Monday, July 21, 2008

Deal Seeks to Offer Drug for Malaria at Low Price - NYTimes.com



 
 

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via www.nytimes.com on 7/18/08

Deal Seeks to Offer Drug for Malaria at Low Price

Published: July 18, 2008

The Clinton Foundation announced Thursday that it had brokered an agreement among several drug makers that it hoped would ensure a steady supply of a crucial malaria medicine at reasonable prices for the world's poor.

The charity, created by former President Bill Clinton, is trying to control spikes in the price of artemisinin, a derivative of the sweet wormwood plant that Chinese scientists turned into the latest miracle drug against malaria.

In 2004, when international donors agreed to pay for artemisinin-based drug cocktails, the price of the raw material soared. In a year, it more than quadrupled, to about $500 per pound from about $115 per pound. (At the time, pharmaceutical executives in China blamed farmers for hoarding the supply.)

The Swiss pharmaceutical maker Novartis, then the only company with an artemisinin-based drug approved by the World Health Organization, absorbed the losses, and makers of generic drugs were scared away from the field.

But by 2006, after farmers rushed to plant more sweet wormwood and pickers gathered it in the wild, the price had plummeted to about $70 a pound. It has remained in that range since.

The complex deal announced Thursday involves two Chinese suppliers of artemisinin, two Indian companies that turn it into active ingredients and two more Indian companies, Cipla and Ipca Laboratories, that produce finished pills.

The Chinese companies have agreed to supply artemisinin at a price of no more than $136 a pound, said Dai Ellis, the foundation's executive vice president for access programs. The drug makers have agreed to buy at that price, but are free to buy elsewhere if they can find it for less than about $125 a pound. In return, they will sell their products at agreed-upon low wholesale prices.

At the moment, with global artemisinin prices well below those levels, the ceiling is "irrelevant," Mr. Ellis said. "Capitalism takes over."

However, he said, donors may soon start subsidizing private-market purchases of such drugs. (In most poor countries, people buy malaria drugs at private pharmacies and shops, while AIDS and tuberculosis drugs are distributed by public hospitals.) Lower prices could create new demand, sending prices of the raw material up again.

It is unclear how much control over the market the arrangement will create. Wormwood is also farmed in Vietnam and Tanzania and grows wild around the world. When prices soared, plans were announced to grow it in South Africa and elsewhere, and to make synthetic versions.

Mr. Ellis said the Clinton Foundation hoped to sign up more suppliers.

It also announced that Cipla and Ipca would produce a new artemisinin-based combination, artesunate plus amodiaquine, for about 30 percent less than its prevailing market price.

Sanofi Aventis, the first company to market a version of this combination approved by the W.H.O., deliberately did not patent it. Novartis's earlier product combines artemisinin with a different drug, lumefantrine.

Daniel Vasella, chairman of Novartis, said he was glad to have more competitors because, even at current artemisinin prices, his company lost 80 cents on each pill it made for public health agencies. With research and distribution expenses, he said, "It has cost us over $100 million."


 
 

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Tuesday, July 15, 2008

Op-Ed Columnist - Nicholas D. Kristof - The Luckiest Girl in the World - Op-Ed - NYTimes.com - Sent Using Google Toolbar

Op-Ed Columnist - Nicholas D. Kristof - The Luckiest Girl in the World - Op-Ed - NYTimes.com

Op-Ed Columnist

The Luckiest Girl

Published: July 3, 2008

This year's college graduates owe their success to many factors, from hectoring parents to cherished remedies for hangovers. But one of the most remarkable of the new graduates, Beatrice Biira, credits something utterly improbable: a goat.

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Fred R. Conrad/The New York Times

Nicholas D. Kristof

On the Ground

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Nicholas Kristof addresses reader feedback and posts short takes from his travels.

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"I am one of the luckiest girls in the world," Beatrice declared at her graduation party after earning her bachelor's degree from Connecticut College. Indeed, and it's appropriate that the goat that changed her life was named Luck.

