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The Medical Device Industry: A New Player in Global Health

Jeremiah Norris

On February 16, the Kaiser Family Foundation sponsored a presentation by the Center for Strategic and International Studies (CSIS). The key speaker was Jean-Luc Butel, Executive VP & Group President International of Medtronics. His subject: “Tackling the Global NCD Epidemic: How the Private Sector can and Should be Part of the Solution”.

Late last year, Medtronics made a $1 million contribution to the Clinton Global Health Initiative. This has since been transferred to the NCD Alliance, comprising the International Diabetes Foundation, the Union for International Cancer Control, the International Union Against TB and Lung Disease, and the World Heart Federation.

Some key issues addressed by Mr. Butel:

  1. a need to develop guidelines for NCDs, and to have them placed on the Millennium Development Goals;
  2. two important components for (1): a) access to medicine; and b) affordability;
  3. on access, he mentioned the need to lower costs of NCDs;
  4. he stated that we need to be at the UN High-Level Meeting in September on NCDs with a set of standards for them—we have to “lay out the value proposition for outcome measurements;
  5. then, his power point presentation focused largely on the economic aspects of NCDs, e.g., lost productivity, etc.

CSIS had prepared a publication entitled: “Getting the Politics Right for the September 2011 UN High-Level Meeting on Noncommunicable Diseases”. It stressed the need for advocacy on four diseases: CVDs, cancer, diabetes, and chronic respiratory conditions. CSIS recommended that there has to be a sharp focus on treatment, e.g., “exploring the most cost-effective means to ensure treatment of the most common NCDs, and availability of medicines on essential drugs list”.

In another recommendation, CSIS states a requirement for a “new prominent lead personality—an interim NCD czar, operating under a UN flag, and overtly empowered to lead—this would be invaluable”. Further on, it comments: “WHO has taken a formal leadership role of the meeting with the UN—they should seek under UN auspices the appointment of a prominent NCD czar”.

The forthcoming UN High-Level Meeting has troublesome vestiges of the UN Millennium Declaration on Access to Medicines in 2000. It committed the international community to remedy the situation of global disparities in access to medicines. The Secretary-General specified that it was to be done “in cooperation with pharmaceutical companies”. Subsequently, WHO marginalized their participation.

The CSIS publication praised such organizations as the World Bank, UNAIDS, WHO, the United Nations and civil society for their effective response to the global HIV/AIDS epidemic—a central programmatic effort of the Millennium Declaration.

There was nothing in its publication to suggest the role played by the R&D pharmaceutical industry on its compliance with access to medicines for communicable diseases. Nor does it exist within the UN community or the media. Nothing suggests that the U. S. industry alone contributed more than $32 billion in drugs and medical supplies in a six year period; nothing to suggest that it adhered to the TRIPS’ Article 31 provision and transferred production technology to developing countries; nothing to suggest that it built nine research facilities to develop therapies for neglected diseases; including one for the development of vaccines; nothing to suggest that it was industry’s intellectual property that extended the life span of 5.2 million AIDS patients; nothing to suggest that industry stood without legal challenge while the FDA certified over 100 different ARV and OI therapies as true generics, produced mainly in India; nothing to suggest that it built Africa’s first Pediatric AIDS Hospital in Botswana, along with a national AIDS Reference Laboratory nothing to suggest that it built Tanzania’s first Children Hospital for AIDS, then expanded its reach into ten specialty clinics in rural areas; nothing to suggest that it built and financed Africa’s first Infectious Disease Institute in Uganda, now credited with training more than 60% of the continent’s medical cadre in the clinical care and treatment of AIDS patients; nothing to suggest that it is building a Center of Excellence in AIDS, TB and Malaria in Kenya, and another in Nigeria; nothing to suggest that Ecuador has become the first country in the world to have eradicated river blindness via industry’s partnership over a 23-year period; nothing to suggest that it was industry’s IP that catapulted India as an international competitor into global markets, making it the prime supplier of ARVs to Africa; and there is nothing to suggest that it sponsors a Pediatric AIDS Corps with close to 300 qualified physicians in residence within ten Southern African countries.

Yet, there was everything to suggest that in the CSIS recommendation for a noncommunicable disease czar, it should be one appointed by the UN and WHO!

At Hudson Institute’s Index on Global Philanthropy & Remittances, we track the U. S. Net Economic Engagement with the Developing World, comprising ODA as well as resource flows from corporations, foundations, religious organizations, etc. During the period 2004-2008, the total Net Engagement was $848.8 billion, of which only 14% was ODA. In 2004, ODA was 20% of the total. The next Index is due in May. Given the global economic crisis, ODA is likely to fall below 14% of the total U. S. Engagement.

According to WHO, approximately 75% of all healthcare expenditures are in the private sectors of the largest developing countries, such as Nigeria, India, Bangladesh, China, Indonesia, etc. The treatment of NCDs is largely in the domain of ministries of higher education, which control the medical schools, provide clinical staff to teaching hospitals, administer the professional medical societies, and work with health insurance and social security-type medical care system in the private sector.

Now, with the medical device industry assuming a leadership position in preparation for the UN High-Level Meeting on NCDs in September, will it be received any differently after it than was the R&D pharmaceutical industry following the UN Millennium Declaration on Access to Communicable Disease Medicines in 2000!

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