Yellow fever - a tropical acute viral hemorrhagic disease - is a substantial burden that nearly a billion people in the world are currently vulnerable to. This disease is caused by a flavivirus that is transmitted via the bite of infected mosquitos. The name ‘yellow fever’ holds true to symptoms that are commonly associated with those infected which include jaundice, otherwise known as yellowing, of the skin and sclera due to liver damage. Severe cases result in shock, internal bleeding, jaundice and organ failure, and even death.
The infection is currently endemic, meaning always present, in forty-seven countries including Africa (34) and Central and South America (13). In 2013 alone, 127,000 individuals suffered severe infections with 45,000 succumbing to the infection.
More recently in susceptible regions of Brazil, yellow fever has begun to spread through the bite of infected Haemagogus mosquitoes. The outbreak began in mid-2017 and as of January 2018, there have been 35 confirmed cases with 20 reported deaths. As a result, mass vaccination projects supported by the WHO have been launched in Nigeria and Brazil in which the organization plans to vaccinate 25 million people and 24 million people, respectively.
The WHO is deploying nearly 3000 vaccination teams in Nigeria, mainly focused on camps for displaced inhabitants. The vaccination efforts in Brazil are mainly centered around Rio de Janeiro and Sao Paulo where cases of the disease have been prevalent.
Yellow fever is currently preventable through the use of a vaccine that costs between $50 USD to $100 USD. A major roadblock for the mass vaccination initiatives in Nigeria and Brazil is the shortage of yellow fever vaccines available to the public. Even within wealthy countries such as Canada and the United States, the supply of yellow fever vaccines has been temporarily depleted. The vaccine is not recommended for Canadian and US residents unless they are planning to travel to tropical destinations where yellow fever is prevalent. This means that the production of vaccines is not a priority for pharmaceutical companies and thus supplies are not being prepared for mass immunization campaigns like those currently underway.
Good news comes from the fact that during a 2016 yellow fever outbreak in the Democratic Republic of the Congo, supplies of vaccines similarly ran low which forced officials to administer smaller doses of the vaccine to the population. This demonstrated that a lower dose was effective in conferring temporary immunity to the disease which is sufficient in containing outbreaks.
Officials in Brazil and Nigeria have been delivering these fractional doses, which consist of one-fifth of a full vaccine, in order to extend the current supplies and maximize the proportion of the population vaccinated.
A partial dose is effective in providing immunity to the disease for at least twelve months, but the full extent is unknown. Ideally, full doses of the vaccine should be administered as they confer lifelong immunity for 99% of persons vaccinated. Therefore, it is yet to be seen how effective this solution is for immunizing the vulnerable populations. It is critical to vaccinate at least 80% of populations at risk to reduce levels of transmission through herd immunity.
Current initiatives to reduce the prevalence of yellow fever include the Eliminate Yellow fever Epidemics (EYE) Strategy which was launched in 2017. With the collaboration of more than 50 partners, the EYE partnership supports at-risk countries in Africa and the Americas to prevent, detect, and respond to yellow fever suspected cases and outbreaks. By 2026, it is expected that over 1 billion people will be protected against the disease and strategies will be developed to prevent international spread and contain outbreaks rapidly.
We, as university students, have a role to play in bridging the gap in access to essential medicines such as the yellow fever vaccine. Due to the current shortage in Brazil, this vaccine remains out of reach for many vulnerable populations. Life-saving vaccines should not be a luxury. Let's address the drug availability problem by advocating for and developing initiatives that allow all of those at risk to have access to the vaccines they need.
References and Further Reading:
Written by: Ethan McQueen and Michael Bridgeraj
Ethan and Michael are currently in their second year of undergraduate studies at Western University. Ethan serves as a UAEM Access Representative and Michael serves as an UAEM Innovation Representative.
A harrowing fact was the subject of a recent study in the Journal of Clinical Oncology: the prices of life-saving injectable cancer treatments in America are increasing even faster than the rate of inflation.
