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  1. 1
    Peer Reviewed

    Is G8 putting profits before the world’s poorest children?

    Light DW

    Lancet. 2007 Jul 28; 370(9584):297-298.

    Several affluent countries have announced donations totalling US$1.5 billion to buy new vaccines that will help eradicate pneumococcal diseases in the world's poorest children. Donations from the UK, Italy, Canada, Russia, and Norway launch what many hope will be a new era to ease the burdens of disease and foster economic growth. Yet only a quarter of the money will be spent on covering the costs of vaccines-three-quarters will go towards extra profits for vaccines that are already profitable. The Advanced Market Commitment (AMC), to which the G8 leaders and the Bill & Melinda Gates Foundation have committed, is the difficulty. An AMC is a heavily promoted but untried idea for inducing major drug companies to invest in research to discover vaccines for neglected diseases by promising to match the revenues that companies earn from developing a product for affluent markets. By committing to buy a large volume of vaccine at a high price, an AMC creates a whole market in one stroke. However, no moneyis spent until a good product is fully developed. (excerpt)
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  2. 2
    Peer Reviewed

    Multinational corporations and health care in the United States and Latin America: strategies, actions, and effects. [Corporaciones multinacionales y atención de la salud en Estados Unidos y América Latina: estrategias, acciones y efectos]

    Jasso-Aguilar R; Waitzkin H; Landwehr A

    Journal of Health and Social Behavior. 2004; 45 Suppl:136-157.

    In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American countries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institution and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector. (author's)
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  3. 3

    Enlisting business support for Africa's Millennium Goals.

    Africa Renewal. 2005 Oct; 19(3):21.

    Africa will not be able to achieve the Millennium Development Goals (MDGs) unless it is able to mobilize all stakeholders, including the private sector, concluded more than 200 participants at a conference in London on 4 July. Coming on the eve of the Group of Eight summit in Scotland and on the same day as the opening of the African Union summit in Libya, the event formally launched a project of the New Partnership for Africa's Development (NEPAD), "Bending the Arc," which aims to encourage businesses in Africa to advance the MDGs. The meeting was organized by the NEPAD Secretariat, the African Business Roundtable (ABR) and the United Nations. It also received sponsorship from Coca-Cola, Visa International, Nestlé and other corporations. Making Africa more attractive to business is crucial if "we are to end Africa's dependency on aid and ensure the self-sustaining growth that is needed to achieve the Millennium Development Goals in Africa," said Mr. Bamanga Tukur, president of the ABR and chair of the NEPAD Business Group. Mr. Mark Malloch Brown, chief of staff to the UN Secretary-General, lauded the project's aim, since achieving the MDGs "is beyond the reach of government alone." But he also cautioned against "pure private sector solutions" that may push the costs of water or information technologies out of reach of the poor. Africa needs "creative partnerships, where public guarantees, strong public regulations and, possibly, public start-up funds create the incentives and regulatory frameworks to allow the private sector to do its bit, and start to connect people to these vital infrastructures." (excerpt)
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  4. 4

    Corporate social responsibility: opportunities for reproductive health.

    Deloitte Touche Tohmatsu. Commercial Market Strategies

    Washington, D.C., Deloitte Touche Tohmatsu, Commercial Market Strategies, 2004 May. [5], 25 p. (Working Paper; USAID Contract No. HRN-C-00-98-00039-00)

    Although health-related CSR programs are fairly common, reproductive health (RH) and family planning (FP) initiatives are underrepresented in the global portfolio of CSR programs. These programs might include maternal and child health, STI/HIV/AIDS prevention and education, and provision of contraceptives. To help facilitate the inclusion of RH initiatives in CSR programs, this paper addresses the following questions: What are the motivations behind CSR programs, and what are current CSR trends? What characterizes different CSR models, and how does each model lend itself to the inclusion of family planning and reproductive health services? What opportunities exist for partnerships focused on reproductive health? To answer these questions, CMS conducted in-depth interviews with more than 50 business leaders whose companies are noted for their CSR programs. CMS’s research was designed to unearth the depth and detail of CSR processes from the corporate perspective, seeking to understand why corporations become involved in CSR, as well as how they do it, so that this knowledge could be applied to potential RH initiatives. CMS’s research clearly shows that corporate culture and values drive CSR initiatives. There are usually both internal and external motivations for these programs. Most companies do not view their social and financial responsibilities as mutually exclusive; instead, they link CSR to their core business strategies. CMS also found that a company’s stakeholders play an influential role in selecting and designing its CSR program. Companies are increasingly interested in forming partnerships with the public sector or NGOs, in order to bring technical expertise or other resources to CSR programs. (excerpt)
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  5. 5
    Peer Reviewed

    The role of civil society in protecting public health over commercial interests: lessons from Thailand.

