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.
In this battle to make sustainable healthcare more accessible, it is great to hear yet another group of passionate people who advocate equal rights. Novartis International AG, a Swiss-based pharmaceutical company is pitching for exclusive patents rights on the drug Glivec in India. While the drug shows potential for cancer treatment, exclusive patent rights for a private organization undoubtedly translates into millions of people being deprived of this provision.
Being a member of the World Trade Organization, India imposes a strict patent law to avoid second-party transaction monopolies on medicines. While Glivec is sold for $40.46 by Novartis, the generic drug can be sold for $3.28. On average, 1300 people die on cancer every day in India, and thus access to medicine is a necessity.
In a situation like this, it is important to voice the ideology of affordable medicine for all and prevent the system from breaking under the influence of powerful private organizations. Such a step was taken when in an open letter to Novartis, the representatives of Doctors without Borders plead Novartis to “focus on innovation and not take actions that reduce access to essential medicines.” With the actions of spreading awareness and learning about the implications that supply of generic drugs have on lives of people, especially within the developing world will go a longer way to making medicines affordable for all.
With court proceedings running for over a decade, the Indian Court System ruled against evergreening the sale of Glivec for Novartis in 2013. The decision was widely accepted by global organizations including the World Health Organization and Doctors Without Borders who highlighted the benefits of the ruling for millions of people in poverty.
As students from Canada, a country with universal healthcare system, we can understand the importance of having access to medication. Being a member of the access committee in UAEM Western Club and through this blog, I want to highlight this one global issue and see how we as Western students can work to carry the philosophy forward.
To learn more about similar global issues, you can visit the following sites: http://www.msf.ca/en/article/stop-threatening-access-affordable-medicines-millions
http://www.msf.ca/en/access-medicines http://www.forbes.com/sites/judystone/2016/11/13/new-pharma-rankings-on-glob al-access-to-medicine/#3e1050402123
Written by: Janhavi Patel
Janhavi is currently in her second year of undergraduate studies at Western University and serves as one of UAEM Western's Report Card Leaders.
Have you ever been prescribed a course of antibiotics to treat your bacterial infection, but neglected to complete the full course of medication? You may think that there will not be any serious repercussions, but in truth, there may be. If you were to stop your treatment early, there is a risk that the antibiotics may not have killed all the bacteria and that they will mutate and develop resistance to the antibiotic. Not only does this pose a danger to you, the individual, as the infection may recur and be more difficult to treat, but there is also an associated risk to the general population due to the infecting bacterium becoming more resistant to the specific antibiotic.
On September 9, 2016, Harvard Medical School released a video online titled ‘The Evolution of Bacteria on a “Mega-Plate” Petri Dish (Kishony Lab)”, wherein they carried out a lab experiment demonstrating how the bacterium E. coli adapts to increasingly higher doses of antibiotics. In less than two weeks, the researchers observed as the bacteria spread towards the highest drug concentration of the antibiotic trimethoprim at an alarmingly rapid rate. The bacteria produced mutant strains that were capable of surviving a dose of the antibiotic that was 1,000 times greater than the one that killed their progenitors. While this petri dish experiment does not perfectly imitate the conditions in the real world, it does provide insight to the adaptive and survival abilities of bacteria more accurately than traditional lab cultures. This study ultimately demonstrates the possible implications of people misusing and overdosing on antibiotics.
The implications of this example may not seem significant until it is applied to the real world. In the same month as the Harvard experiment above, a woman in her 70’s died from infection caused by carbapenem-resistant Enterobacteriaceae (CRE), a strain of bacteria that is now resistant to all existing antibiotics. But why haven’t we heard anything about it on the news? Last year, a Pew Charitable Trust report revealed that too few antibiotics are in development, and that a majority of antibiotics are being developed by small companies, rather than large pharmaceutical companies. Not only are these big pharmaceutical companies not stepping up to the plate, but there has been a complete lack of media coverage and awareness regarding these issues. This crisis of antimicrobial resistance has not been receiving the attention and coverage it deserves.
It is a lesser known fact that nowadays, antibiotics are not only used and abused by humans but also fed to livestock to keep the animals healthy, thus contaminating our environment and indirectly influencing us again. This puts us, as a global community at high risk of developing an accelerating resistance to many forms of harmful bacteria. As more and more antibiotics are exhausted, we are at a desperate need to discover more new antibiotics that the bacteria have never been exposed to before. Without time on our side, this is a concern that is quickly becoming a global crisis at an alarming rate.
