Day laborers sleep under a mosquito net in Islamabad, Pakistan. Between 2002 and 2014, Global Fund efforts, such as net distribution, helped reduce the number of malaria deaths worldwide by 48 percent. (AP Photo/Muhammed Muheisen, File)
Last month, Turing Pharmaceuticals raised the price of Daraprim by 5,555 percent, after acquiring a company that had been selling the drug, which cures a parasitic infection called toxoplasmosis, for decades. The price went from $13.50 per pill to $750 per pill overnight.
This week, an uproar broke out over the move, not least of all because of the dangers of putting profiteering ahead of the public good. Faced with public outrage, last night, Turing CEO Martin Shkreli said the company would lower the price, but didn’t give details about the new charge.
Turing isn’t alone in rapidly increasing drug pricing, but there’s an easy rebuttal for Shkreli’s argument to the New York Times amid this latest controversy — “This is still one of the smallest pharmaceutical products in the world. It really doesn’t make sense to get any criticism for this” — Daraprim is a first-line therapy for a serious illness, and is on World Health Organization’s list of essential medicines.
The same need exists for cycloserine, a medication for drug-resistant tuberculosis. Yet it too recently underwent a severe (but temporary) 2,000 percent surge in price. The same thing happened to malaria prophylactic and antibiotic drug doxycycline, which has seen a price increase nearly as large in recent years.
But there’s good news that’s been lost amid the outraged op-eds about the dangers of pharma’s aggressive profiteering and Hillary Clinton tweets: On Monday, the Global Fund to Fight AIDS, Malaria and Tuberculosis, released “17 Million Lives Saved.” Beyond the triumphant title, the impact report offers a range of uplifting facts — and a good head start on saving the lives people like Shkreli would imperil.
The Global Fund is a major player in the worldwide drive to eradicate malaria, an effort also promoted by a Millennium Development Goal and a Gates Foundation-led malaria initiative. In the recent past, the disease has killed nearly one million people per year and, in some parts of sub-Saharan Africa, has been so hyper-endemic as to create a noticeable drag on local economies.
But between 2002 and 2014, the Global Fund’s efforts helped reduce the number of malaria deaths worldwide by 48 percent. A global distribution system passed out 548 million bed nets, and that, combined with other efforts, helped avert 115 million malaria infections. Over 50 nations have reduced their malaria burden by 75 percent. Of these, 11 are in the “pre-elimination” stage — meaning they are reaching the point of nationwide eradication (as the U.S. did long ago).
The Global Fund also contributed to 8.1 million people receiving antiretroviral treatment for HIV, and assisted 13.2 million people, HIV-positive and HIV-negative, to receive TB treatment. Both are life-saving efforts that also have massive (albeit somewhat slower-growing) impact in helping avert future disease spread.
The Global Fund works largely by giving grants to developing nations. While one-third of all monies help developing nations to build sustainable healthcare systems, a significant portion of its grants go to medication.
Its report says little about drug pricing and doesn’t weigh in directly on controversies over drug costs. (The Global Fund did not reply to a request for comment for this article.)
That said, its efforts on HIV and TB help reduce the need for the drugs now priced out of many people’s reach. Antiretroviral therapy for HIV suppresses the virus, helping to hold off the opportunistic infections, including toxoplasmosis, that arise when T-cell counts drop. Treating tuberculosis likely reduced need for the drug cycloserine, which is used for cases resistant to multiple other tuberculosis drugs.
Happily, the drugs favored for malaria treatment are also outside the reach of the current drug pricing debacle — despite Daraprim’s relevance. The drug, which is also known as pyrimethamine, is used alone for toxoplasmosis but in combination with another drug, sulfadoxine, for the prevention and treatment of malaria. But the Global Fund emphasizes its use of another option, artemisinin combination therapy (ACT), against malaria.
The Global Fund report acknowledges that, on malaria, “Progress has slowed in recent years, as resistance to existing medications has spread.” Sulfadoxine-pyrimethamine is one option for replacing ACT — and initially was being used widely when another drug, chloroquine, encountered resistance. However, the answer to ACT resistance might simply be reversion to use of earlier drugs. And if sulfadoxine-pyrimethamine returns to common use, Turing Pharmaceuticals doesn’t stand to benefit from jacking up the price of Daraprim: This formulation, Fansidar, is owned by another company.
Drug pricing has long been understood to affect health worldwide. In advance of the advent of the Global Fund, public health physicians Paul Farmer and Jim Yong Kim, who co-founded Haitian NGO Partners in Health, spent years advocating for prices of costly TB drugs to be lowered for the global poor. The upshot, many feel, was the aversion of drug-resistant strains of TB that could cause a highly deadly global epidemic.
Even if drug pricing doesn’t directly interfere with massive gains on malaria, TB and AIDS, the ire directed at profiteering hints at a correct intuitive understanding: Pricing life-saving drugs out of reach is a dangerous game.
As it is, the Global Fund projects it will help save another five million lives through 2016. Yet the Fund acknowledges the difficult road ahead. “It’s no time to celebrate,” a press release on its website reads. “We are only half way there. Tremendous challenges in global health still await us.”