1. How can Seychelles in future obtain affordable, good quality medicines for HIV/AIDS, Hepatitis C, cancer and other non-communicable diseases? Medical View Wilbert Bannenberg wilbert@sarpam.net Seychelles TRIPS workshop 18 Sep 2014

3. Main death causes in Seychelles Cardiovascular (32%) Cancer (20%) Diabetes and other NCDs (22%) Communicable diseases (19%) – HIV/AIDS – Hepatitis-C – Respiratory infections Injuries (7%)

4. We all know what to do... NCDs – Healthy life style, exercise, salads, vegetables – Stop smoking, drink less, lose weight HIV/AIDS, Hepatitis-C – Educate population – Safe sex, condoms – Needle exchange programmes Safer roads, control cars, don’t drink & drive...

5. Needed but medicines New medicines may be patented Non-communicable diseases: – Cancer medicines – Diabetes (leading to kidney failure) – High blood pressure – Stroke (new expensive heparins) 2 nd and 3 rd line antiretrovirals New DAA treatments for hepatitis-C Can the government afford them?

6. Remember the South Africa case? Antiretrovirals were unaffordable – $7000-12000 pp/year due to the patents of big pharma – Brazilian/Indian generics cheaper ($900, then $360, now $62) – But generics could not be bought due to patents SA govt made a law to make patented medicines cheaper; – 39 drug companies vs. Nelson Mandela South Africa eventually won the case in 2001 – Not with lawyers! But with AIDS activists (TAC) testifying in court, press releases, TV interviews, public pressure (MSF) etc SA govt first did not want to make ARVs available – No trust in ARVs or multinational drug companies – Finally accepted ARVs using economic arguments – Now has the biggest ARV program in the world (>2.5m on ART)

7. Anti-retrovirals and patents First fixed-dose combinations by generic co’s Generic competition (India <2005) ↓ prices Old 1st line access after SA court case New 1st line (tenofovir, $500 to $26) due to voluntary licences by Gilead to 8 generic co’s 2nd and 3rd line ARVs patented and expensive but licenses available in Medicines Patent Pool Future? India > 2005 no generics unless voluntary licenses or compulsory license for export

8. Hepatitis-C in Seychelles 440 HCV cases diagnosed so far 360(82%) males and 80(18%) females – IV drug users (needle exchange = cost effective!) 36 (9%) had HIV + HCV co-infection 13 HCV related deaths Peg-Interferon expensive, injectable, serious side-effects (depression) and not very effective

9. DAAs: new hope for hepatitis-c Hepatitis-c can now be cured by taking 2 new directly acting antiretrovirals (DAA) for 12-24 weeks – Stops progression to liver failure and liver cancer Example: Sofosbuvir by Gilead – 1 tablet costs $1000; a cure (to survive) > $84,000 – Difficult discussions in USA, Europe: can we afford? – Seychelles: 440 HCV cases x $84,000 = $37 million... Egypt, Mongolia got 99% discount: $900 per course Raw material cost only $68 - $136 per course New voluntary licenses announced by Gilead this week – Awaiting lower price generic DAAs in coming years

10. Cancer medicines 14m new cancers discovered globally (8.2m deaths) – Fastest growing market for big farma Seychelles: cancer 20% of all deaths Government spends SR 4.5m on cancer medicines – 30% on Herceptin (trastuzumab, for breast cancer) – Many patient-specific medicines Older anti-cancer medicines are available as generics in India Newer anti-cancer medicines patents granted or pending, but: – Patent not accepted (2nd use), application withdrawn or compulsory license – Check patent status of cancer medicines in Seychelles!

11. Conclusions Many diseases are preventable. – Sometimes treatment is prevention Treatments are expensive (often because of patents), but thanks to the large numbers of PLWHIV in low income countries we may get cheaper generics Non-communicable diseases often need chronic and new medications Such medicines may be patented and expensive Lower prices generics nevertheless possible if there is demand and use of patent law flexibilities Seychelles use TRIPS flexibilities in procurement practices

12. Thank you! Wilbert Bannenberg – wilbert@sarpam.net until Dec 2014 wilbert@sarpam.net – wilbert@hera.eu from 2015 wilbert@hera.eu