The price of novel cancer drugs have more than doubled in the past decade, as they now cost on average $10, 000 per month, though some have reached more than $30, 000 per month. Old treatments have also skyrocketed in price - the average percent change in costs for cancer drugs over only an 8-year period was +25%. Some of the most extreme price hikes include:
Many patients bear the sentiment that spending their income and liquidating their assets is not worth extending their lives by a matter of months, and choose to forgo treatments and/or doctors’ orders – in fact, up to 20% of cancer patients do not follow their advised treatment plan for this reason, as reported in a nationwide study that involved more than 100 American oncologists. A separate study that followed 200 patients over a spectrum of cancer types and degrees of severity found that 66% of men and 79% of women believe that the costs of their treatments are or are becoming unmanageable (see Figure).
The costs of cancer drugs are a market anomaly: for most products, competition decreases prices. However, competition has only driven the prices of these medicines up. Dr. Daniel Goldstein of Emory University in Atlanta posits that this atypical pattern may be the result of pharmaceutical companies communicating with each other and agreeing to simultaneously raise their prices, though he has yet to verify this posit.
This all, then, raises the question: why do cancer drugs cost so much? There are numerous factors that contribute to these high costs. Interestingly, the efficacy of a drug seems to have little influence on its price. It seems, then, that pharmaceutical companies price cancer drugs based off of what they think the market will bear. Pharmaceutical companies themselves claim that these prices are a reflection of the high cost of research and development. Advancing drugs from the bench to the bedside is a very long and expensive process, costing about $1.2 billion to $1.3 billion per new drug. The process of developing a drug is made even more onerous due to the amount of regulatory procedures that are imposed by health agencies such as the National Cancer Institute. A drug must pass up to 600 regulatory procedures, half of which researchers feel are unnecessary. Furthermore, a cancer patient is regularly treated with a multitude of cancer drugs. This creates a monopoly, because the use of one drug does not mean that the others are not needed.
There have been a number of reforms that have been proposed to try to solve this problem and ultimately make these life-saving drugs more accessible. Unlike in Canada, there are laws that prohibit the American government (Medicare) from negotiating with pharmaceutical companies for lower prices. These laws have been contested; though, this has been met with resistance from the pharmaceutical and biotechnology industries. Furthermore, there is a need for improved and more transparent evidence-based national guidelines regarding cancer treatments. The current American cancer guidelines outline all the possible treatments, but fail to assess the cost against the effectiveness (i.e., the mortality rate and the quality-adjusted life years (the number of years, adjusted for quality of life, that a treatment is projected to provide)) of each treatment. Dr. Peter Bach, the Director for the Centre for Health Policy Outcomes at Memorial Sloan Kettering Centre in New York, supports value-based pricing; this pricing approach accepts the reality that drug development is costly, and instead prices the drug based on its performance: if a patient responds well to a drug, pay more; if not, pay less.
However, it seems that America is reluctant to adopt value-based pricing. The Republican administration favours pricing based on supply-and-demand, and believes in personal responsibility for health care. Ultimately, efforts must be made to strive towards a framework that will strike the balance between affordability for the payers and profit/incentive for the payees. Failing to do so may result in a healthcare system that fails the very people that it is supposed to protect.
References and Further Reading
Written by Janine Ting
Janine is currently in her second year of undergraduate studies at Western University and serves as a UAEM Access Representative.
If you could change your own DNA, how would you do it?
Well, one person has already officially done it. Meet Josiah Zayner, a biohacker with a Ph.D. in Biophysics, he is the first individual to publicly edit his own DNA as well as publish the process on a live stream. He accomplished this by utilizing a relatively new tool available to genetic engineers, commonly referred to as CRISPR-Cas9 technology in order to “knock out” a target gene [1.b].
