Thank you very much for having me here. I will keep my remarks a little briefer than my colleague and make sure I stay close to time.
I'm a family physician, an HIV primary care physician, and as you've heard, I'm a founder of the Canada Africa Community Health Alliance, a small local volunteer-based charity based out of Ottawa working with partners in Africa to improve the health of rural African villages. There are about 150 to 200 Canadians a year who choose CACHA in order to volunteer on medical missions. They volunteer their time and underwrite the full cost of each mission, including the medications that we dispense free of charge and the medical supplies, as well as surgical supplies needed to enhance the level of care of our partners.
We work on a determinants of health model, and we believe that health is proportional to access to housing, secure food supplies, education, water, sanitation, transportation, employment, and personal security and freedom. We do not restrict our efforts to medical care only. We also support orphans and vulnerable children programs; build infrastructure, including a made-in-Canada floating dispensary; provide solar lighting in villages for students to study; drill wells; support microfinance; and support people living with HIV and AIDS. Given the recent reports on Canadian charities, we do this using at least 90% of all taxable revenues directly in the countries. This is a young organization, an organization that's only been around since 2002.
Today what I want to talk about is the whole issue of access to medications in resource-limited countries and the role Canada had hoped to play and could still play in order to contribute in a significant manner to the world's continued and growing needs for affordably priced essential drugs.
In 2003 I was here supporting legislation for Canada's access to medicine regime, and we believed at the time that it was the right thing to do and it was a good move. I will admit that also at that time, given the complexity of the regulations around securing a compulsory licence to produce, we seriously doubted that any drug under this regime would ever make its way from Canada to another country. We didn't criticize Parliament's efforts at the time but rather took pride in the fact that Canada was the first G-8 country to amend its national laws in order to implement the World Trade Organization's decision to allow generic versions of still patented drugs to be manufactured and exported under compulsory licensing.
Canada's leadership would bolster efforts in other countries to do the same, so that developing countries could have access to a steady supply of cheaper drugs available in a more competitive market. In the area of HIV, access to generic, co-formulated, triple-drug therapy available from India became the hope of nations in the scale up of treatments of AIDS in Africa. So in 2003 we had 400,000 people in low- to middle-income countries who received antiretroviral drugs. By 2005 we had 1.3 million, and by the end of this year, there will be 5.2 million people on antiretroviral therapy in resource-limited settings. In 2009 alone, there were 1.2 million new patients initiating antiretroviral therapy.
In 2002 at the International Aids Conference in Barcelona, we were all told it couldn't be done. I remember attending a presentation that was done by Médecins Sans Frontières, who were working on a project outside of Cape Town in South Africa, and a Harvard group in a project in Haiti. They had presented successful demonstration projects that we then used in order to replicate these thousands of times across Africa and the Caribbean.
At that time I remember a very heated discussion and a lot of criticism coming from the International Monetary Fund and the World Bank. It was said at the time that people in resource-limited settings would not be compliant with therapy, not as compliant at least as people in North America or Europe, that local governments could not put in place the infrastructures as well as the procurement and distribution systems necessary to get drugs to patients, that there were not the trained personnel needed to treat so many people, that the world could just not afford it, and that the business model was flawed.
To the credit of the G-8 leaders, at the insistence of groups like Médecins Sans Frontières and others, and the World Health Organization's global fund, and the bilateral U.S. President's emergency plan for AIDS relief, they committed to the goal of three million people in treatment by 2005.
So procurement processes were put in place, thousands of allied health-care providers were trained, clinics were built, testing programs and mother-to-child transmission strategies were expanded, as well as programs dealing with the social and economic fallout, including millions of orphans and vulnerable children. There are now home-based programs and local AIDS service organizations in place throughout all of the world today.
Essentially what we have been able to do is develop a comprehensive model of care many believed could never be built, and this in only a few short years. What was accomplished is nothing short of a miracle: 5.2 million people on treatment by 2010.
CAMR and other compulsory licensing programs should also have evolved during this time to ensure that we have a continuous flow of medicines at affordable prices. In all other areas, other than procurement of drugs, the concerted international efforts ensure today that all that needs to be in place to get medicine to people is in place.
CACHA is working with partners in Benin, Gabon, Tanzania, and Uganda, now since 2002. We concentrate our efforts in the hardest-to-reach populations in remote rural communities where there were no services for people living with HIV and AIDS. We help our local partners articulate needs, identify those infected through testing, and secure infrastructure necessary to treat people with HIV. And we secure this through strategic partnerships that are south-south, north-north, and north-south.
In Tanzania in three remote village areas we have seen our partners go from no HIV patients in care to more than 10,000 people in care in less than three years. Up until recently drug procurement and access has not been an issue. But this success is now being threatened in other countries, not only in Tanzania, by the limited supplies of affordable therapies.
The supply issues have nothing to do with getting drugs to local markets. The problem is procurement of cheaper, first-line therapies in sufficient quantities to treat all those who should be on treatment. Today, 5.2 million need to remain on treatment, and close to another 5 million need to be on treatment.
Canada's access to medicines regime should become a viable source of affordable medication available in a manner consistent with traditional procurement practices of purchasing countries that would allow these countries to ask for competitive tenders in order to ensure best pricing and timely delivery of product to market.
What we have in place is not meeting the desired goal. We have worked with government officials in two of the countries and we have examined with them the procurement mechanisms in both cases. And both countries have found that they are too cumbersome when other markets were available to them, despite their strong desire to purchase drugs from a North American generic company.
The other issue we have is that today, as people fail on therapy because of drug intolerance or toxicity, or compliance issues, countries now need to invest in newer drugs, second-line therapies, but these are at ten to fifty times the costs of first-line therapies. Health-care budgets in these countries cannot sustain such costs without significantly limiting the number of new patients who would access cheaper first-line treatments. Compulsory licensing, therefore, is needed even more today. It is needed to ensure an adequate supply of both affordable first and second-line treatments.
We can't rely on a system that's so encumbered by regulations. We need a system of compulsory licensing that is not time-limited, with no set limit on quantities to be purchased, and that can turn on a dime.
So CACHA supports a one-licence solution: one compulsory licence on patented medicine, regardless of quantity of medicine ordered or the number of eligible countries requesting the drug. Doing this will cost Canadian taxpayers nothing, beyond the international aid dollars we have already committed. And doing this will do nothing to reduce the profits of multinational pharmaceutical companies. There really is virtually no market for their patented drugs in developing countries, and without a market there is no real threat to their future or to the future of research and development in resource-rich settings like our own. In fact, CAMR royalties from otherwise non-existent markets would be paid to these patent holders.
This doesn't mean that these drugs that are produced in Canada that are destined for other markets would make their way back to Canada to be sold on the black market in resource-rich settings. We have enough processes in place in terms of the labelling and sanctions, and in fact if we look at our market and at that of our neighbours to the south, virtually all people with HIV and AIDS have access to drugs that are paid for through either private or public funding mechanisms. So enacting Bill C-393 will make the much-needed medicine more accessible and, through competition, also more affordable.
Thank you.