    Ford N; Wilson D; Bunjumnong O; von Schoen Angerer T

    Lancet. 2004 Feb 14; 363(9408):560-563.

    In October, 2002, two Thai people with HIV-1 won an important legal case to increase access to medicines. In its judgment in the didanosine patent case against Bristol-Myers Squibb, the Thai Central Intellectual Property and International Trade Court ruled that, because pharmaceutical patents can lead to high prices and limit access to medicines, patients are injured by them and can challenge their legality. This ruling had great international implications for health and human rights, confirming that patients—whose health and lives can depend on being able to afford a medicine—can be considered as damaged parties and therefore have legal standing to sue. The complexities of pharmaceutical intellectual property law are most poorly understood by those most affected by their consequences—the patients who need the drugs. The Thai court case was the outcome of a learning process and years of networking between different civil society actors who joined forces to protect and promote the right of access to treatment. Our Viewpoint, based on key interviews and published reviews, summarises the efforts of civil society in Thailand to achieve a fair balance between international trade and public health. These efforts have focused on didanosine, an essential antiretroviral drug that in Thailand has become symbolic of how multinational companies and governments of industrialised countries protect their own interests at the expense of access to essential medicines for the poor. (author's)
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  6. 6

    Romania declares victory in fight against AIDS.

    McNeil DG Jr

    New York Times. 2004 Feb 11; [6] p..

    After a long, clumsy war against AIDS, Romania has finally declared itself the winner. "Yes — at this moment, we have a victory," said Dr. Adrian Streinu-Cercel, president of the National AIDS Committee. "Everyone who needs triple therapy is getting triple therapy." The country, which became infamous in 1990 for the squalid orphanages and babies dying of AIDS that marked the final years of Nicolae Ceausescu's dictatorship, is now being cited as a model of how governments, drug companies and international agencies can bring AIDS under control by ensuring that the necessary three-drug anti-retroviral cocktails are available and paid for. (excerpt)
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  7. 7

    [AIDS and poverty: breaking the vicious circle] Sida et pauvrete: rompre le cercle vicieux.

    Tesson-Millet MC

    Equilibres et Populations. 2001 May; (68):3.

    Poverty facilitates the development of disease, but at the same time, by attacking developing countries’ active populations, disease frustrates countries’ capacity to organize and produce. AIDS’ devastating effects upon poor countries threatens the development process. On the heels of the UN Conference on Underdeveloped Countries, UNFPA and IPPF dedicated a day to explore the links between AIDS and poverty. Following the notion that AIDS should lie at the core of all development aid policies, a new global fund against AIDS and infectious diseases has been developed. It will be administered by an independent council comprised of representatives from donor and recipient countries, the UN, nongovernmental organizations, and the private sector. The fund’s resources will be used to implement recipient country strategies, based upon needs in the field and already existing capacities. The private sector and the pharmaceutical industry have very important, yet still undefined roles. Efforts must certainly be made to enable developing countries to develop or build, together with their healthcare system infrastructure, pharmaceutical supply policies together with the World Health Organization, major industry groups, and international partners. Prior to mobilizing fund resources, agreements will have to be worked out with the pharmaceutical industry, while diversifying product demand concerns and implementing a differential pricing system.
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  8. 8

    More corporations join global AIDS fight.

    Sternberg S

    USA Today. 2001 Jun 25; [1] p..

