CAMR criticisms unfounded

The Senate committee hearings on Bill S-232 took an unexpected break this afternoon in order for the whole Senate to vote on Bill C-25. During that break, I took the opportunity to speak to Richard Elliott, the Executive Director of the Canadian HIV/AIDS Legal Network, who was testifying before the committee alongside Médecins Sans Frontiers and Universities Allied for Essential Medicines. During his testimony, Elliott laid out the legal reasons why the CAMR bill does not interfere with Canada’s WTO obligations, as the government bureaucrats suggested during the previous hearing.

Q: Have you had much consultation with the Senators before today’s appearance?
A: We’ve had meetings with a couple of Senators – not all of them yet. So this is the first time to actually address all of them.

Q: How has that gone so far?
A: Some of them are certainly receptive, and some I think still have some questions about the details of this, so we’re hoping to address those questions and get them to realise that this is entirely legally compliant and makes sense just as a matter of efficiency.

Q: I was speaking to Marc Garneau, the Liberal industry critic, a couple of months ago, and he was giving some pushback on this, saying the problems are more on the receiving ends of the medications, and we should be perhaps be engaging CIDA to address those problems instead of revisiting CAMR. What would you say to that particular notion?
A: I would say that it’s wrong to think that it’s an either/or question. In many parts of the developing world, there is plenty of capacity to receive and procure and distribute medicines to people, and that capacity is growing over time, what with donor funding, the interventions of the global fund to fight AIDS, TB and malaria. Technical capacity building is being provided – more and more people are being put on AIDS treatment – that number is steadily increasing, though it’s far from where it needs to be. So in those circumstances, I think the point that he makes is actually not relevant because there is that capacity there. Where there is weak capacity, because that is certainly also the case in many parts of the developing world, we need to build up that capacity. That doesn’t preclude us from fixing the problems at the Canadian end about actually getting the lower-cost medicines to those countries in the first place. You can’t just deal with the issue in isolation – you have to deal with this on all fronts. It’s not really an excuse to say well, countries don’t have the capacity, therefore we don’t need to deal with problems on our end – you need to do both.

Q: At the last hearing, there was some consideration that perhaps other countries’ generic manufacturing capabilities, like India, were able to make drugs for cheaper than they could in Canada using the CAMR provisions. Have you heard anything to that effect as to why they haven’t accessed the CAMPR provisions?

A: There’s two things to say about that. One is that the only time that CAMR been used, the Canadian generic company actually offered a competitive price to Rwanda – it offered the product that it was making at the same price was being offered by Indian generic manufacturers. So to the extent that we have any evidence on that point, it actually is to the contrary – that in fact Canadian generic manufacturers can compete. Obviously their ability to compete in an ongoing fashion is going to depend on just how costly and cumbersome the Canadian legislation is. The more it’s difficult to use, the more cost it adds, so we’re actually hindering the ability of companies to supply the product their countries need at a good price. It’s a red herring to suggest that they won’t be able to compete – they have, and I think they can and they will. As for the question of countries procuring generic medicines from Indian manufacturers, that has been historically a hugely important source of generic medicines, and it continues to be because India has a very strong generic drug industry. Until 2005, India did not grant patents on pharmaceutical products, so they were able to make generic versions to supply developing countries. That continues to be the case for the first generation of AIDS drugs. Post-2005, all new drugs are being patented in India, and as we need multiple options in the treatment toolbox for people with HIV, you need to be able to switch people eventually onto newer generation drugs because the virus starts to develop resistance to first generation drugs. Those are dramatically more expensive because precisely they’re under patent including in places like India now, so the real crunch of the patent system on access to drugs for developing countries at affordable prices is still to come. It’s already had a huge impact – it’s going to get worse, which is why we need to make sure that there are simple processes for overcoming those patent problems, including in a place like Canada where we have the capacity to make drugs and can sell them for cents per pill. We need to get that right in Canada because we can’t expect that India is going to be able to supply everything for the world – it doesn’t now, and it will become even more difficult and costly to get Indian generics in the years ahead. India certainly needs to fix its legislation as well – Canada should do the same.