However, not all hope is lost in this seeming futile battle against antibacterial resistance. Recently in November of 2016, professor Sean Brady, head of the Laboratory of Genetically Encoded Small Molecules at Rockefeller University, and his team discovered a new method of finding new antibiotics. They used computational methods to scan the genomes of many microbes for sequences that may produce useful antibiotics, and then synthesized these compounds in the lab. They produced two new antibiotics this way without having to culture any bacteria, which is a tricky process as not all bacteria can grow in labs, and often the genes that will code for antimicrobial resistance won’t be turned on. Brady says that he hopes his new method will inspire the scientific community to take advantage of new technologies to further digitally mine the genomes of many bacteria that have not been sequenced yet, to produce novel antibiotics efficiently.
But in essence, this does not solve the root problem of the antimicrobial resistance crisis, as resistance will still persist even as we continue to churn out new medicines. It’s a never-ending arms race, and we must continue to creatively max out all of our resources to discover novel ideas and approaches to counteract resistance. One thing to take home from all this, is that currently, antimicrobial resistance cannot be stopped, but can be slowed down - and that requires the global knowledge of the effects of antibiotics and its proper usage. In this fight, less is more, and controlling our intake of antibiotics is the first step in buying us more time in research and development.
For more readings:
WHO Antimicrobial Resistance Fact Sheet: http://www.who.int/mediacentre/factsheets/fs194/en/
Harvard Medical School Study: https://hms.harvard.edu/news/bugs-screen
Bacteria Resistant to All Antibiotics: http://www.forbes.com/sites/brucelee/2017/01/15/woman-dies-from-bacteria-resistant-to-all-antibiotics-why-dont-more-people-care/#37462a570329
Prof. Sean Brady of Rockefeller University: http://www.futuretimeline.net/blog/2016/11/20.htm#.WIpmtfkrKM8
Written by: Sherry Cui and Elenka Yu
Sherry and Elenka are currently in their first year of undergraduate studies at Western University and serve as UAEM Empowerment and Events’ representatives.
Our nation has been one of the drivers of innovation in the field of medicine and we are very fortunate to have so many research institutions, such as Western University, contributing to pushing the boundaries of knowledge. I know that many science students are involved in research or at least are thinking about pursuing an area of research. The question I want to ask in the context of Western is, what areas have we been focusing on? What areas have we been neglecting?
As researchers, we have the curiosity that drives us to further explore our passions but also the noble goal of benefiting our society and humanity. Have you heard of Chagas disease? Dengue fever? Lyme disease? These are diseases that devastate a huge proportion of the world’s population yet hasn’t been brought to the public awareness or the topic of discussion in academia. This is also the case for the rising problem of antimicrobial resistance illustrated in the previous blog posts. All of these observations of a lack of research in areas that have lower profitability illustrates a larger problem in our research and development system. In many ways, it is failing to address global health needs.
We see that this is important to address because universities play a role; one quarter to one third of new medicines originate in a university lab. “The social mission of academic institutions allows them to use public resources to serve and strengthen society. Our universities can, and should, be challenging this profit-driven system using their unique leverage to both propose and implement solutions to create a patient- centered R&D system.”- Rachel Kiddell-Monroe.
As science students who are active in the research community, we believe that access to healthcare should be a right, not a privilege. It is important to consider the potential impacts of our research on society and global health. We need to take the initiative to ensure the fruits of our research are disseminated to people who need them most. Students also play a role in this global health issue and they will continue to play a role because they will make up the next generation of researchers, educators, and policy makers.
For more readings:
Written by: Emmy Sun
Emmy is currently in her third year of undergraduate studies at Western University and serves as UAEM Western's VP Innovation.
Dr. Chil-Yong Kang of Western University and his team of researchers have been making waves in the scientific community for their development of a prophylactic vaccine against HIV. More than 36 million people around the world are currently living with the virus, and almost as many have died from AIDS-related diseases since its discovery in 1983. Over the years, there have been countless efforts to produce a drug or vaccine against HIV but they have met with little success.
What sets Dr. Kang’s research apart from previous attempts is that his vaccine uses a deactivated whole HIV-1 virus to build the body’s natural immune system against it. Although vaccines against diseases such as polio and hepatitis A use a similar approach, it is controversial in the fight against HIV as the virus’s quick mutation rate makes it difficult to inactivate completely. To overcome this issue, Dr. Kang’s team genetically modified the HIV-1 virus using genes from honeybees and further used chemical treatment and gamma radiation to ensure the virus is entirely deactivated.