By using easily obtained materials valued under 400$, the goal of his demonstration was to show the world that gene editing is no longer a thing of the past. Zayner explains, “Though this experiment was on me. I don't want it to be only about me. I want it to be about how this technology is inexpensive and easy to use. I want to it to be about helping people use this technology to better their lives [1.a]”
In Zayner’s specific experiment, he injected his muscles with a serum made with CRISPR technology that essentially “knocked out” the gene which coded for myostatin, a protein that inhibits muscle growth [2.a]. When myostatin’s inhibitory effects are removed, muscles start to grow . This was achieved by a CRISPR complex formed after the injection which causes missense mutations, a type of mutation that changes the coding sequence, to form in the target gene and render it ineffective [1.a]. This specific modification of the myostatin gene is currently being tested on rats in hopes of treating severe forms of muscle atrophy in humans .
While it doesn’t mean that we should all go out and purchase a CRISPR gene editing kit, it does mean that genetic engineering is becoming increasingly more accessible to the public. It takes groups of people to create scientific change but, with greater access it becomes a lot easier. No longer is genetic research restricted to multi-billion drug development agencies, but also available to individuals and aspiring scientists. Zayner is driving forward a change in mindset that entices individuals (scientists or not) to conduct their own research and ultimately, his CRISPR kits may eventually serve as a cheap and an alternative solution to genetic disorders in the future.
Photo Credits: http://www.ifyoudontknownowyaknow.com/p/about.html
Written by: Kevin Sun
Kevin is currently in his first year of undergraduate studies at Western University and serves as one of UAEM Western's Empowerment and Events representatives.
HIV? Malaria? Tuberculosis? At some point in your life you must have heard about one of these diseases whether it be through increased online exposure, the media or strikingly high mortality rate. Now try leprosy, schistosomiasis or Chagas disease? It is likely you have not and you are not alone. The diseases mentioned are part of a group called Neglected Tropical Diseases (NTD).
NTDs are various infectious diseases caused mainly by viral, protozoa, bacterial or Helminth agents found in low-income countries with tropical and subtropical climates where they are most prevalent. The primary contributing factors of NTD involve inadequate housing, poor hygiene and the lack of accessible clean water. Sadly, it is commonplace for individuals living in poverty to be infected by more than one parasite or infection simultaneously. Although unrecognized by many, NTD has killed 534,000 people on estimate and affected more than 1 billion people worldwide; a burden not only to the health and well-being of many but to the economic growth of low-income countries.
But the question is, WHY is it neglected? There are several factors involved, primarily being the social stigma surrounding the diseases. NTDs often cause physical disfigurement, blindness and impaired cognitive development resulting in alienation from family, friends and society. The consequences that occur are tremendous. Individuals are prevented from receiving educational and employment opportunities, health and social service resources and restricted civil and political rights. Nonetheless, poor mental health encapsulates these patients and reinforces the entrapment within the cycle of poverty.
Consequently, NTDs are rarely found in developed countries, affecting the “bottom billion”—individuals who live less than the World Bank poverty figure of $1.25 per day. Due to the lack of a strong political voice, low socio-economic status and profile of the individuals, they are typically disregarded as a problem, rendering them invisible to a helping hand. Furthermore, with a high morbidity rate but a low mortality rate amongst NTDs, the disease group is overlooked and typically forgotten. In other words, countless individuals are suffering from NTDs and endure a low standard of living but very few experience death by NTDs. In comparison to other diseases such as Zika and Ebola- it is not as horrific or infectious.
On another note, many NTDs are highly treatable and can be prevented with accessible medicine and correct healthcare tools. The Gates Foundation founded by Bill and Melinda Gates has been active in this field where they have implemented a new plan of action in the treatment of multiple infectious diseases which include mass drug administration, public-health surveillance and vector control. The effort exerted by The Gates Foundation has made significant progress in the elimination of leprosy in numerous countries, however this is simply not enough.
For people like us, who are privileged enough to have access to numerous healthcare resources, this problem can seem imperceptible and distant. Yet, it is a harrowing reality faced by far too many. The underlying issue in the Research & Development system is highlighted by the insufficient funds that are put towards research in NTD and the fact that there are rarely new drugs being developed. Ultimately, everyone deserves an equal opportunity at living a healthy life. Therefore, it is essential to raise awareness and gather support from the public, in order to pressure policy makers and pharmaceutical companies into making changes to an unjust and biased system that denies people their basic human rights.
