Tuberculosis rates may rise due to inferior treatment

It is an unusual day when I agree with a large group of socialist health groups. But activists correctly raise the alarm that changes in policies by large multilateral donors may lead to the rise of inferior tuberculosis medicines and poor patient outcomes.

Tuberculosis patients outside Chiulo Hospital in Angola on February 22, 2018. REUTERS/Stephen Eisenhammer

Donor policy changes were understandable and inevitable. Taxpayers in richer nations cannot be expected to fund health programs in emerging markets forever. There have to be transition policies in place so that as a nation (like China) moves from relative poverty to riches, it should fund its own programs. This is both rational and self-interested of the donor bodies, since if they don’t demand transition they will lose taxpayer support.

But recipient nations become addicted to financial support and rarely handle transitions well. And when it comes to drug procurement, the health activists have themselves partly to blame. It was the mantra of Western health activists that local production of medicines was part of the solution to expensive medicines. Dozens of times over the past two decades I’ve interacted with emerging market officials, several Western officials who should have known better, and most health groups that claim that drugs would be more available and cheaper if only they were made locally.

That such companies can rarely maintain standards or keep costs down never really bothered activists whose main aim seemed to be to bash Western pharma companies. As a result, nascent pharma industries have sprung up in emerging markets. The one I looked at closely myself was Quality Chemicals of Uganda, part-owned by the president’s family (nepotism is rife on such companies). On the surface it wasn’t a bad operation, but ignoring quality control concerns, it couldn’t compete with Western companies, let alone Indian generics companies, on price.

The temptation to favor local producers with tariffs or quotas on imports starts as local companies cannot hope to compete. And as donors now start to pull back from nations and programs, local companies are likely to win business since they employ people and pay taxes locally.

But the outcome for TB patients, and possibly malaria and HIV patients, is not a good one. Expect quality to go down and price to go up.

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