    Several major corporations including Viacom, AOL Time Warner and Unilever, pledged to take a leadership role, develop workplace HIV policies and lend business expertise to the fight against AIDS. Other companies like Coca-Cola, DaimlerChrysler, and Credit Suisse have donated to the Global AIDS Fund of the UN and provided aid in the shipment of condoms to developing countries. Other businesses may play their own role in the fight against AIDS through supply of expertise and other corporate resources. However, few big companies, with the exception of pharmaceutical companies, have pitched in against AIDS. The UN fund has US$528 million in pledges which falls short of the US$9 billion needed annually. Bill Roedy, chairman of the Global Business Council on HIV and AIDS and president of Music Television Networks International has asked US ambassador to the UN, Richard Holbrooke to recruit more corporate partners to join the AIDS fight.
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  9. 9

    [L'Oreal aids women in science in the countries of the South] L'Oreal aide la science au feminin dans les pays du Sud.

    de Sainte Lorette C

    EQUILIBRES ET POPULATIONS. 2001 Mar; (66):4.

    The L’Oreal Award for Women in Science rewards 5 scientists annually with UNESCO support. As such, L’Oreal, a cosmetics manufacturer, is making an effort to support women’s role in research in both developed and developing countries. Professor Adeyinda Gladys Falusi, a 2001 award recipient, describes the difficult conditions in which she has studied, for 25 years, the molecular genetics of often seen hereditary blood diseases in Nigeria, such as falci-form anemia. In Africa, and especially Nigeria, a lack of resources frustrates research. When resources are available, the equipment is old and poorly maintained. Energy and transport problems also exist, including frequent power outages. It is common for lights and computers to lose power in the middle of an experiment. Regarding information sources, research centers and universities lack funding to subscribe to scientific journals. Although many of her colleagues have gone to work in countries with better research conditions, Professor Falusi prefers to remain in Nigeria with hopes of having a more significant impact upon her society. She hopes her research will directly and significantly help populations. Professor Falusi visits schools to help prevent the diseases she researches, such as anemia, affecting 3 million people in Nigeria and associated with multiple complications. She also researches malaria. Falusi and her colleagues lack the resources and support they need to properly teach the population about its health and provide access to health services. They depend upon international aid, which should be more forthcoming.
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  10. 10

    Bangladesh: the youngest workers.

    Tranberg P

    In: All of us. Births and a better life: population, development and environment in a globalized world. Selections from the pages of the Earth Times, edited by Jack Freeman and Pranay Gupte. New York, New York, Earth Times Books, 1999. 121-3.

    This paper discusses the impact of the International Program on the Elimination of Child Labor (IPEC) on child labor in Dhaka, Bangladesh. A program of the International Labor Organization (ILO), IPEC works to eliminate child labor by providing child laborers access to a school financed by the ILO and UNICEF. Three times a week for a period of three years, a team of two ILO inspectors, a representative of the government labor department, and a representative from the Bangladesh Garment Manufacturers and Export Association conducted unannounced visits in 2100 exporting garment factories in Bangladesh to check for child laborers. In 1995 IPEC found children working in 43% of Dhaka's garment factories, while today they are found in less than 5%. In 1994 the US Senate approved the Harkin Law forbidding the importation of goods made by children. Within a day the garment factories in Bangladesh fired approximately 50,000 child workers. The children, whose parents could not afford to educate them, went to work in other industries, often more dangerous, such as the machine industry or prostitution. Since its inception in 1995, the program was able to send more than 10,000 children to school. Each child receives a small stipend of about US$8 a month to partially compensate for lost wages. Still there are an estimated 6.3 million children working in Bangladesh, and 9 out of 10 work in the informal sector: collecting garbage, crushing stones, working as prostitutes, or in agriculture.
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  11. 11

    Commercial sector partnerships for malaria control [editorial]

    Macdonald MB; McGuire DJ

    Tropical Medicine and International Health. 1999 May; 4(5):319-21.

    The World Health Organization-led "Roll-Back Malaria" (RBM) initiative opens the possibility for malaria control programs to explore new and broader strategies against malaria. Through the RBM, there is closer collaboration with UNICEF, the World Bank, the UN Development Program, and other public organizations working in health, economic, and community development. The commercial sector can also be used by national malaria programs to broaden the scope and sustainability of preventative and curative services. This paper outlines a model for engaging the commercial sector in launching a nationwide insecticide-treated materials (ITM) initiative in Ghana, and how the model can be used with the pharmaceutical sector to promote a national malaria drug policy. The model described has been successfully used to promote contraceptives in Morocco, reproductive health products and services in Indonesia, hand washing with soap in 5 Latin American countries, and oral rehydration solution in Bolivia.
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  12. 12

    HIV vaccine development: would more (public) money bring quicker results?