Written by: Gigi Liu
Gigi is currently in her second year of undergraduate studies at Western University and serves as one of UAEM Western's Campaign Core Leaders
What is the value of science and technology? Not very much, according to the latest budget proposal from the Trump administration. Whether it is due to President Trump’s inability to comprehend the complexity of the work being done by scientists in America, or simply because he realizes facts produced by the research will negatively impact businesses, one thing is for certain, the new president is not a fan of scientific research.
Many science programs in America will be taking a huge hit due to this proposal including programs listed below:
Trump’s vision of the budget sounds economically reasonable, less money for science means more money for other programs such as national defense. However, like many other people, Trump does not realize the impact of basic research on our day-to-day lives.
The NIH will soon experience a reduction of 20% in their overall budget under the Trump administration. Most of the NIH’s budget currently goes towards funding research in health care and universities across the country. For many scientists in biomedical research, this funding provides money to pay salaries, purchase equipment, and train prospective PhD students; ultimately allowing them to conduct cutting edge research. As the years go by, it has become increasingly difficult for scientists to receive funding for their projects. The graph below shows that the amount of NIH funding has plateaued in recent years resulting in a decline in the number of proposal successes. Because of insufficient funding, many interesting and potentially impactful questions are not being investigated.
Unlike the work done in pharmaceutical companies, the research conducted in basic biomedical research is not the kind that will produce a tangible, marketable product. Instead, it allows researchers are able to gather data about the impact of certain substances on organisms, investigate new physiological properties, and uncover new effects of substances being used currently; all of which contribute to improving our quality of life. The scientists then publish the results, whether they are good or bad in order to provide an impartial and objective truth.
Pharmaceutical companies are conducting research with a motive in mind: creating a product that will generate profit. They may resort to tampering data in order to force the numbers to produce a desired result, limiting the sample, ignoring issues with control group participants, and eliminating samples that do not conform to their desired result can achieve a more desirable result. In these companies, the production of a single drug can take up to 10 years of research and cost millions of dollars. Thus if a drug is found to be useless at the last stage of testing, the researchers will be under intense pressure to change the data or leave it unpublished in order to maximize company profit.
As governmental funding for basic research decreases, an increasing number of researchers are forced to turn to industries to fund their work. Industry funding can have dire consequences on the data that is obtained. A 1996 study on the effects of nicotine on cognitive performance revealed that nicotine or smoking improves cognitive performance. However, it is important to note that these scientists were also funded by the tobacco industry. Funding by the industry imparts bias to the researchers, and affects the honestly of their work and results. This means the results are no longer impartial because if the findings from the study don’t look good for the funder’s bottom line, it does not get published.
Health care professionals use the data and conclusions generated by researchers in order to make decisions and treatment plans for their patients. By asking researchers to rely on these alternative means of funding, millions of health care professionals may end up receiving “alternative facts”. Patients may be prescribed useless, or harmful drugs which could have been avoided had the professionals been provided all the accurate and unbiased data.
The Trump administration’s budget proposal is not only shortsighted, but it also fails to recognize the critical role of biomedical research in saving the lives of millions of Americans. Good science cannot happen unless it is divorced from corporate interests. It is a matter of pursuing a finding, instead of a pursuit of knowledge. This budget cut will push scientists to seek alternative means of funding. This not only compromises results, but it also compromises the health of all Americans.
Written by: Tiffany Ni
Tiffany is currently in her third year of undergraduate studies at Western University and serves as one of UAEM Western's Report Card Leaders
The results of the United States 2016 presidential election were a shock to many around the world. Donald Trump had made no secret of his plans to repeal Obama’s Affordable Care Act, commonly referred to as Obamacare or Medicaid, and in early March the Republican Party finally revealed its new health care plan.