Phase I trials were completed in 2013 using 33 HIV-1 infected subjects. The results exceeded expectations – the vaccine produced no adverse effects in the subjects and even showed signs of increasing immunity against the virus. Phase II is to begin in 2017 and will further test this immune response.
SAV001 has been approved by the FDA for human testing, and the R&D costs for the vaccine are funded by the Bill and Melinda Gates Foundation and the government of Canada. Currently, Sumagen Canada, a subsidiary of Sumagen Co., Ltd. holds the Exclusive License for the development and subsequent commercialization of vaccine. If human trials produce desirable results, the company will look towards collaborating with pharmaceutical companies to sell the vaccine in countries around the world.
UAEM is a group that is focused on the importance of increasing access of vaccines and drugs to lower and middle income areas, especially in developing countries. Through Western’s Technology Transfer Office (TTO), Sumagen Canada has secured patents for SAV001 in 70 countries, including China and India. While this is great news, life-saving drug patents cannot be handled on a case-by-case basis, which highlights the importance of setting a framework such as the GALF that allows the university’s medicine and biotechnology innovations to be accessible to low- and middle- income areas around the globe.
For more information on the biochemistry behind the vaccine and to learn more about the R&D process, please visit the following websites:
In-depth information on SAV001: http://www.natap.org/2013/newsUpdates/092313_01.htm
Vaccine access and R&D: http://www.doctorswithoutborders.org/news-stories/special-report/giving-developing-countries-best-shot-overview-vaccine-access-and-rd
Role of universities in the access to drugs fight: http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.0030136&type=printable
More coverage on SAV001: http://mediarelations.uwo.ca/2016/12/01/western-virologist-hopes-test-vaccine-600-hiv-negative-subjects-next-fall/
Information on the Global Access Licensing Framework: http://uaem.org/our-work/global-access-licensing-framework/
Written by: Jasleen Dayed
Jasleen is currently in her first year of undergraduate studies at Western University and serves as one of UAEM Western's Report Card Leaders
CRISPR is a powerful gene-editing tool acclaimed to be the biggest breakthrough in biotech since well, the start of biotech. Unlike its gene-editing predecessors, it is able to essentially cut and paste sequences to targeted loci with relative ease by simply synthesizing the corresponding guide RNA. The discovery seems to show limitless possibilities with its implications for genome engineering, disease models and gene therapy.
Western has already made progress in affecting efficacy and possibly off-target effects in CRISPR/Cas9 as David Edgell and his team of researchers have published a paper last month in the Proceedings of the National Academy of Sciences (PNAS) on the addition of I-TevI to Cas9. Other progress in HIV immunity and muscular dystrophy have been made however no “CRISPR drug” exists yet.
With the promising future of CRISPR, control over the technology could be worth billions. Startups have already invested millions into developing CRISPR into cures including Editas Medicine and Intellia Therapeutics, associated to Feng Zhang of MIT-Harvard Broad institute and Jennifer Doudna of the University of California, Berkeley respectively. Zhang and Doudna are currently in a fierce and complex legal battle for patent rights on the commercialization of CRISPR. Until a decision is made, commercialization of CRISPR has come to a halt.
The legal case of CRISPR is just another example of problems within the current licensing system of medical technologies. As the future of one of the greatest discoveries of mankind hangs in the balance of a legal tug-o’-war, it is a reminder of the importance of UAEM’s mission to reform university patenting and licensing policy to enable access and innovation of essential medicines and technologies.
For more readings:
MIT Technology Review: https://www.technologyreview.com/s/532796/who-owns-the-biggest-biotech-discovery-of-the-century/
KQED Science: https://ww2.kqed.org/futureofyou/2016/12/08/billions-at-stake-uc-berkeley-gets-day-in-court-vs-harvardmit/
Bloomberg Businessweek: https://www.bloomberg.com/features/2016-how-crispr-will-change-the-world/
Written by: Soojie Hong
Soojie is currently in her third year of undergraduate studies at Western University and serves as UAEM Western's Finance Leader.
In a nutshell, the process for a drug to come to market is the following: discovery and development, pre-clinical trials, clinical trials, approval by the respective government health agency (ex. FDA or Health Canada), and then finally post-approval research. The patent holder may then license their product to other parties, such as pharmaceutical companies, giving them the rights to distribute and manufacture the medicine.
