Industry Committee on Oct. 21st, 2010

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Have I got my math right--is that 2.5 million a year?

[Richard Elliott]

Yes. These are figures that come from UNAIDS.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Is that only Africa, or is that worldwide?

[Richard Elliott]

That's worldwide.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

That's worldwide.

[Richard Elliott]

Africa is the most heavily affected continent, so the bulk of those deaths are happening in Africa, but it's not only Africa.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

But the majority are in Africa.

[Richard Elliott]

Yes, 90%

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

I'd like to talk about some of the other illnesses, and maybe, Dr. Kilby, I could talk to you about this.

Do we use this legislation, this vehicle, for illnesses like malaria? How many people a year die of malaria? Do you have those figures?

[Dr. Don Kilby]

The numbers in Africa are even greater than the number of people dying of HIV and AIDS, if you look at the straight numbers. In reality, malaria today in Africa is a function of immunity, because when people are immune-compromised, they are more susceptible to malaria and to deaths due to malaria. If we didn't have HIV and AIDS, what would be the deaths due to malaria in Africa today? It would be far lower than it now is. It's the same thing for diarrhea, the same thing for other illnesses, and tuberculosis in particular.

Of course, the global funds program is not restricted to HIV and AIDS and procurement for HIV and AIDS; it's also for malaria and tuberculosis.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

And not because AIDS isn't a horrible disease, but malaria is the number one killer, is it not, across the globe? Isn't it the number one killer of infants?

[Dr. Don Kilby]

No. Diarrhea's probably the number one killer of infants, but malaria is the number one killer. Again, it's my HIV education piece here. People don't die of HIV virus; people die of pneumonia. So we could say the same of Africa. People don't die of HIV virus; people who are HIV-infected die of malaria and tuberculosis. And in the case of tuberculosis, when people are immune-compromised, they activate their tuberculosis and become people who can spread tuberculosis to others as well.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

I guess my question is not to minimize the tragedy of AIDS, but is this legislation helping those who are suffering? Not everybody is infected with AIDS among those who die. I think we have polio just about eradicated. I think Afghanistan and maybe one more country in Africa.... But is this helping, or are we using it as a vehicle to stop that tragedy as well, against other diseases, like, as you said, diarrhea?

[Dr. Don Kilby]

For sure, in terms of the global fund, and in terms of the program that would access most this type of legislation in order to get the drugs--

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Are they getting the drugs, though? Are they getting the drugs?

[Dr. Don Kilby]

They would not only look to break patent, if you would, for HIV, but we do have a serious concern with malaria as well, because the drugs that are not patent-protected are really inferior drugs to those we have available to us throughout the world. So what I use when I go to Africa to protect me, under patent, is not available to people in Africa unless we use this type of legislation.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

So why aren't we doing that? Why aren't we doing that as well with malaria? Why aren't we getting generic drugs put into place for those who suffer from malaria?

[Dr. Don Kilby]

They are doing that as well.

[Dave Van Kesteren, Conservative, Chatham-Kent—Essex, ON]

Are they, and in all countries?

I guess, Mr. Elliott, you wanted to jump in.

[Richard Elliott]

This legislation is not doing that as it stands because, as we were saying, there's been only one use of it, and that has been for an AIDS drug to one country. So we can't say this legislation is doing anything. This legislation could do something, because the legislation, as it stands now, is not limited to only AIDS drugs. It's really important to underline that, because this was an issue that was central in the WTO negotiations that led to the instrument that then led to CAMR.

There was a real effort by the U.S. and the European Union to say we're going to come up with a flexible mechanism so that you can export generic drugs to countries that need them, but there was a real push by them to say this is going to be only for HIV, TB and malaria, and possibly for other epidemics.

There was a really strong push-back, quite rightly, because what are we going to say then--“You're not dying of the right disease, so therefore too bad”? Are we going to say, for example, “We can get those medicines for cancer in the rich world, but we're only going to get AIDS medicines to you folks in the poor world?” That was simply unacceptable, and it is unacceptable. So at the end, the agreement among all WTO members was that this mechanism could be used to deal with public health problems.

They make explicit reference to HIV, TB, and malaria, because they are three big killers, but it's very clear that it's not limited to those diseases. And the current legislation is not limited to those diseases, although in practice it's actually hard to use it for anything else, which is one of the reasons there's a reform proposed that would make it easier for it to apply to drugs to deal with public health problems, because that reflects what the WTO intention was.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Elliott.

Thank you, Mr. Van Kesteren.

Now on to Mr. Masse for five minutes.

[Brian Masse, NDP, Windsor West, ON]

Thank you, Mr. Chair.

One of the interesting things about the bill....The department is very critical of it. Setting up the standards, it could be a runaway success. I guess a runaway success would be that we'd have a lot of different drugs that then would be exported, treating people and actually saving lives. It's kind of an interesting analysis of it. But they also painted the picture that Apotex in Rwanda was a success story.

You know, getting the drugs to those individuals, yes, that is a success. But the process wasn't. And they painted the picture that CAMR worked very efficiently in that, but CAMR requires you to do some work before you actually do your paperwork with it. Can you maybe go through that experience?

What I find kind of incredible about the department's attitude in this is that.... I asked them during a briefing that if they don't think Bill C-393 is a good bill, could they offer suggestions on how to improve it, and not one of the departments could offer one suggestion on that. I find that incredible, because if we don't change it, it's just not going to get used at all.

The hoops that were jumped through to get the Apotex Rwanda thing done.... Back in 2003, when we started this, there were warnings that it wouldn't work. But at the same time, when we had the final piece, we all said we'll put down our swords, stop fighting over it and try to make it work. Now that one success story is being used against fixing the system.

Can you provide some insight into the timelines of what happened in Rwanda?

[Richard Elliott]

Yes.

[Brian Masse, NDP, Windsor West, ON]

Their own customer is now saying they won't do it any more.

[Richard Elliott]

Yes, I can.

I wanted to, before I forget, draw your attention to a document that you have in the materials we gave you. This is a briefing paper prepared by Doctors Without Borders--Médecins Sans Frontières--describing their experience of attempting to use the legislation, working with Apotex to get this drug because MSF had identified that they needed it.

This part of the story that MSF lays out in this brief walks you through the chronology. However, it stops in the middle of 2006 because MSF ultimately abandoned the effort to use it, after trying for about 18 months to get a country to come forward.

When we hear repeatedly that it only took 68 days from start to finish for this piece of legislation to work, to get this licence out the door, that leaves out of the story the entire months and months and months leading up to the point where finally a country did come forward. That's because the law, the way it's drafted now, requires that the country be known ahead of time in order to then move through the process of trying to get a licence. But that's not the full story if you just look at, “Oh, now we finally have a country, so we can start the process of trying to get a voluntary licence from the brand-name company, and if that doesn't work after 30 days, then we can try to get a compulsory licence to supply a fixed quantity of a drug for only two years”, and so on.

All of the back story is left out of that narrative, about why this bill took so long to even have one successful use. It's because it created this kind of impediment where you made the use of it contingent upon knowing one specific country ahead of time.

That's why the one-licence solution that is in Bill C-393 would get around that problem, because it would say it's not contingent upon having one country identified ahead of time to get a licence. You get the licence and then you go out and actually bid to supply countries. If you're offering a good product at a competitive price--which you would be in a better position to do if this is simpler to use--then you can actually supply because you have the licence already to supply that eligible country.

So I would encourage people to learn what the experience was and where the stumbling blocks were encountered with the existing legislation, which is precisely what we thought they were going to be. I think we can then learn from that to make it work better.