The new Republican bill would reduce the expansion of Medicaid, which has provided coverage to more than 10 million Americans in 31 states, and reduce the federal payments to beneficiaries. The new bill will also remove the requirement for larger employers to offer their full-time employees insurance. Furthermore, the bill aims to undo many of the features in the Affordable Care act that were disfavoured by the wealthy; such as, income-based tax credits that help millions of Americans buy insurance, and the taxes on people with high income. Trump’s new plan will also cut off funding to Planned Parenthood clinics through Medicaid and other government programs for one year.
Although the new bill presents many reforms to Medicaid, it retains three of Medicaid’s most popular features: the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps, and the rule allowing young people to remain on their parents’ health plans until the age of 26. The new plan also reduces tax credits for individuals with annual incomes over $75,000 and married couples with incomes over $150,000.
Since the release of this new healthcare plan, there has been a loud outcry from critics that believe the new bill will worsen inequality in America. An article released by the Commonwealth Fund states that the American government spends more money on health care than most other first-world nations, yet has one of the lowest average life spans among first world nations. A recent article published in the Lancet estimated the average life expectancies of Americans to be on par with individuals living in Mexico by 2030, and a fair degree lower than the average life expectancies of those living in other developed nations. However, this does not mean that the average lifespan of all individuals across America is low. The average lifespan of women in Fairfax, Va., is 85 years, while the average lifespan of women just 350 miles away in the relatively poorer McDowell County, W.Va. is just 72 years. The reason for such a large discrepancy, many believe, is because of the better health care afforded to the rich. Critics of Trump’s new plan assert that his new bill will only exacerbate these differences in health care.
Doctor Cynthia Haq remembers the surge of patients she saw in Wisconsin hospitals after the Affordable Care Act became available: “Hundreds of patients were streaming into our clinics for the first time, some who hadn’t seen a doctor in 20 years.” Nearly, 200,000 Wisconsin residents gained insurance coverage when Obamacare came into effect, most of whom were individuals making around $29,000 per year. She is one of many physicians that worry Trump’s new plan will result in a decrease in visits from lower income patients.
Although Trump’s new plan will undoubtedly decrease the coverage provided to lower income and older Americans, supporters of the bill insist that this is balanced out by the increase in coverage to upper middle class Americans whose workplaces may have provided only minimal coverage, as well as younger Americans. Trump’s new bill is planned to be put into effect in April of this year. Whether the new bills benefits outweigh its costs can only be seen with time.
Written by: Mikayla Tyra Hall-Bruce
Mikayla is currently in her first year of undergraduate studies at Western University and serves as one of UAEM Western's Events and Empowerment Representatives
Earlier this week, the World Health Organization released a list of 12 antibiotic-resistant organisms, which they have determined to be the "greatest threat to human health." The list contains pathogens such as carbapenem-resistant Enterobacteriaceae (CRE), which invariably kills half the people who are unlucky enough to acquire it. CRE and other such ‘superbugs’ are one of the biggest problems facing the future of medicine. Rapid bacterial evolution results in the emergence of superbugs that carry genes which make them resistant to antibiotics and extremely difficult to treat. In response to the emergence of a number of resistant organisms, the WHO Director General, Margaret Chan, has warned of a “post-antibiotic era” where even common infections could be deadly.
Antibiotic resistance is commonly attributed to antibiotic misuse and overuse. Fingers get pointed at lazy doctors who prescribe antibiotics for common colds and patients who do not adhere to their antibacterial treatment regimens correctly, allowing drug-resistant bacteria to flourish. The intensive farming industry is also to blame for pumping livestock and poultry full of antibiotics to sustain the mass production of meat. The considerable quantities of antibiotics used in factory farming serve to inadvertently create resistance genes that can jump between bacteria-- resulting in the creation of drug-resistant strains that can infect humans.
Although antibiotic misuse is an important cause of antibiotic resistance, it is certainly not the only one. Superbugs are a significant threat not only due to bacteria evolving too quickly, but also because antibiotics are evolving too slowly. In the arms race between bacteria and antibacterial agents, the bacteria are winning. To say that the development of antibiotics is lagging would be an understatement-- the antibiotic pipeline is basically bone dry. Both the total number of antibiotics brought to market and the discovery of novel classes of antibiotics have declined precipitously in recent decades. The number of new antibiotics on the market has been declining since the 1980s and almost every currently available antibiotic is derived from a class discovered before the mid 1980s. When bacteria become resistant to antibacterial agents, they tend to be resistant to multiple agents in the same class. Without the development of new types of antibiotics with unique mechanisms of action, we don’t stand a fighting chance against drug-resistant organisms.