Due to the profit-driven nature of the R&D system, a lot of the incentive comes from return on investment. For example, antibiotic resistance is becoming an increasing issue due to excessive use, misuse, and lack of innovation—evident by only 5 out of the 150 major pharmaceutical companies even running active antibiotic development programs. Antibiotics, which are taken for a short period of time and generally cure the targeted disease, do not generate a lot of profit for a pharmaceutical company. In contrast, a medication for diabetes or hypertension which must be taken by a patient every day for the rest of their lives, generating large amounts of revenue.
Another example of the drive for profit can be seen with the Ebola virus. Ebola has been around for the last 40 years; however, it has traditionally been confined to poor African nations. Once the Ebola outbreak occurred in 2014, no one was prepared for it, as there was a serious lack of treatments available. Although deadly, Ebola had not been much of a research interest due to its lack of profitability for pharmaceutical companies. In addition, the World Health Organization (WHO) has compiled a list of neglected tropical diseases such as Dengue and Chagas Disease that affect more than a billion people worldwide. Again, there is little incentive in the pharmaceutical industry to innovate solutions for these diseases, since they mainly affect populations living in poverty.
The R&D system also fails to deliver affordable medications. Take the case of Martin Shkreli for example, the former of CEO of Turing Pharmaceuticals. He famously hiked up the price of the antiparasitic drug Daraprim from US $13.50 to $750 per pill, making the medication virtually unaffordable. Contrast that with the fact that Daraprim was recently recreated by high school students in Australia for a mere $2 per pill, clearly demonstrating that Turing’s price hike could in no way be justified.
There are some serious flaws with the current R&D system. This is why UAEM is working with WHO to implement an alternative global R&D agreement. A global R&D agreement would ensure that WHO Member States provide appropriate funding centered around global health needs. It would also ensure WHO Member States commit to seek alternative mechanisms for innovation that are not backed by a financial incentive. Finally, this agreement would encourage collaboration among researchers all over the world to ensure that innovation is as fast and efficient as possible.
For more readings:
Written by: Christina Blagojevic
Christina is currently in her third year of undergraduate studies at Western University and serves as one of UAEM Western's Global Research and Development Leaders.
I once heard Rachel Kiddell-Monroe (the former president of UAEM) give a talk about her time working in a MSF hospital in Rwanda during the genocide. Upon arrival, she was being given a tour around the various units when she encountered a door that was completely shut. When she looked inside, she saw a room full of patients with HIV, all very close to death, and nothing being done to improve their health. The response she received from the MSF headquarters was simple: “Do you know how much it costs to treat a single patient with HIV? There’s nothing we can do for these people.”
As an international organization, UAEM aims to collaborate with universities to develop licensing policies that promote access to medicines in developing nations. Considering that universities develop one-third of all new medicines annually, this approach is justified. A clear example of a policy that would increase access to medicines is the use of non-exclusive rather than exclusive licensing in agreements with pharmaceutical companies. Exclusive licensing would give a single pharmaceutical company rights over the manufacturing, distribution, and importantly the price of the drug. On the other hand, non-exclusive licensing would allow multiple companies to produce and sell the drug, introducing generic competition and driving the price down.
Real-life examples of how these policies help address this global health crisis are abundant. In 2007, the University of British Columbia (UBC) licensed their first medical innovation under a global access licensing policy. The drug was a low-cost oral formulation of Amphotericin B, a novel agent with improved ease of administration and reduced toxicity, which could potentially treat 12 million individuals (nearly all of whom were in developing nations). It was only because these socially responsible licensing policies had been put in place that UBC was able to reach an agreement with iCo Therapeutics to ensure that the drug would be sold at-cost (with no profit gain) in developing nations. Considering that 0.8% of revenues generated yearly by US pharmaceutical companies come from Africa, India, and China, I believe that the marginal decrease in profits would be well worth saving the lives of millions in the developing world.
Regarding Western, our UAEM student group is leading a campaign to advocate for our university to form its own global access licensing policy using measures outlined in existing frameworks, such as the Statement of Principles and Strategies for the Equitable Dissemination of Medical Technologies (SPS) and the Global Access Licensing Framework (GALF). Through formal communication and collaboration with university administration and relevant policy makers, it is our hope that Western recognizes the importance of these policies and takes steps to adopt them, so that if any medicines are discovered by Western researchers in the future, we’ll be able to say that we certainly can do something for these people.
Written by: Michael Lee
Michael is currently in his third year of undergraduate studies at Western University and serves as UAEM Western's VP Access.
