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[e-drug] Uganda NMS re-selling discounted ARVs? (cont'd)

E-drug: Uganda NMS re-selling discounted ARVs? (cont'd)

> [this message dates back to 15 May; anyone in Uganda who can 
> tell how this ended? Should discounted drugs be allowed to be 
> resold (and thus probably be re-imported into high-priced 
> countries)? WB]

>From The Lancet Volume 361, Number 9372, 31 May 2003. 
Copied as Fair Use.


Douglas Ball
Dept. of Pharmacy Practice
Faculty of Pharmacy, Health Sciences Center
University of Kuwait, PO Box 24923 Safat 13110
Tel: (965)531-2300 ext. 6048
Fax: (965)534-2807
E-mail: dball@hsc.kuniv.edu.kw 

Uganda's state-owned drug firm pressured to drop drug deal  

State-owned drug firm warned to be more careful when selling on
cut-price, donated drugs.
Charles Wendo reporting from Uganda 

The Ugandan government's pharmaceutical company, the National
Medical Stores, abandoned a deal on May 17 where discounted
drugs were sold on to unregulated local retailers. 

The National Medical Stores (NMS) was due to receive supplies of
cut-price combivir from GlaxoSmithKline (GSK), which they would
then sell to a local drug firm, Eris Ltd, who in turn were buying the
drugs for Landmark Pharmaceuticals. The deal means that NMS
would have no say as to where the drugs would end up. And GSK
would risk losing out if the discounted drugs were sold for profit to
European suppliers. 

According to NMS this was as normal as any other business
transaction. But other sectors of the government opposed the deal
from the outset. The Inspector General of the Government, the
government's ombudsman, objected. He said the deal might harm
relations between Uganda and pharmaceutical companies that supply
cut-price antiretrovirals. 

The state-owned New Vision newspaper, which first broke the story,
called it insane. "The National Medical Stores is crazy to be doing this
deal", the paper said in an editorial. The paper argued that such deals
could undermine painstaking efforts that lowered the cost of
antiretrovirals in Uganda from an average of US$1000 per patient
month in 1998 to the current $30 per patient per month. 

The state minister for health, Mike Mukula, immediately set up a
probe into the deal. "The Ministry of Health can not allow such a thing
to happen", he said. 

Over the past few years pharmaceutical companies have been
reducing the prices of antiretrovirals in Uganda after pressure from
AIDS activists as well as competition from generic drug

The price reductions have meant that the number of Ugandans on
antiretrovirals has grown from a few hundred in 1998 to 10 000

However, some drug firms are concerned that cut-price donated
drugs might be re-exported from Africa to under-cut suppliers in

GSK's country manager in Uganda, Patrick Abelle, warned on May 19
that abuse or misuse of antiretrovirals may force the Anglo-American
company to stop supplying their products to Uganda at subsidised
rates. He further warned that any re-exportation should be registered
by Uganda's drug regulatory agency, so that GSK can trace its

"It has come to our notice that some of our products could be getting
into the wrong hands once supplied to you", he wrote to NMS. 

Abelle's fears are not far fetched. In October, 2002, the Dutch
government recalled a large supply of combivir and epivir after
discovering that 35,000 drug packages, sold to Africa, had been
re-exported to Europe. 

In Kampala the police last year uncovered illegal sales of diflucan
donated by Pfizer for the treatment of AIDS-related fungal infections.
Under the scheme, Pfizer had donated 290 000 diflucan tablets
clearly marked "Not For Sale", to the government of Uganda. The
drugs were then distributed to 110 health facilities, from where they
were illegally siphoned off. The Ugandan police anti-fraud squad,
posing as buyers, bought 106 tablets, which were being sold illegally
in pharmacies. The operation led to the arrest of 15 health workers. 

However, NMS denies planning to re-export subsidised antiretrovirals.
In a statement released on May 17, NMS explained that GSK
supplies antiretrovirals to Uganda under two distinct schemes. The
heavily subsidised combivir is supplied through a Ugandan company
called Medical Access, under the HIV/AIDS Drug Access Initiative.
The commercial combivir is supplied to any company and is not
subsidised. "The combivir which NMS had discussed with Eris Ltd
and Landmark Pharmaceuticals is the commercial type which is
neither donated nor subsidised", the company stated. 

GSK concurs that not all of the drugs they sell to Uganda are
subsidised. Some are only sold at slightly reduced prices, meaning
they are still more expensive than the subsidised drugs. However, the
explanation put forward by NMS remains unconvincing to the
pharmaceutical community in Uganda. Subsidised or discounted, the
imported drugs are cheaper in Uganda than they are in Europe and
the current system could still be abused.
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