Beatrice's story helps address two of the most commonly asked questions about foreign assistance: "Does aid work?" and "What can I do?"

The tale begins in the rolling hills of western Uganda, where Beatrice was born and raised. As a girl, she desperately yearned for an education, but it seemed hopeless: Her parents were peasants who couldn't afford to send her to school.

The years passed and Beatrice stayed home to help with the chores. She was on track to become one more illiterate African woman, another of the continent's squandered human resources.

In the meantime, in Niantic, Conn., the children of the Niantic Community Church wanted to donate money for a good cause. They decided to buy goats for African villagers through Heifer International, a venerable aid group based in Arkansas that helps impoverished farming families.

A dairy goat in Heifer's online gift catalog costs $120; a flock of chicks or ducklings costs just $20.

One of the goats bought by the Niantic church went to Beatrice's parents and soon produced twins. When the kid goats were weaned, the children drank the goat's milk for a nutritional boost and sold the surplus milk for extra money.

The cash from the milk accumulated, and Beatrice's parents decided that they could now afford to send their daughter to school. She was much older than the other first graders, but she was so overjoyed that she studied diligently and rose to be the best student in the school.

An American visiting the school was impressed and wrote a children's book, "Beatrice's Goat," about how the gift of a goat had enabled a bright girl to go to school. The book was published in 2000 and became a children's best seller — but there is now room for a more remarkable sequel.

Beatrice was such an outstanding student that she won a scholarship, not only to Uganda's best girls' high school, but also to a prep school in Massachusetts and then to Connecticut College. A group of 20 donors to Heifer International — coordinated by a retired staff member named Rosalee Sinn, who fell in love with Beatrice when she saw her at age 10 — financed the girl's living expenses.

A few years ago, Beatrice spoke at a Heifer event attended by Jeffrey Sachs, the economist. Mr. Sachs was impressed and devised what he jokingly called the "Beatrice Theorem" of development economics: small inputs can lead to large outcomes.

Granted, foreign assistance doesn't always work and is much harder than it looks. "I won't lie to you. Corruption is high in Uganda," Beatrice acknowledges.

A crooked local official might have distributed the goats by demanding that girls sleep with him in exchange. Or Beatrice's goat might have died or been stolen. Or unpasteurized milk might have sickened or killed Beatrice.

In short, millions of things could go wrong. But when there's a good model in place, they often go right. That's why villagers in western Uganda recently held a special Mass and a feast to celebrate the first local person to earn a college degree in America.

Moreover, Africa will soon have a new asset: a well-trained professional to improve governance. Beatrice plans to earn a master's degree at the Clinton School of Public Service in Arkansas and then return to Africa to work for an aid group.

Beatrice dreams of working on projects to help women earn and manage money more effectively, partly because she has seen in her own village how cash is always controlled by men. Sometimes they spent it partying with buddies at a bar, rather than educating their children. Changing that culture won't be easy, Beatrice says, but it can be done.

When people ask how they can help in the fight against poverty, there are a thousand good answers, from sponsoring a child to supporting a grass-roots organization through globalgiving.com. (I've listed specific suggestions on my blog, nytimes.com/ontheground, and on facebook.com/kristof).

The challenges of global poverty are vast and complex, far beyond anyone's power to resolve, and buying a farm animal for a poor family won't solve them. But Beatrice's giddy happiness these days is still a reminder that each of us does have the power to make a difference — to transform a girl's life with something as simple and cheap as a little goat.

I invite you to comment on this column on my blog, www.nytimes.com/ontheground, and join me on Facebook at www.facebook.com/kristof.

Monday, June 2, 2008

Progress Has Been Made in Fight Against AIDS, but Not Enough, U.N. Report Sa...