The WHO’s list of 12 superbugs published earlier this week classifies drug-resistant bacteria based on the urgency of developing antibacterial agents. This list is part of a global action plan and a call to spur the pharmaceutical industry to focus their efforts on the development of new essential antibiotics. One of the key reasons for the lack of progress in antibiotic development, is the retreat of the pharmaceutical industry en masse from antibiotic development. Of the 18 largest pharmaceutical companies, 15 had cancelled their antibacterial research & development programmes by the early 2000s. There is simply not a sustainable return on investment for antimicrobial drugs, compared with drugs for chronic conditions and cancer which can be sold for higher prices, have a larger market and are prescribed for a longer course than antibiotics. The abandonment of the antibiotic market by the leading pharmaceutical companies left academic institutions and smaller pharmaceutical companies with limited financial backing to bear the brunt of antibiotic development-- unfortunately with little success.
That is not to say that there is no hope. Upon recognizing the potential catastrophic consequences of inaction, governments, industry and international bodies have made steps towards combatting superbugs. Last year at the World Economic Forum, 85 companies in the pharmaceutical and biotechnology industries, signed the “Declaration on Combating Antimicrobial Resistance”, among these signatories were pharmaceutical giants such as AstraZeneca, GlaxoSmithKline and Pfizer. The declaration calls on governments to support R&D of antibiotics through incentivizing drug discovery. This global commitment is promising, and marks a recommitment of many major pharmaceutical companies to antibiotic R&D.
A lack of effective antibiotics to treat increasingly common infections will change medicine as we know it. The emergence of new superbugs and the rapid progression of bacterial antibiotic resistance can certainly be slowed by proper antibiotic stewardship. But a sustainable solution to the problem of antibiotic resistance must include the development of new antibiotics, including those in different drug classes with novel mechanisms of action. The lack of antibiotic alternatives can be explained by the pharmaceutical industry’s reticence to fund the development of new antibiotics. There must be a massive push from government and industry to revolutionize the antibiotic market through implementing financial incentives and regulatory policies that support antibiotic development. Without major changes in the drug development pipeline we will be powerless in the fight against superbugs.
Written by: Emily Stephenson
Emily is currently in her first year of medical school at the Schulich School of Medicine and Dentistry and serves as UAEM Western's medical school liaison.
You sit face-to-face with a notorious public figure. “Hear me out,” he says.
Several hundred Harvard College students made their decision when Martin Shkreli made his appearance on campus two weeks ago and asked them the exact same thing. The former drug executive, who notoriously raised the price of a life-saving drug from $13.50 per pill to $750, was invited by the Harvard Financial Analysts Club (HFAC) to speak to undergraduate students about investments and healthcare. Inevitably, his appearance sparked controversy--some students planned a peaceful protest, others pulled a fire alarm to trigger evacuation, and some attendees walked out after calling him a “sexual predator” and “racist.” Many also stayed.
Although important topics, today’s blog post will not discuss the integrity of the HFAC’s decision or form an opinion about the student reactions. Rather, we would like to take this opportunity to step outside of our predominantly liberal space to explore opposing opinions, gain knowledge, and think critically to develop a well-informed opinion.
While the majority of us want to immediately denounce Shkreli’s drug hike decision, there’s always two sides to a coin and it’s important that we explore his point of view and justification in raising the price. Throughout his many interviews with journalists, Shkreli pointed out a few ‘justifications’, one of them being raising the price of Daraprim for research and development purposes. He hopes to improve the current formulation of the drug and to develop new therapeutics since no significant advances into the disease have been made for a decade. But according to many physicians and professors, there is no need for new advancements, as the toxoplasmosis targeting drug works perfectly well (Fortune). So I guess it comes down to how much of that 5000% increase is actually going into R&D?
