2015-03-21

Pharmaceutical opportunities in_Latin_America_and_Africa

3.4, 3.7, 3.15, 3.16: pol/healthcare/
Pharmaceutical opportunities in Latin America and Africa
summary:
Which countries in Latin America and Africa
have the greatest need for Pharmaceutical products
especially difficult to get drugs, [specialty pharmaceuticals]
such as, cancer medications?
Which agencies and individuals in those governments
handle the financing of these medications?
Which NGO's [non-governmental organisations]
are fulfilling that need?
a key resource is the eligibility list
of the Global Fund for AIDS;
many needy governments appear to be
working with the Global Fund .
. wwIII will likely climax before Fall 2016,
and that will dramatically change the market:
there will be a global government in place after that,
in order to control the new Tesla beam weapons;
and a global government might tend to
distribute pharmaceuticals more fairly .

what pharmaceuticals are we talking about?

specialty pharmaceutical products:
Specialty products are those having
at least 5 of the following attributes:
( for chronic, often rare conditions
such as cancer, HIV/AIDS, infertility, MS,
hep'C, hemophilia, autoimmunity;
. Initiated only by a specialist
. expensive($6,000 to $750,000 a year)
. Generally not taken orally
. Require special handling (e.g., maintaining a cold chain)
. unique distribution management, or paperwork
. supervision needed to ensure compliance
. assistance in securing reimbursement
) -- IMS Health is the world’s leading provider of
market intelligence to the
pharmaceutical and healthcare industries.
. usa's medicaid defines a "specialty drug"
as one costing over $600/month;

. HIV is a major reason for bringing specialty pharma
to those countries most in need of them .

list of financial aid sources for HIV:

(some might not involve drugs)

GFATM (Global Fund to Fight AIDS, Tuberculosis and Malaria),
PEPFAR (US President’s Emergency Plan for AIDS Relief),
the African Union,
Clinton Foundation,
Bill & Melinda Gates Foundation [unaids 2011];
Ford Foundation,
Elton John AIDS Foundation,
Fund for Global Human Rights [unaids 2014];
UK DFID [Department for International Development],
AusAID [Australian Agency for International Development]
UNODC [United Nations Office on Drugs and Crime]
Netherlands Ministry of Foreign Affairs,
Open Society Foundations,
NORAD [North American Aerospace Defense Command]
World Bank,
GTZ[Gesellschaft für Technische Zusammenarbeit],
DROSOS Foundation,
Swedish SIDA, Canadian CIDA,
Levi Strauss Foundation,
AIDS Fonds (Bridging the Gaps)
American Jewish World Service
Robert Carr civil society Networks Fund
International HIV/AIDS Alliance [ihra 2014];

sources known to fund HIV drugs:

HIV funding from Global Fund:
. this is a list of eligible countries,
who can receive funding from GFATM
it is favouring low-income countries
but also includes those with more income
if they are badly in need of HIV medications.
. they finance anti-retrovirals .
# america(lower income):
Bolivia, El Salvador, Guatemala, Haiti,
Honduras, Nicaragua, Paraguay;
# america(middle or upper income):
Colombia, Costa Rica, Dominica, Dominican Republic,
Ecuador, Grenada, Panama,
Saint Vincent and the Grenadines, Suriname;
# africa (lower income):
Burkina Faso, Burundi, Central African Republic,
Chad, Congo (Democratic Republic), Côte d'Ivoire, Cameroon,
Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Guyana,
Kenya, Liberia, Madagascar, Lesotho, Malawi, Morocco, Mozambique,
Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone,
Somalia, South Sudan, Sudan, Swaziland, Tanzania (United Republic),
Togo, Uganda, Zambia, Zanzibar, Zimbabwe;
# africa (middle or upper income):
Algeria, Angola, Botswana, Congo, Gabon,
Namibia, South Africa, Tunisia .

countries with high HIV (> 2%):
# america:
Suriname
# africa( 2% ... 10%):
Guinea-Bissau, Rwanda, Chad, South Sudan
Nigeria, Republic of the Congo,
Togo, Democratic Republic of the Congo
Cameroon, Central African Republic
Equatorial Guinea, Gabon, Tanzania, Kenya, Uganda
# africa (> 10%):
Malawi, Mozambique, Zambia, Namibia, Zimbabwe,
South Africa, Lesotho, Botswana, Swaziland

PEPFAR [US Pres' Emergency Plan for AIDS Relief]:
"The Accelerating Children’s HIV/AIDS Treatment (ACT)
is a two-year initiative to double the number of
children receiving anti-retroviral (ARV) treatment
across several African countries.
The Global Pediatric ARV Commitment-to-Action
will mobilize development and supply of
child-friendly ARV medicines.
Bill & Melinda Gates Foundation:
"We focus our efforts in the poorest hyper-endemic
countries of Sub-Saharan Africa.
We have also committed more than US$1.4 billion
to the Global Fund.
Beyond our direct investments in HIV,
we advocate for sustained and increased
funding for HIV service delivery.
Our largest investment is in an HIV vaccine;
we also work on cheaper anti-retroviral treatments .
The foundation has supported national efforts to
design and deliver HIV services to
high-risk populations in Botswana [africa] ".
Clinton Foundation:
"When the Clinton Health Access Initiative (CHAI)
was founded in 2002, only 200,000 people
were receiving treatment for HIV/AIDS
in low and middle income countries,
with medicines that cost over $10,000 per person per year.
Over a decade later, more than
eight million people are receiving treatment
and CHAI has helped reduce the cost of medicines
to around $100 to $200 per person per year in many countries."
the African Union 2013:
"African leaders further agreed to step up the
mobilization of domestic resources
to strengthen the health system
while ensuring that strategies are in place for
diversified, balanced and sustainable
financing for health, in particular AIDS, TB and Malaria
through development of strategic health investment plans
and strategies for innovative financing,
including from the private sector .
They explored in particular, the importance [of]
South-South Cooperation and
collaboration with the BRICS partners
[ Brazil, Russia, India, China, South Africa ]
to scale up investment in
African pharmaceutical manufacturing capacity,
especially for generic essential medicines
and other essential commodities ...".