    Winsbury R

    AIDS ANALYSIS AFRICA. 1999 Jun-Jul; 10(1):11-3.

    Globally, $200-250 million/year are devoted to HIV vaccine research. Most of those funds pay for basic research rather than product development. Moreover, most of the funds are aimed at the HIV strain commonly found in the US and Europe, and not at the strains common to Africa and other developing countries. While US President Bill Clinton set in 1997 a 10-year target for the development of an HIV vaccine, that target date is looking increasingly unlikely. International vaccine and pharmaceutical companies typically drive vaccine research and development. However, concern over the ultimate profitability of developing and marketing an HIV vaccine, and the fear of major litigation should an eventual vaccine go awry have caused such firms to shy away from investing large amounts of money into HIV vaccine development. These companies somehow have to be attracted back into the field. A World Bank special task force is slated to present its report by mid-1999 on possible funding mechanisms to promote HIV vaccine development. It remains to be resolved whether public funds could and should be used, perhaps through a pooled international vaccine development fund. 2 new International AIDS Vaccine Initiative projects are described.
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  13. 13

    MMV: New Medicines for Malaria Venture.

    TDR NEWS. 1999 Feb; (58):2, 4.

    New Medicines for Malaria Venture (MMV) is a public/private, nonprofit initiative to develop 1 new drug against malaria every 5 years. It will operate under the umbrella of Roll Back Malaria, a new project launched by World Health Organization (WHO) Director General, Dr. Gro Harlem Brundtland. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) helped establish the MMV through its product R&D unit, and there has been considerable industrial input. The World Bank and the Global Forum for Health Research are other international agencies involved in the initiative, while several philanthropic organizations such as the Rockefeller Foundation and the Wellcome Trust have also played major roles. MMV will create a fund and operate by financing and resourcing a limited number of projects in a manner compatible with industrial procedures. The fund is mainly supported financially by the public sector, while a funding commitment of US$15 million/year rising to US$30 million a year is being sought. Companies are providing mainly in-kind support.
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  14. 14

    Drug companies, UNAIDS make drugs available.

    AIDS ALERT. 1998 Jan; 13(1):3.

    Although 1.6 million people in Uganda are infected with HIV, the country has only 6 health care centers equipped to deliver antiretroviral treatment. Uganda, Chile, Vietnam, and Cote d'Ivoire will participate in a pilot program which will help provide the health infrastructure and affordable drugs to ensure that combination therapies are used and used appropriately. Thus far, Glaxo Wellcome, Hoffmann-La Roche, and Virco NV have agreed to participate in the project. The 4 countries have agreed to create a national HIV/AIDS drug advisory board and a nonprofit company to serve as a clearinghouse for ordered drugs. The board will establish a coordinated national drug policy for the use of HIV drug therapy, including criteria for choosing the most appropriate drugs and who will receive them. The program should initially enable up to 3000 Ugandans to receive therapy, still far from meeting the total need for such therapy. The pharmaceutical companies will sell the drugs at subsidized prices, while local health ministries will create new sources of funding and UNAIDS will provide a $1 million grant. The pilot programs will be evaluated with regard to the improvements realized in overall health care delivery, the number of people treated, their impact upon the demand for emergency care, and rates of morbidity and mortality.
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  15. 15

    Reflections on the role of business in health promotion and the challenge of partnership.

    Davies R


    Engaging private sector business in partnerships to promote health is one of the most important challenges for all who are concerned with improving health in the 21st century. The Jakarta Declaration is a major step toward realizing that goal. The Prince of Wales Business Leaders Forum is an international organization formed by 50 multinational companies from Europe, America, the Middle East, and Asia to promote the active involvement of businesses in country and community development. Member companies include many of the leading investors in emerging markets, employ approximately 25 million people directly and indirectly through their supply chains, and operate in every country and territory in the world. The Forum works through national and international partnerships in more than 30 countries around the world, and also brings together the major global hotel chains with 10% of the world's hotel rooms in the International Hotels Environment Initiative global alliance. This paper discusses why concern should be had over private sector involvement, why businesses want to be involved, what business can bring to the partnership, and the conditions for effective partnerships.
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  16. 16

    Glaxo's AZT announcement welcomed, but detail is yet to follow. mother-to-child transmission.

    Worthington H

    AIDS ANALYSIS AFRICA. 1998 Apr; 8(2):2.