While you may have heard about it only recently, the infamous Zika virus was first discovered back in 1947. Scientists researching yellow fever in Uganda identified the new virus in a rhesus monkey in the Zika forest (hence the name "Zika" virus). The first human case was detected in Nigeria in 1954, followed by decades of relatively rare outbreaks in Africa and Southeast Asia. It wasn’t until 2007 that the first large Zika outbreak took place in the Pacific Island of Yap in Micronesia, which led to over 70 percent of the island residents being infected by the virus. Since then, there have been many outbreaks throughout different parts of the world.
Unlike many diseases which primarily rely on airborne transmission, Zika spreads from person to person via the bite of infected Aedes mosquitoes. Zika has also been shown to transmit through sexual contact as well as blood transfusions. Surprisingly, while symptoms of Zika include fevers, headaches, joint pain, and skin rashes, only 1 in 5 people infected actually develop these symptoms. As a result, many people may be infected without actually realizing it. Accurate diagnosis of Zika virus can be done via lab tests on body fluids (i.e. blood, saliva, urine). While there is currently no cure for Zika, the disease is usually mild enough to only require some rest, fluids, and pain/fever medicines as needed.
Given the relatively low likelihood of developing such mild symptoms, what is the big deal behind Zika? It turns out that Zika can be transmitted from a pregnant mother to her offspring, and this can lead to a number of devastating birth defects. Most prominently, Zika has been shown to cause offspring microcephaly – a brain abnormality that leads to intellectual disability, reduced head size, and in more severe cases, death. Currently, scientists are trying to understand the link between Zika and microcephaly. While a vaccine is still in development, preventative measures are already being put in place to reduce exposure to mosquitoes that could be spreading the virus.
It’s been over 60 years since Zika was first detected in humans, and yet extensive research into the virus started only recently. Why did it take so long? Just as with the Ebola virus, Zika only affected small populations in less developed regions around the world, which meant that there wasn’t a sufficient economic incentive to intervene at the time. It is only when these viruses started affecting more developed areas (i.e. North America and Europe) that governments decided to intervene. Moving forward, neglected diseases need to be researched when they are first discovered, as this is the only way to be able to successfully combat these diseases before it is too late.
BBC News: http://www.bbc.com/news/health-35370848
World Health Organization: http://www.who.int/mediacentre/factsheets/zika/en/
Centers for Disease Control and Prevention: https://www.cdc.gov/zika/
Written By: Aly Balbaa
Aly Balbaa is currently in his third year of undergraduate studies at Western University and serves as UAEM Western's VP Empowerment.
As we wrap up A2M week, it’s important not to lose sight of one of the most threatening yet neglected issues facing humanity – antibiotic resistance. According to the World Health Organization, “globally 480 000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria.”  Multi-drug resistant (MDR) microorganisms are a product of natural selection. Bacteria and viruses that acquire mutations that impede with antibiotic efficacy pass down their genes and give rise to strains of “superbugs” .
The urgent issue of antibiotic resistance further compounds the issue of access to medicines, many of which are lucratively priced. As more medicines are needed to combat multi-drug resistant strains, the exponentially higher the price for patients. Patients suffering from neglected diseases are especially vulnerable. A recent article on drug-resistant tuberculosis (DR-TB) published by MSF features Simphiwe Zwide, a South African man fighting DR-TB . He follows an intensive MDR-TB treatment regime that consists of ingesting up to 26 pills each morning. South Africa has one of the highest burdens of TB and DR-TB in the world, with around 20 000 people diagnosed with DR-TB in 2015.
During A2M week, we advocated against profit-driven research, which neglects research on antibiotic resistance. According to a 2015 peer-reviewed paper, “of the 18 largest pharmaceutical companies 15 abandoned the antibiotic field” and “antibiotic research conducted in academia has been scaled back as a result of funding cuts”. Big pharmaceutical companies tend to neglect antibiotic development because antibiotics are widely used for short-term conditions and are deemed not as profitable as investing in drugs that treat chronic conditions .
Beyond A2M week, we must push researchers, pharmaceutical companies, and government to increase research on antibiotic resistance. In an evolutionary “arms race”, novel drugs that have the ability to eradicate superbugs unlike current drugs on the market must be developed. Furthermore, education on antibiotic use is essential. Misuse and overuse of antibiotics have contributed immensely to antibiotic resistance. Margaret Chan, Director General of the World Health Organization, warned in 2012, “in terms of new replacement antibiotics, the pipeline is virtually dry. A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.”
Written by: Wenna Deng
Wenna Deng is currently in her third year of undergraduate studies at Western University and is one of UAEM Western's Global Research and Development Leaders.