Immunocompetent

This isn't the really interesting news I promised the other day (that's still being vetted elsewhere); but it's pretty darn telling.

(Above: What it would cost different regions to stockpile Tamiflu under Roche's plan.)

Roche and Glaxo, with their flu antivirals Tamiflu and Relenza (respectively), are offering us a little preview of what's going to happen with pandemic vaccines (and other biologicals) if the patent trend continues unabated.  What happens, in a phrase, is that the rich get treated and the poor get dead.

Today's news brings an item about Roche and Glaxo's hawking of their drugs to corporations for private stockpiles.  Think of it as a sort of pandemic "health insurance", mega-corporation style. According to this report, the pharma giants are hoping to convince corporations to buy a pandemic drug stockpile for their employees for $6 per person (course) per year (Tamiflu) or $37 per course (Relenza).(I'm going to put the vulgarity of determining who gets antivirals on the basis of their employer - as opposed to need - aside for this post and focus on the economics.)

AP quotes pathetic, should-be-indicted-by-history-for-their-abject-failure-and-subservience-to-business, US authorities as encouraging this, saying "Private stockpiles (would) improve the ability to achieve the national pandemic response goals of mitigating disease, suffering and death, and minimizing impacts on the economy and functioning of society." Whatever happened to public health in the US?

Let's take Roche's Tamiflu stockpile program as the example (because its terms are more clearly stated than Glaxo's).

Six bucks a year, for the wealthy, doesn't sound like too much. But when you start looking around the world, it is apparent that this expense would take an enormous bite out of public drug budgets in developing countries. In the case of Sub-Saharan Africa, already being crushed by AIDS, buying a Tamiflu stockpile at the corporate "discount" rate would consume nearly all of the public drug budget, leaving little for everything else - like AIDS drugs, simple antibiotics and painkillers and other essential medicines.

Even in comparatively wealthy Mexico and Chile, it is unlikely that the state could afford Roche's patent monopoly-backed fees. According to June 2008 OECD figures, Mexican annual per capita public expenditure on pharmaceuticals is US $28. Thus, $6 per capita per year funded by the state would represent an outlay of 21.4% of the entire annual national public expenditure on pharmaceuticals - only for Tamiflu. And Tamiflu is, frankly, not even a very good insurance policy against H5N1. In Chile, total annual per capita spending on pharmaceuticals is reportedly US $81.4. Buying into Roche's scheme would represent an annual cost of 7.4% of ALL (public and private) money spent on pharmaceuticals in the country. In addition, set this against a current expenditure on flu antivirals that is likely close to nil.

But Mexico and Chile are "good" case scenarios.  South Africa has "the largest and best developed pharmaceutical market in Africa", yet total annual per capita expenditure on pharmaceuticals (in 2005) was US $63.5. Thus $6 per person per year would represent nearly 10% of all spending on all drugs in the country, pubic and private, and quite likely a very large percentage of the key public budget. (Try convincing a landless farmer or a squatter on the urban periphery to set aside $6 per family member per year for a private pandemic preparedness plan. Hint: It ain't gonna happen.)

But the starkest evidence of how unaffordable the big pharma intellectual property-intensive flu drug model is for developing countries comes when one compares WHO's data on 2007 median per capita annual public drug expenditures (see here, PDF download) against Roche's Tamiflu stockpile fees. I've added the Roche stockpile calculation.  Read it and weep:

This is just a preview of what is going to happen with (pre)pandemic vaccines as the patent claws dig deeper into H5N1 vaccines and, indeed, the virus itself. This is a big reason why the debate over virus sharing and reform of the Globlal Influenza Surrveillance Network is so important. Restoring the integrity of the GISN offers at least some hope of making vaccines and other treatments available to far more of the world's population than the Roche-Glaxo model can possibly serve.