    Following recently completed trials of AZT in Thailand among pregnant women which showed that a short course of AZT can significantly reduce the mother-to-child transmission of HIV, Glaxo Wellcome recently announced that it will supply the antiretroviral drug AZT at a preferential price for pregnant women infected with HIV in developing countries. Since the size of the HIV/AIDS epidemic and the quantity of AZT needed cannot be predicted, Glaxo Wellcome has stated that it is unfeasible to implement a mass donation program of the drug. The preferential public sector pricing was instead arrived at after 3 years of discussions and collaboration with UNAIDS, governments, and nongovernmental organizations (NGOs). Glaxo and UNAIDS both agree that the pricing will be a price reduction and not a subsidy, but additional details remain unclear. Eligible countries will be defined according to World Health Organization guidelines, with UNICEF likely to play a key role in the AZT's distribution.
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  17. 17

    A fresh injection of interest for vaccines.

    AIDS ANALYSIS AFRICA. 1998 Feb; 8(1):3, 6.

    In recent years, HIV/AIDS funding has gone largely to prevention measures, drug therapy for people who are already infected with HIV, and basic related science. HIV/AIDS vaccine development has been of only low priority, and almost no effort is targeted toward vaccines appropriate for use in developing countries. A vaccine, however, is theoretically the only way to end the epidemic. An attempt was made at the Abidjan AIDS Conference to reinvigorate the AIDS vaccine research program, but because the potential market for such a vaccine is in the poorer developing countries, it will be difficult to convince the pharmaceutical industry to renew investment in vaccine research. Pharmaceutical companies see no profit potential in vaccine development and marketing. The World Bank's suggestion on how to encourage the pharmaceutical industry to invest again in vaccine research is discussed. The gp120(E) vaccine is undergoing an early-stage trial in Thailand, and another trial is scheduled for later in 1998 in Uganda. However, none of the 25 possible vaccine types which have been developed in the laboratory and tested for safety on humans has gone into efficacy trials. Experts calculate that even if more intensive work were to begin now, a vaccine could not become generally available before 2005, due to the 8-year product evaluation cycle. Whether a vaccine based upon one HIV subtype will be effective against other subtypes, and the need for governments and donors to invest in the development of a vaccine are discussed.
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  18. 18

    Female condom importance acknowledged in HIV prevention.

    AIDS WEEKLY PLUS. 1996 Dec 9; 7-8.

    The Female Health Co. (FHC), London, United Kingdom, has signed a three-year agreement with the Joint United Nations Program on HIV/AIDS (UNAIDS) to provide a global public sector price for the female condom to 193 affiliated countries. An adjunct education and social marketing program, supported by UNAIDS, will be launched. High rates of acceptance have been shown previously when the female condom has been introduced with an effective educational approach. Negotiations between FHC and UNAIDS began in September 1996; 80 of 193 countries, upon inquiry, have already identified a requirement for over 7 million female condoms in 1997. UNAIDS estimates that nearly 50% of new human immunodeficiency virus (HIV) infections are in women; the female condom is the only woman-controlled product providing protection against sexually transmitted diseases (STDs), including HIV and acquired immunodeficiency syndrome (AIDS). Studies have indicated that the number of unprotected sex acts decreases when the female condom is available. Dr. Peter Piot (UNAIDS) states that the female condom is important in those cultures and situations where women have limited control over sexual decisions. Dr. Mary Ann Leeper (FHC) states that the company is committed to making the female condom available in developing countries.
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  19. 19

    Secondary research review for Venezuela.

    Cisek C

    [Unpublished] 1990 Oct. iii, 29 p.