To shed some more light into the mind of Martin Shkreli, his ‘whole life has been one theme, of self sacrifice for his investors. He did [the price hike] for his shareholders’ benefit because that’s his job’. He continues saying that by charging $750 a pill to big companies like Walmart, it makes him feel like a hero since the money earned would go towards research for dying kids (The Guardian). So what if Shkreli is actually a robin hood in disguise? Taking from the rich and giving to the poor. Maybe we’ve had him wrong this entire time, maybe the media painted a nasty picture of him without hearing him out? To Shkreli, he certainly feels that’s the case.
During a casual lunch with a journalist, Shkreli expressed his concerns about the media and politicians that attacked him. He feels he became a target not because of what he did but because he was so easy to parody - essentially, he feels ‘misunderstood’ since other companies have jacked up drug prices with no consequences. Why should he get the blame when many other price hikes go unnoticed? How can you hate a person who says “I care more about drug science than anyone you can point at. I love this business and I love science and I hold my yardstick to that. I know I’m helping patients. That’s all I need to know” (Forbes).
To conclude, Turing pharmaceuticals’ actions should be no surprise at all, since one would be a fool to forget that pharmaceutical companies are profit-driven institutions. The issue is not the increased profits per se, but rather the use of these profits. While Shkreli claims that the increased profits from the price hike in Daraprim will support research and development of drugs, documents reveal that they are in reality being spent on lavish company celebrations and six-figure Turing executive salaries (the New Yorker).
What should be a surprise to us is what this reveals about the pharmaceutical industry. After Turing acquired rights to produce and sell Daraprim, it essentially became a monopoly for the drug in America. The reason for this was that there were insufficient policies and regulations in place to expedite the transition to generic drug production and promote competition. This serves as a critical warning of the fallacies in the regulation of the pharmaceutical industry, and by extension, emphasizes the importance of adopting more socially responsible patent and licensing policies to prevent the greedy hands of profit-minded executives from stripping helpless patients of essential medicines. If a roof leaks water after a heavy storm, who is to blame—the storm or the mason who constructed the roof? Shkreli is simply a scapegoat towards which the public is directing its anger. In reality, we should channel our concerns towards more critically evaluating the failure of the pharmaceutical industry.
Written by: Nancy Wu, Nabeel Mansuri, Kevin Fan
Nancy, Nabeel, and Kevin are currently in their third year of undergraduate studies at Western University and serve as Directors of the Access Committee
Back in 2012, the federal government in Canada passed a bill that would cut refugee healthcare funding by a quarter, saving around $20 million annually. On January 27, 2017, president Donald Trump issued an executive order that would ban the immigration of refugees and citizens in seven predominantly Muslim countries. Yet in a world that is becoming increasingly more divided—pushing away vs. reaching out to refugees with open arms—one particular action may have just tipped the scales in favour of humanitarian and social justice.
Recently, the Canadian federal government announced that it would restore refugee healthcare benefits to pre-2012 levels. Although the effects of better healthcare have yet to be seen on a macro level, the following passage is a testimony to the efficiency of the healthcare system, and if anything, offers a glimpse of hope.
The anecdote that follows is from a third-year medical student:
I have the privilege of working at a community health centre affiliated with McMaster University which is one of the centres dealing with refugee health. The family doctor I work with primarily deals with Syrian refugees, due to the fact that he speaks Arabic. When the government first accepts refugees they screen them for TB. When they arrive in Canada, they get put into a group home (the one in Hamilton is called Wesley Urban Ministries). Ideally, within two days of arriving in Canada, we visit the refugees at their group home and interview them. When I walk in, I immediately notice the stark contrast between this and the normal hospital setting. There’s a seven-year-old girl who’s missing a leg from a bomb explosion, and another man with fungal skin infections everywhere. We give them a head-to-toe assessment: taking their height, weight, blood pressure; accessing their history on previous immunizations and medications; auscultating their heart and lungs; and screening them for diseases such as lice and fungal skin lesions. After our visit, Wesley Urban Ministries arranges the family to see a dentist and an optometrist. Considering the amount of refuges that have cavities, I’m really impressed by this aspect of their healthcare. When we get the patients’ blood work back, we perform a comprehensive screening (hepatitis, MMR, varicella, etc.). The refugees come back to get all the immunizations they need, and usually a flu shot as well. We prescribe further medication, and perform a more thorough medical history is necessary. Part of the purpose of the second visit is to see how the refugees are coping with life in Canada, and how they are getting by at Wesley Urban Ministries. A big part of all of it is ensuring that they are healthy both physically and mentally. When you think about how little people that aren’t refugees actually receive this level of care, I’m surprised about how good the system really is, it’s actually quite good.