 
 

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via www.nytimes.com on 6/2/08

Progress Has Been Made in Fight Against AIDS, but Not Enough, U.N. Report Says

Published: June 3, 2008

JOHANNESBURG — The good news on AIDS: Nearly a million people began life-prolonging drug treatment in developing countries last year. The bad news: 2.5 million people were newly infected with H.I.V.

As new infections continue to far outstrip efforts to treat the sick, the United Nations released a progress report on Monday that highlighted both the notable gains in combating the AIDS epidemic and the daunting scale of what remains to be done.

Unaids and the World Health Organization, two United Nations agencies, had initially set a 2005 deadline for getting three million people in developing countries onto treatment regimens, but that goal was not achieved until last year. In 2007 alone, the number of people receiving antiretroviral therapy rose by 54 percent. Still, that is less than a third of those believed to need the treatment.

There was also significant headway in providing antiretroviral treatments to help prevent women from infecting their babies with H.I.V., the virus that causes AIDS, during pregnancy and childbirth. About a third of H.I.V.-positive pregnant women got the treatments last year, compared with 10 percent in 2004, with the greatest gains in West and Central Africa, the report found.

"It demonstrates our efforts have started to bear fruit," Patricia Doughty, a program officer at Unicef, said in a telephone briefing.

But even as health systems geared up to prevent mothers from passing on the disease to their children, the needs of the mothers themselves were neglected. Only 12 percent of H.I.V.-positive pregnant women were assessed for whether they needed treatment themselves. When mothers die of AIDS and their children are orphaned, the opportunities and even survival of the babies who were saved from infection are undermined.

The statistics were laid out in "Towards Universal Access: Scaling Up Priority H.I.V./AIDS Interventions in the Health Sector," a collaboration of Unaids, the World Health Organization and Unicef. It is the annual report that documents the provision of prevention, care and treatment services for H.I.V. and AIDS.

More than a year after clinical trials in Africa found that male circumcision reduced the risk of heterosexual men contracting H.I.V. by about 60 percent, "many high burden countries are exploring how and whether to scale up male circumcision programs," the report said.

Experts estimate that male circumcision, if widely applied in Africa, could avert two million infections and prevent 300,000 deaths over the next decade.

Dr. Kevin M. De Cock, who heads the World Health Organization's H.I.V./AIDS department, said performing circumcisions on a large scale was no simple task for overstretched health care systems in southern African countries, where the approach was most needed. He acknowledged that adoption of the strategy had been "relatively slow."

"There has been progress, but it would be nice to see it faster," he said.


 
 

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The World - Royal Care for Some of India’s Patients, Neglect for Others - NY...

via www.nytimes.com on 6/2/08
The World

Royal Care for Some of India's Patients, Neglect for Others

Ruth Fremson/The New York Times

WHAT MONEY BUYS Robin Steeles of Alabama was pampered during his 10 days at the private hospital in Bangalore, where he underwent heart surgery


Published: June 1, 2008

BANGALORE, India — "To get the best care," Robin Steeles said gamely, "you gotta pay for it."

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Ruth Fremson/The New York Times

WHAT BEING POOR MEANS A government hospital in Banglaore that treated poisoning victims lacked equipment that might have saved lives.

Mr. Steeles, 60, a car dealer from Daphne, Ala., had flown halfway around the world last month to save his heart, at a price he could pay. He had a mitral valve repaired at a state-of-the-art private hospital here, called Wockhardt, and for 10 days, he was recuperating in a carpeted, wood-paneled room, with a view of a leafy green courtyard.

A dietician helped select his meals. A dermatologist came as soon as he complained of an itch. His Royal Suite had cable TV, a computer, a minirefrigerator, where an attendant that afternoon stashed some ice cream, for when he felt hungry later. Three days after surgery, he was sitting in a chair, smiling, chattering, thrilled to be alive.