    This summary provides key background information for the design and development of a contraceptive social marketing (CSM) project in Venezuela. The country situation is described by providing a map; graphs illustrating population growth, age structure, total fertility rate, and infant mortality rate; the demographic characteristics of the population; the social situation; and leading economic indicators and factors. The population/family planning (FP) environment is then described in terms of the national population policy and goals, the legal and regulatory environment, the media, other international donor agencies and nongovernmental organizations active in the field of population, and the commercial contraceptive market. Available data are then presented on contraceptive usage by methods, the most available methods in the country, discontinuation, abortion, maternal age, needs, desired family size, and contraceptive awareness. The summary lists the following implications for project design from the point of view of the consumer: 1) the most recent data (1977) indicated an unmet need for FP, but more recent data must be obtained to access current demand; 2) more data are needed on the benefits and barriers to oral contraceptive and condom use; 3) data are needed on current use rates, sources of supply, and knowledge of correct use of oral contraceptives (OCs); 4) a significant target population exists for OCs and condoms; 5) marketing strategies should influence women to use modern contraceptives instead of abortion to limit family size. Project implications resulting from the market situation are that 1) despite the fact that commercial distribution networks within urban centers (83% of the population) are well-developed, contraceptives are not widely available at the retail level and are expensive; 2) obstacles to the commercial contraceptive industry exist at the importer, retailer, and consumer levels; and 3) most homes have radios and televisions, but all advertising must be government-approved, and the government has never approved contraceptive advertising. Appended to this document are charts showing 1) fertility rates by region, 2) urban and rural population growth, 3) an analysis of the urban population, 4) the incidence of abortion among current contraceptive users, 5) an analysis of the female population of reproductive age, 6) the age breakdown of women who desire no more children, 7) the contraceptive method used by women who desire no more children, and 8) desired family size.
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  20. 20

    Should developing countries be testing grounds for vaccines rejected by the USA?

    AIDS ANALYSIS AFRICA. 1994 Jul-Aug; 4(4):2.

    The World Health Organization (WHO) plans to start large scale trials of human immunodeficiency virus (HIV) vaccines in developing countries. It has been placed in a difficult position by the decision of the National Institutes of Health to postpone such trials in the US, a poor decision according to Genetech, owner of 1 of the vaccines. WHO will, however, carry out the trials in Brazil and Thailand in 1995. Some will ask if the people of developing countries should be used as guinea pigs; others will point to the urgency of the pandemic in areas of the Third World. Testing is cheaper and fewer ethical questions are asked in developing countries. But the vaccines, once tested, will be too expensive for these same countries to afford. A working vaccine for the US or western Europe provide a profit incentive for companies like Genetech; the same vaccines for developing countries do not. The decision by the National Institute of Allergy and Infectious Disease (NIAID, a component of NIH) to discontinue phase III trials changes the momentum of research on HIV vaccines by private companies. Genetech fears a repeat of its hepatitis B vaccine, which, at $1, is still too expensive for countries such as Uganda or Kenya. Vaccines developed to date have involved strains dominant in North America and Europe. These strains also occur in Latin America, the Caribbean, and some parts of Thailand; however, there have been no clinical trials of strains prevalent to Africa. Vaccines for Africa are unappealing to drug companies in terms of profit.
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  21. 21

    Local production of oral rehydration salts.

    Tomaro J

    [Unpublished] 1990 May. [2], 12 p. (PRITECH Field Implementation Aid)

    Control of Diarrheal Disease (CDD) programs need to move more and more toward self-sufficiency. Thus they want a reliable supply of low cost, locally produced oral rehydration salts (ORS). 2 obstacles hinder the process: low demand and an inadequately developed pharmaceutical industry. It takes about US$200,000 to begin ORS production. In 1987, pharmaceutical plants in developing countries made 75% of all ORS produced. In Indonesia, for example, 12 private and parastatal manufacturers can produce ORS, but low demand is forcing some to decrease production. In Bangladesh, however, only 1 parastatal and 1 private company produces all ORS used in the country, but they cannot keep up with demand. Other developing countries producing their own ORS include Costa Rica, Tunisia, Zambia, Mali, Egypt, and Ghana. Any group that considers local ORS production must first examine various factors including an assessment of potential demand, the extent that diarrhea is treated with oral rehydration therapy (ORT), and the government's position on ORS production and distribution. The group should contact the local UNICEF office to gain its support and guidance. It should also work with WHO and Ministry of Health officials and speak with the chief pharmacist or head of the pharmacy board. This group also needs to consider economic factors such as pricing and costs of importing raw materials. It should also see to a detailed cost analysis and market research. The group also needs to determine production capability in the country which includes the ability of companies to adhere to the international Good Manufacturing Practices code. In the beginning of project development, the group must consider ORS promotion with ORS production, e.g., it should scrutinize the potential producer's record for marketing and organize field research. The group can obtain technical assistance from UNICEF, UNIDO, and USAID funded projects such as PRITECH, PATH, HEALTHCOM, and SOMARC.
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  22. 22

    Paying for family planning. Le financement du planning familial.