Despite all this, there is still a lot of work to be done. As of now, only government-assisted, privately sponsored, or approved refugees are given access to proper healthcare. For those who can’t readily access the treatments that may potentially save their life, Canada may as well be one of the worst places to immigrate to. In fact, Canada pays the second highest drug prices in the world, only after the US. Amlodipine, a drug used to treat coronary artery disease, is priced at $130 in Canada, but only $10 in New Zealand. So it’s quite embarrassing that I’ve seen articles titled, “The Canadian Remedy: How to save hundreds on prescription drugs” written by ABC affiliated-WZZM where they advocate travelling across the border to “save hundreds, even thousands” on prescription drugs. Canada needs more systems and companies like New Zealand’s PHARMAC, which dramatically lowers the price of drugs to make them more affordable and accessible.
And although there is still a lot of work to be done in a world where so much of society is divided, and where Muslims have never felt more unwelcome, the recent appeal has given the refugees the sole most important thing in this battle for social justice: hope.
Written by: Jason Liu
Jason is currently in his first year of undergraduate studies at Western University and serves as one of UAEM Western's Empowerment and Events representatives.
The World Health Organization (WHO) defines “health” as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. However, it is imperative to note that access to quality care and essential medicines is a strong determinant of how healthy individuals are. Explanations of lifestyle are dominant in Western views, but social factors are better predictors of health and are more effective, especially at the group or population level of analysis. The social determinants as a whole, can have varying effects on the health of vulnerable population groups such as those in remote and rural settings.
Populations in developing countries do not have the same access to health care and treatments that we take for granted. The World Health Organization estimates that up to 3 million children die each year in Africa from diseases, of which a significant amount can be prevented. These children suffer from vaccine-preventable diseases including measles, polio, meningitis, tuberculosis and pneumonia. This can be directly attributed to the lack of rural health service delivery in remote places across the continent. There is no infrastructure in place to address these limitations because there has not been investment to do so. There are safe and effective treatments to cure or prevent all of these ailments, but a combination of societal and geographical factors makes it hard to do so.
Additionally, the current research and development system has hindered the delivery of essential medicines to these populations. Societies are suffering from treatable illnesses because they simply cannot afford the price of expensive Western medication. The for-profit pharmaceutical industry has made it increasingly difficult to provide inexpensive care because of the high cost of essential medicines. The World Health Organization has a list of essential medicines that should be available to adults and children all over the world in sufficient amounts and at any time. However, this is not the current reality. Individuals in low socioeconomic settings in developing countries cannot access the lifesaving treatment that they need.
Above all, access to health care is an issue that affects different subsets of populations all over the world. Not only do we see this problem in developing countries, it can be found even in Northern Ontario and the aboriginal populations. To address this issue, the price of people’s lives need to be valued more than the price of pharmaceutical drugs. This is the essence of what UAEM is trying to achieve. It should be mandatory for individuals all over the world to be given the same level of access to essential medicines so that they can treat curable diseases. For further reading, check out the link below and get in contact with any UAEM member to find out what you can do to get involved.
Written by: Gagan Dhaliwal and Yallenni Imanvaluthy
Gagan and Yallenni are currently in their third year of undergraduate studies at Western University and serve as one of UAEM Western's Global Research and Development Leaders and Campaign Core Leaders respectively.