On his bed lay the morning's paper. Dominating its front page was the story of other men, many of them day laborers who laid bricks and mixed cement for Bangalore's construction boom, who had fallen gravely ill after drinking illegally brewed liquor. All told, more than 150 died that week, here and in neighboring Tamil Nadu State.

Not for them the care of India's best private hospitals. They had been wheeled in by wives and brothers to the overstretched government-run Bowring Hospital, on the other side of town. Bowring had no intensive care unit, no ventilators, no dialysis machine. Dinner was a stack of white bread, on which a healthy cockroach crawled while a patient, named Yelappa, slept.

Wockhardt has 30 ventilators, including some that are noninvasive, so the patient does not have to have a tube rammed down his throat. At any one time, a half-dozen are in use. An elderly woman had been in its intensive care unit for a week, on dialysis; her family wanted to do whatever possible to keep her alive, no matter the cost.

At Bowring, one of the young doctors, named Harish, said a ventilator and a dialysis machine would have allowed him to keep half of his patients alive. The most severe case, Mohammed Amin, was breathing with the aid of a hand pump that his wife squeezed silently. Dr. Harish sent the relative of one man to get blood tests done at the nearest private hospital; there was no equipment to do the test here. Then the doctor rushed to the triage section in Bowring's lobby, where the newest patient, writhing, resisting, disoriented from the poison in his gut, had to be tied down with bedsheets.

Where you stand on the Indian social ladder shapes to a large degree what kind of health you're in, and what kind of health care you receive. The beds in Bowring were taken up by small skinny men. One of Wockhardt's most popular offerings is a weight loss program, and the majority of walk-ins at its outpatient clinic suffer from diabetes, closely linked to obesity.

This is no anomaly. A government-sponsored National Family Health Survey released last fall says a woman born in the poorest 20 percent of the population is more than twice as likely to be underweight than one in the richest quintile, and 50 percent more likely to be anemic.

For children, the gap is equally stark. The poorest quintile is more than twice as likely to be stunted, a function of chronic malnutrition, and nearly three times less likely to be fully immunized.

It is not as if the poor do not seek treatment, Jishnu Das, an economist who studies health and poverty for the World Bank, points out. They do, and sometimes more often than the rich. It is just that they are more likely, Mr. Das says, to land at the doorstep of a caregiver who is incompetent, ill-trained or indifferent to their needs.

"The poor are not dying and sick because they do not go to seek medical care," he said. "In fact, the poor are going to doctors in droves. There are no good options for the poor. The private hospitals and care they are able to access is of very low quality, and when they try and access government care, they receive no attention whatsoever."

The survey found that two-thirds of Indian households rely on private medical care when sick, a preference that cuts across class. Asked why they don't use public facilities, the most common answer was poor care.

India has a countrywide network of government-funded primary health centers and hospitals, but staffing, medicines and resources vary widely. Some, especially in rural India, are notorious for having staff doctors on paper at best. This is only beginning to change. The government has increased health spending in recent years, and this year began a health insurance program that would allow people in poverty access to a hospital of their choice.

The Planning Commission of India this year found that in government-run health centers, 45 percent of gynecologist posts and 53 percent of pediatric posts went unfilled, and that salaries for government doctors are a fraction of those at new private hospitals like Wockhardt.

Wockhardt struggles to fill its slots, too, but its facilities allow it to aggressively recruit, including from among Indian doctors who have worked abroad for years.

The morning papers did not let Mr. Steeles forget the vast gulf between his predicament and that of the hooch drinkers fighting for life at Bowring. Yet as far apart as they were, their tales followed a somewhat parallel plot. The American health care system could no more care for Mr. Steeles than the Indian system could for Mr. Amin.

Mr. Steeles came here because he is uninsured, and could not afford heart surgery in the United States, he said, without liquidating most of his assets. After five months of research and e-mail messages to doctors worldwide, he chose a heart surgeon here in Bangalore. "I'm over here for a fraction of what I would have paid in the United States," he said. "In my personal situation, I'm just delighted I took the road that I did."