other ways countries are in need:

countries with high cancer:
# america:
Uruguay, Argentina, chile, ecuador, hoduras
# africa:
uganda, s.africa .

intensity of hepatitis C rates:
most of africa > 2%
most of america > 1%

HIV spread by needle-sharing drug users:
2013:
# america:
Argentina, Brazil;
# africa:
Egypt, Morocco, Nigeria, South Africa,
Tanzania (mainland and Zanzibar)

countries with the most pharma growth:

"The 21 "Pharmerging" countries will together add $187bn
in annual sales between 2012 and 2017.
This is two thirds of global pharma growth
and will increase the pharmerging markets’global share
from 23% in 2012 to 33% in 2017".
the following countries will have
a CAGR [Compound Annual Growth Rate]
of given percentage between 2012 and 2017.
12.7% for Brazil
. enhancement of current public healthcare provision
private healthcare, consumer medicines
11% for africa:
(Countries with 2012 pharma sales *below* $85 per capita)
South Africa,
Algeria,
Egypt,
Nigeria
-- a combined market size of $45bn in 2017.
Over half rural population (except algeria & s.africa)
Higher poverty rate
Higher out of pocket healthcare spend
More limited access to healthcare
9% for america:
(Countries with 2012 pharma sales *above* $85 per capita)
Argentina,
Mexico,
Venezuela,
Colombia.
-- combined market size of $82bn in 2017.
Over half urban population
Higher government healthcare spend
Stricter cost containment measures
Typically better intellectual property (IP) protection

Pharma FRONTIER countries:
(country, 2012 sales, expected growth to 2017):
# america:
Chile $2.3Bn 8.2%
Peru $1.5Bn 7.8%
Ecuador $1.3Bn 8.6%
# africa:
Morocco $1.2Bn 4.5%
Tunisia $0.8Bn 10.0%
Ghana $0.8Bn 12.4%
Kenya $0.5Bn 16.9%
Ethiopia $0.4Bn 10.0%

"hard-to-get drugs" might correlate with
original brand drugs vs generics .

countries with a large original brands market:
(country, brand-names spending, $Billions
/ total pharma spending, $Billions):
# america:
Brazil 10/28
Mexico: 6/13
Venezuela: 3/10
Argentina: 2/5
Colombia: 1/2
# africa
S. Africa: 2/3
Egypt: 1/2
[src: FIGURE 10: MARKET VALUE COMPARISON]

. the top 17 brandnames in Pharmerging markets,
includes some cancer treatments:
Herceptin (HER2 Positive Metastatic Breast and Gastric Cancer)
Mabthera (lymphomas, leukemias, transplant rejection, and autoimmune disorders),
Glivec(leukaemia and soft tissue sarcoma),
Augmentin (antibacterial)
Seretide(asthma)
Voltaren(arthritis or ankylosing spondylitis)
Nexium,Pantozol(GERD, excessive stomach acid)
Lantus,Novomix(insulin)
Lipitor(high cholesterol)
Crestor( high cholesterol and high triglycerides)
Plavix( blood clots )
Lovenox(deep vein thrombosis)
Betaloc(hypertension, angina pectoris, arrhythmias).
Diovan(hypertension, congestive heart failure, left ventricular dysfunction)
Cialis(erectile dysfunction, benign prostatic hyperplasia)
[src: FIGURE 11: TOP 20 BRANDS BY 2012 SALES]

interesting further reading:

Africa: A ripe opportunity:
Understanding the pharmaceutical market opportunity
and developing sustainable business models in Africa

"While the role of health facilities owned by NGOs
in low income countries is well documented,
national and international wholesaling
of essential medicines by NGOs
is largely unstudied.
This article [Globalization and Health 2011]
describes and assesses the activity of
NGOs and social enterprise in essential medicines wholesaling."

++++++++++++++++++++++++++++++++++++
. the following are notes less relevant
that I got during my initial search .
++++++++++++++++++++++++++++++++++++

. people with diabetes also often have
kidney and eye disease, and metabolic syndrome
(high blood pressure, high cholesterol),
... but unless diabetes is related to cancer rates
there is not much use of specialty pharma .

Prevalence of Diabetes mellitus in adults (20-79 years),
is greater than 10% in these countries:
-- in america:
mexico, guatamala, nicaragua, guyana, suriname
not far behind are:
brazil, chile, french guiana
-- in africa:
egypt, gabon,
not far behind are:
libya, sudan, s.sudan, tanzia, zimbabwe,
s.africa, tunisia, w.sahara,
at more than 6% is:
algeria, morocco, central africa repub, congo, somalia, namibia

countries with high rate of dying from diabetes:
all of central america except panama;
# in s.america:
guyana, paraguay, suraname
# in africa:
most except egypt .