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Opinion: Misguided policies keep life-saving drugs out of reach

Politically motivated drug policies in Uganda and Kenya have cost lives to malaria.

Nancy Bosbori, a 2-year-old suffering from malaria, is held by her mother as doctors check her at Kisii general hospital, about 420 kilometers from Nairobi, July 9, 2002. (George Mulala/Reuters)

WASHINGTON — Malaria is a preventable and curable disease that kills nearly 1 million people, mostly children, every year.

This disease continues to kill in large part because so many poor people living in Africa lack access to safe, effective and affordable medicines. Yet in an attempt to increase access, some governments and funding agencies have promoted policies that might undermine treatment outcomes. Political interference in medicine production and procurement must end and governments must instead focus their efforts on fixing medicine distribution systems that limit access.

Some countries have imposed tariffs on imported drugs in order to protect local drug manufacturers. Such favoritism not only increases the price of drugs but it also constricts the supply of imported drugs, which are often of higher quality. Kenya and Uganda, for example, once imposed tariffs, but these were removed under pressure from local health activists who argued that this regressive tax harmed the sick and the poor. Yet both these countries have pursued policies that have harmed access to medicines in other ways.

The government of Uganda, along with Indian drug producer Cipla, has financed a state-of-the-art drug production facility near Kampala owned by Quality Chemicals Industries Ltd. (QCIL). The government has invested tens of millions of dollars and taken a 22 percent shareholding in the company. QCIL, which now lobbies for a re-introduction of import tariffs, aims to supply anti-retrovirals for the treatment of HIV/AIDS as well as anti-malarial drugs.

Yet despite the substantial investments of taxpayers’ funds over several years, there is little evidence that this company has produced a single anti-malarial drug. Furthermore, it hasn’t sought quality approval from the World Health Organization (WHO) or another stringent regulatory authority. Even if QCIL were to produce malaria drugs of acceptable quality, the high production costs in Uganda mean the drugs would be more expensive than quality-assured imported drugs.

The Ugandan government appears to have bought into the idea that locally produced goods are inherently cheaper and hence automatically improve access; however, there is no evidence to support this notion.

Kenya has pursued a different path for its drug procurement. In August 2008, the Global Fund sub-recipient Kenya Medical Supplies Agency awarded the tender for its annual supply of anti-malarial drugs to Indian generics firm, Ajanta Pharma Ltd. Ajanta’s tender price was substantially lower than competitors, which made it appear an attractive option. Yet at that time Ajanta’s malaria drug had not been approved by the WHO, an approval that has been subsequently granted. The firm had little history in delivering the large amounts required for international tenders of this sort, a fact that proved disastrous for ordinary Kenyans.