Good news for Rwanda’s breast cancer and diabetes patients

It made for some amusement about two weeks ago when the internet lit with the news that a group of Australian high school students had recreated a drug worth $750 per dose for only $2, leaving the “owner” of the said drug – Martin Shkreli – with egg on his face. Shkreli, who has earned the dubious label “the most hated man” on the internet, is a morbid example of the profit motive gone mad and has become something of a metaphor for greed often perceived of some of the big Western drug manufacturers. He is an American pharmaceutical entrepreneur whose company, Turing Pharmaceuticals, purchased the patents for the anti-parasitic drug, Daraprim, in August last year. Unheeding of the usefulness of the drug, which is listed on the World Health Organization’s (WHO) list of essential medicines, and can be used by malaria and HIV infected patients, he, almost overnight, hiked the price by 5,000 per cent from US$13.50 per dose to the extremely prohibitive US$750. It is this that inspired the Australian high schoolers, to whom I will return shortly. Shkreli’s insensitive business antics are the dark side. There’s also the other more considerate side that showed itself last year as well when the pharmaceutical company, Novartis, announced the launch of a portfolio of 15 drugs that will be sold at US$1 a month to 30 low and middle-income countries. The 15 on- and off-patent medicines under the Novartis Access initiative address key non-communicable diseases (NDCs), including heart-related diseases, Type 2 diabetes, respiratory illnesses and breast cancer. The initiative will offer much-needed relief for many that are struggling to meet the high cost of managing, among other related conditions, hypertension and asthma. A monthly dose of similar treatment currently costs anywhere between Rwf32,500 (US$40) and Rwf81,500 (US$100), or more. Kenya has just completed a year under the initiative, with Rwanda having signed a memorandum of understanding with Novartis Access in September 2016 to become the third country after Ethiopia. (See “Novartis Access one-year report: Capturing first learnings”). Novartis says the medicines are expected in Rwanda in the coming months. It observes that while life expectancy has impressively increased “from 39 years in 2004 to 59 years in 2014 [there also has been] a rise in NCDs. The WHO estimates that NCDs are now responsible for 36% of all deaths in Rwanda.” It is worth noting that some 75 per cent of the world’s population – about 5.5 billion people – live in mostly low- and middle-income countries where a significant number of the population needlessly succumb to NCDs as modern lifestyles take hold. The non-communicable diseases are a not only a burden in the countries’ economies, but push families deeper and deeper into poverty making the NCDs a developmental issue. The Novartis initiative is, therefore, welcome. It says submissions from 19 countries to be part of the initiative are ongoing, with countries in the region set to benefit including Tanzania, Uganda, Burundi and Sudan. But developing countries need not wait for the likes of Novartis’ magnanimity; which is why the saga of Shkreli and the Australian high schoolers is instructive. It is reported that the students were looking for a chemistry project, just as Shkreli’s insensitive price hike was drawing global condemnation, giving them inspiration to try and synthesise pyrimethamine, the key ingredient of Daraprim. It throws the challenge at us in the region and the developing world that mere high school students could manage such a feat. It makes one wonder where our local scientists are, not to mention the inadequate – if any – research funding by our governments in the region. It challenges our commitment to the idea of homegrown solutions. The key ingredient of the drug is not protected by patents, of which the students hope to inspire other manufacturers to try their technique and have published it in full online (http://malaria.ourexperiment.org/daraprim_synthesis) An equivalent to the student’s dose is available in many countries for around US$1 or US$2 per tablet, and can be bought in India for as little as US$0.10 (Ten US Cents).

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Good news for Rwanda’s breast cancer and diabetes patients