Mr. Steele's Royal Suite, incidentally, is available to anyone, Indian or foreigner, who can pay for it. After his stay here, he would move to a room at a private club for 16 days of further recovery, before flying home. All told, he said it cost him about $20,000, a tenth of what he would have paid at a private American hospital.

Across town, among the hooch drinkers, a few of the worst cases had been transferred to private hospitals that had agreed to take them, at the government's expense.

Mr. Amin was too frail to be transferred. He died at Bowring, leaving behind a wife and two young children.

A $10 Mosquito Net Is Making Charity Cool - NYTimes.com

“I think the concept of something simple, and conceptually powerful and concrete seems to mobilize people, even catalyze action.”

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via www.nytimes.com on 6/2/08

A $10 Mosquito Net Is Making Charity Cool

Mike Mergen for The New York Times

Lynda Commale and her daughter, Katherine, 7, raised money for mosquito nets on Sunday at a church in Malvern, Pa.

Published: June 2, 2008

Donating $10 to buy a mosquito net to save an African child from malaria has become a hip way to show you care, especially for teenagers. The movement is like a modern version of the March of Dimes, created in 1938 to defeat polio, or like collecting pennies for Unicef on Halloween.

Unusual allies, like the Methodist and Lutheran Churches, the National Basketball Association and the United Nations Foundation, are stoking the passion for nets that prevent malaria. The annual "American Idol Gives Back" fund-raising television special has donated about $6 million a year for two years. The music channel VH1 made a fund-raising video featuring a pesky man in a mosquito suit.

It is an appeal that clearly resonates with young people.

Addressing a conference of 6,000 Methodist youths in North Carolina last year, Bishop Thomas Bickerton held up his own $10 and told the crowd: "This represents your lunch today at McDonald's or your pizza tonight from Domino's. Or you could save a human life."

The lights were so bright that he could see only what was happening at his feet. "They just showered the stage with $10 bills," Bishop Bickerton said. "In 30 seconds, we had $16,000. I'm just lucky they didn't throw coins."

Part of what has helped the campaign catch on is its sheer simplicity and affordability — $10 buys one net to save a child. Nothing But Nets, the best-known campaign, has raised $20 million from 70,000 individuals, most of it in donations averaging $60.

That is a small fraction of the overall need, which experts estimate at $2.5 billion. But it gives the effort a populist edge, and participation is psychologically rewarding for anyone whose philanthropic pockets are shallower than those of Bill Gates.

"The first time I donated money, after my bar mitzvah, it was for someone who needed a heart transplant," said Daniel Fogel, 18, a founder of his Waltham, Mass., high school's juggling club, which raised $2,353 for nets last year. "But I had the feeling: Am I really helping? But if you can say $10 saves a life, that makes students feel they can help a lot. And every student has $10."

Emily Renzelli of West Virginia University learned about malaria on a trip to South Africa. She raised about $1,000 through bake sales and parties where students were snagged in nets and not released until they recited facts about malaria.

Naomi Levine, an expert on philanthropy at New York University, said young people "more than ever want to do something."

"You won't find them giving money to research," she added. "It's too far off. But a net is something you can hold in your hand. And any time young people get interested in any form of philanthropy, it's a good thing."

Crucial to the drive against malaria, which kills an estimated one million people a year, mostly in Africa, has been the development of an inexpensive, long-lasting insecticidal net. Unlike old nets, which either had no insecticide or had to be dipped twice a year, the new ones keep killing or repelling mosquitoes for three to five years. When more than 60 percent of the inhabitants of a village use them over their beds while they are sleeping, malaria rates usually drop sharply.

Major donors have focused on malaria since the creation in 2001 of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has paid for 106 million nets. President Bush in 2005 started the President's Malaria Initiative, which has bought 6 million so far.

