smoking bans. Now Chapel Hill/Carrboro can do what it has been wanting to do for years and finally kill smoking in all public places.

condom.jpg

A post I wrote quite a while back on circumcision and AIDS remains my most commented post ever. In it (if you’re too lazy to click) I said that while research indicating a reduction in HIV infection in circumcised men was promising, there were a couple of concerns. One, that this could be a distraction from the single most effective prevention measure (no, not abstinence!), condom use. And two, that in certain cultures, especially among Hindus, this would be an absolute no no because circumcision is identified with being Muslim.

Anyway, in a review article, the Cochrane Centre in South Africa summarizes results from a meta analysis of a number of trials indicating a 50% reduction in HIV incidence among circumcised males. At this point in time, it is clear that circumcision is effective in reducing HIV incidence among heterosexual males. Based on this, the institute encourages the widespread use of circumcision as an AIDS prevention strategy.

So, am I still circumspect? Absolutely. I am still concerned that this research will be misinterpreted in a way that discourages condom use. In fact, the authors note that circumcised men indulged in more risky behaviour. Also, the incidence of HIV in the women these men were sleeping with increased from 9.6% to 13.8%, a 40% uptick. This increase was not statistically significant. No arguing with that, though the study was stopped early once it was clear that the men were helped, never mind the women, or reaching statistical significance in their case.

Given that it is very unclear what the effects of circumcision are on anything other than circumcised penises, which are only one half of the equation (or less!), I don’t think it is responsible to call for widespread use of circumcision as a public health strategy for the prevention of HIV until its effects on the other parties are known. While people are aware of this issue, I don’t think the science or the cultural landscape promote the use of circumcision as a HIV prevention strategy until its proven that women are not at risk from increased HIV incidence either biologically from a yet unknown mechanism, or socially from increased risk taking.

Men have more power in most societies to demand and receive sex on their terms. So the male centric nature of this research, and the conclusions drawn are disturbing. How irresponsible is it to encourage a public health strategy that appears to increase risk taking behaviour among men when the effects on the women are yet unknown, with only a statistically “insignificant” 40% increase in HIV incidence among women being observed?

I am. for very good reason, still circumspect on circumcision.

Whisky flavoured condoms courtesy bruno  girin’s photostream used under a creative commons license. Now how’s that for a turn on, whisky!

(b.1) that a person operating or riding as a passenger on a cycle on a path or way designated under paragraph (b.3) must properly wear a bicycle safety helmet

British Columbia Helmet Law

I got my bike on Thursday and finally, the vile flu that laid me low for a week has decided to sink slowly back into a tuberculotic cough. Blogging should get back to normal speed and topics as I unpack, start biking, and can live life again without being racked by chills and bad dreams.

Figured I should get back on my bike ASAP, but I decided to first check if BC had any bicycle helmet laws, because we’re like that, we have a lot of what would be considered “paternalistic” laws south of the border. And, it does, and guess what, the project evaluating the law was performed by UNC’s Highway Safety Research Center, small world, ai!

Apropos nothing, here’s the US list of states and their various bicycle/motorbike laws. Note that only 20 states (and DC) require the use of helmets for motorcyclists, quite insane. Fall on your bare head at 50 miles an hour and you are dead, vegetable, or both. In contrast, All of Canada is under universal motorbike helmet laws. Of course, no U.S state has bicycle helmet laws that cover adults. In contrast, four Canadian provinces have mandatory bicycle helmet laws.

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