    Lande RE; Geller JS

    Population Reports. Series J: Family Planning Programs. 1991 Nov; (39):1-31.

    This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.
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  23. 23

    Trip report: boosting ORS commercialization in the Philippines (part II), September 12-22, 1989.

    Saade C

    Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1989. [2], 19, [4] p. (USAID Contract No. AID/DPE-5969-Z-00-7064-00)

    A social marketing consultant sponsored by the US Agency for International Development visited the Philippines to assist in boosting oral rehydration solution ORS commercialization. The task includes following up on current ORS commercialization efforts in analyzing proposals from companies for strategies on rural distribution, promotion, pricing, and introduction scheduling as requested by the Department of Health (DOH) and to develop a plan of action that will lead to a final selection of companies and to develop the terms of reference for working relationship between the DOH and the selected companies. The 6 companies contacted were divided into 2 groups, 1 that insisted on using ORESOL exclusively, and those willing to use ORESOL as a generic name. All the advantages for the selected companies as well as the disadvantages for each, was weighted. Other factors considered were the political environment within the pharmaceutical market and the timing of the ORESOL launch. To provide DOH with the best objective decision, the Keptner-Tregoe decision making technique was used. This process showed an advantage to use the open market companies. An action plan outlining specific tasks to be done, responsibilities of various parties, and the dates of completion is described.
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  24. 24

    Finding ways to stem the tide of deforestation.

    Myers N

    PEOPLE. 1990; 17(1):11-4.

    In the 1980's we were losing 100,000 square kilometers of tropical rain forest per year, and today we are losing over 130,000 square kilometers due to general degradation. The greatest losses have occurred in Brazil; other countries include Bolivia, Ivory Coast, Burma, Thailand, Malaysia, Indonesia and more. By stopping the excess logging and cattle ranching almost 1/2 the problem would be solved. Such as in the Brazilian Amazon where the population is 147 million, and is projected to be 239 million by the year 2020. The economic imbalance, with the top 10% of the people having the larger share than the other 90%, and 10% of the land owners having more than 50% of the land, contributes to the problem. In 1 area, the use of extractive reserves, is producing higher income than cattle ranching and agriculture, and preserving the forest. Deforestation contributes to the greenhouse effect; reforestation of 3 million square kilometers of lands in the tropics could counterbalance this. It would cost $12 billion/year for 12 years to complete the project. If the present rate of deforestation continues we could lose 1/3-1/2 of all species in these forests. This implies that a priority should be to identify all critical areas within tropical forests, so that conservationists can use their scarce resources most efficiently. The most productive ways to slow deforestation needs to be determined, and evaluation of the goods and services generated, so that forests can be exploited in a rational and sustainable way. The areas of biodiversity should be identified, enabling us to preserve millions of threatened species efficiently.
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  25. 25

    Obstacles to developing vaccines for the Third World.

    Robbins A; Freeman P

    SCIENTIFIC AMERICAN. 1988 Nov; 259(5):126-33.

    Despite the tremendous strides in global immunization in less developed countries (LDCs) in the last 25 years, much remains to be done and the momentum has slowed. Vaccination programs continue to prove that they are less expensive, easier to implement, and in some cases more effective than other public health programs. Therefore it is imperative to produce and deliver new or improved vaccines to LDCs to prevent many infectious diseases and save the lives of children. Yet economic and political obstacles impede the development of these vaccines, even though the scientific know-how already exists. Manufacturers of vaccines that have been around for a long time and used widely in developed nations have often sold these vaccines to international agencies, such as WHO, at production cost. They do this because they have already recouped research & development (R&D) costs. When it comes to R&D of new vaccines, however, manufacturers are generally unwilling to invest time and money into R&D since they may not recoup their costs and make a profit. International agencies do not have the money to pay the high prices charged by manufacturers. Instead of the public health community in LDCs deciding on the development of new vaccines, the decision is left almost entirely in the hands of a few institutes or commercial manufacturers in the developed world. Other than continuing with the status quo, however, possible solutions do exist. For example, the UN could create an institute to develop and manufacture its own vaccines. Another possibility is that R&D and production of vaccines for diseases prevalent in an LDC or region could take place within that specified area.
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