The Gates Foundation has spent almost $1.2 billion on malaria, and although most goes toward research into vaccines and new drugs, part went to match the first $3 million raised by Nothing But Nets.

Although in recent years a welter of malaria campaigns has sprung up worldwide, participation in the United States was anemic until two years ago when Rick Reilly, then the back-page columnist for Sports Illustrated, took his daughter to Venice.

Exhausted from shopping, he said in a recent interview, he returned alone to their hotel. Idly channel-surfing, he stumbled onto a BBC documentary about malaria in Africa. Imitating a British accent, he said: "Up to 3,000 children die needlessly each day of malaria — and all they need is a net."

"I thought, 'That's a column,' " he said. "Sports is nothing but nets — basketball nets, tennis nets, soccer nets, lacrosse nets, jumping the net, cutting down nets, the New Jersey Nets, girls in fishnets, whatever ... ."

Before asking his readers to donate $10 or $20, he searched for an agency to collect the money and buy the nets. He found the United Nations Foundation, which was started in 1998 by Ted Turner. Although it was already sponsoring another campaign, Malaria No More, it agreed to his request that a new group be started with the name Nothing But Nets. "That's a real title," Mr. Reilly said. "It's so simple that even sports fans can get it."

The foundation put a donation form on its Web site and promised to cover all administrative costs. Within a few days, $1.6 million had flowed in.

Soon after, Major League Soccer and the National Basketball Association became sponsors.

Players like Diego Gutierrez of the Chicago Fire and DeSagana Diop of the New Jersey Nets, who is from Senegal, helped raise money and traveled to Africa to hand out nets.

The United Methodist Church, the Lutheran Church and the Union for Reform Judaism also joined the effort, as did corporate sponsors like Orkin Pest Control and Makita tools.

The two Protestant churches pledged to raise up to $100 million each. They organize youth basketball tournaments and ask for money from their own adherents. For example, Bishop Bickerton said, at the Methodist general conference in April, a basketball signed by all the church's bishops was auctioned off for $430,000.

But most of the contributions have been modest, raised by students.

Yoni D. P. Rechtman, a seventh grader on the undefeated middle-school team at St. Ann's School in Brooklyn, organized a 3-on-3 basketball tournament as part of his "mitzvah project," the tradition of raising money for a good cause before one's bar mitzvah. Unfortunately, he said, it rained that day; but the nine players who showed up anyway had family pledges totaling $1,900.

At Howard University in Washington, Ololade Ajayi helped organize the African Student Association fashion show to raise $2,300. She had a personal interest, she said, because she caught malaria several times growing up in Nigeria and lost a friend to it.

"We had to take our own nets to boarding school," she said. "There were stagnant water pools on the school grounds. If your net got holes in it, you'd be bitten."

But the champion for her age and weight class is undoubtedly Katherine Commale of Hopewell, Pa., who has just turned 7 and has raised $43,000.

Her mother, Lynda Commale, said it started in April 2006 when she was watching television while the family slept and learned from a PBS documentary that a child died of malaria every 30 seconds.

"I couldn't sleep," Ms. Commale said. "The next morning, the kids said, 'Mom, what's wrong with you?' I told them — and Katherine was just 5, and she started counting on her fingers. She got to 30, and she looked horrified. And she said 'Mommy, we have to do something.' "

With her 3-year-old brother, Katherine built a diorama from a pizza box and some Barbie dolls to represent an African family in a hut. Then, with a piece of tulle and a toy bug, she developed a short skit showing how nets protect sleeping children.

"She tucks it in, she says, 'You're safe now,' " Ms. Commale said. "Kids get this in like 90 seconds."

Soon, she and Katherine made a presentation at their church and raised $2,000, and they have continued visiting churches. Katherine and her friends also hand-decorate gift cards (which can be ordered at lyndacommale@yahoo.com.) that say, "A mosquito net has been purchased in your name." They have raised about $8,000 each Christmas, Ms. Commale said.