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Huge drug firms leave

poor traders in the cold
RACHEAL NINSIIMA

In the middle of 2011,

Kenny Silas Soloci, a
pastor and founder of Elim
church in Busia district,
came down with back
pain that lasted more than
four months. Initially, the
75-year-old father of nine
thought it was another light
illness until it completely
paralysed his movement.
It was during this time
that his first born, Beatrice
Mawero, noticed that her
father had become more
emaciated and could hardly
walk. The pain slowed his
pastoral work and confined
him to his home all day.
This was so unlike
him because he loved
travelling from door to
door, spreading the gospel
and he was very outgoing,
says Mawero, who remains
by her fathers bedside
at the Uganda Cancer
Institute (UCI) in Mulago.
Donning a white vest,
Soloci lies, eyes wide open,
waiting for a doctor. He can
neither speak nor move.
Day and nighttime drips
and pills are his lifeline. He
is afflicted with multiple
myeloma, a cancer that
forms in the bone marrow,
the soft spongy centre of
most bones.
Multiple myeloma causes
cancer cells to accumulate
in the bone marrow, where
they crowd out healthy
blood cells. Rather than
produce helpful antibodies,
the cancer cells produce
abnormal proteins.
Before coming to UCI,
Soloci had been through
multiple
sessions
of
physiotherapy
at
Mt
Elgon hospital in Mbale
and Nairobi hospital but
his condition seemed to
worsen. This was in July
2012.
One of our relatives
recommended that he
be moved to Mulago
hospitals
orthopaedic
department. But after a
short while, Dr Othieno
recommended that he be
transferred to UCI where
his bone marrow, urine and
blood was tested, Mawero
sadly recounts.
The diagnosis results
were bewildering. Instead

Kenny Silas Soloci at Mulagos cancer institute Photo/RACHEAL NINSIIMA

of an orthopaedic problem
as everyone had expected,
it was cancer, and it had
already spread to the rest
of the body.
Solocis case is not
the only unique one.
Every year, some 300,000
Ugandans
develop
invasive cancers and more
than 10,000 of these die,
according to information
from UCI.
The most common cancer
types among male adult
patients are prostate cancer
and Kaposis sarcoma,
while cervical and breast
cancers are the most
common amongst females.
In children, it is Burkitts
lymphoma, a potentially
fatal and disfiguring virus
that often develops in the
jaw or abdomen.
Kaposi sarcoma is the
biggest killer. It is the
largest cause of death
among cancer patients in
Uganda. When someone
has HIV, their chances of
developing Kaposi sarcoma
is 20,000 fold, says Dr Fred
Okuku, a senior oncologist
at the institute.
According
to
information from the noncommunicable disease unit
of the Health ministry, 300
people per every 100,000 are
estimated to have cancers.
Approximately
2,000
newly diagnosed cancer

patients get admitted to the

UCI annually.
The issue of cancer has
become more pressing in
recent years because of
limited access to drugs.
There is no known
giant pharmaceutical that
is currently investing in
research and development
of cancer drugs. This
is because there are no
profits in selling cancer
drugs. Majority are instead
looking to producing drugs
for diabetes, HIV and
malaria, says Benjamin
Mwesige, a pharmacist at
UCI.
CHASING PROFITS,
BURYING LIVES

Mwesige
notes
that
accessibility to the latest
cancer drugs is rare and
even unheard of in many
developing countries like
Uganda.
This is because giant
pharmaceuticals
such
as Norvatis in the US,
AstreZeneca in Switzerland
and Roche in Spain are not

willing to invest in such

countries as they cannot
recoup their research and
development costs, and
cannot make profits off the
drugs.
Owing to the limited
number of pharmaceuticals
investing
in
cancer
drugs, this has led to the
emergence of monopolies
which patent drugs and set
prohibitive prices.
Medicines
are
a
tradable commodity on
the international market
and the free market forces
affect it. However, prices of
drugs vary depending on
whether the drug is under
a 20-year patent protection
or generic-off patent.
For
example,
one
vial of the patented
Cyclophosphamide, 5-FU
and Doxorubicin drug
combination used in the
treatment of breast cancer
costs about $1,200.
Nevertheless,
Uganda
uses the generic versions
of the drugs, procured
mainly from Hospira and
Teva pharmaceuticals in
the USA.
The generic version
of the combination drug
costs $310 (Shs 790,000)
and these have to be
administered after every
three weeks. Although the
bulk of the purchasing cost
is met by government, it

cannot keep up with the

growing population. Some
patients have to buy the
drugs which many cannot
afford, Mwesige notes.
He adds that patients
with complicated cancers,
which the institute cannot
afford to treat, always run
to solicit help from the
public through the media.
Currently, at least 52
different drugs are needed
at the institute but some
are lacking because there
are few pharmaceuticals
supplying the National
Medical Stores (NMS).
DIRTY SECRETS

In 1994, World Trade

Organization
(WTO)
completed
the
TradeRelated
Aspects
of
Intellectual
Property
(TRIPS)
agreement
requiring all members
to
standardize
minimum standards of
intellectual property (IP),
including
patents
for
pharmaceuticals.
IP rights give the creator
an exclusive right over the
use of his or her creations
for a certain period of
time such as 20 years for
a scientific innovation like
medicine.
The
pharmaceutical
industry in developed
countries is more strongly
dependent on the patent

system than most other

industrial
sectors
to
recoup its past Research
and Development costs,
to generate profits, and
to fund research and
development for future
products.
Moses Mulumba, the
executive director of the
Centre for Health, Human
Rights and Development
(CEHURD),
criticises
TRIPS for its obligation to
all countries to grant at least
20-year patent protection
for new medicines, thereby
delaying production of the
inexpensive generics.
If a country is trading
in scientific innovations,
the WTO has developed
a system where it protects
you. This has led to
monopolies in the market
which
set
prohibitive
prices.
The
demand
for cancer treatment is
high compared to what
the country can treat,
Mulumba said.
Under
TRIPS,
least
developed
countries
(LDCs) are supposed to
enforce patents on all
medicines by 2021.
In effect, countries such
as India and Brazil where
generics are produced now
grant medicines patents
in order to comply with
their obligations as WTO
members.
New
drugs
are already patented in
these countries, which
means that production of
affordable generics was
now restricted.
For
example,
Swiss
pharmaceutical
giant,
Novartis has fought a legal
battle in India since 2006
to patent a new version of
Glivec, which is mainly
used to treat leukaemia
and is known as Gleevec
outside India and Europe.
Cipla,
a
generic
manufacturer in India,
and a majority shareholder
in the former Quality
Chemicals, makes a version
of Glivec for less than a
tenth of the original drugs
selling price.
Some researches point
to the fact that current
patents do not necessarily
create financial incentives
for the development of
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