If At First You Don't Succeed
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If At First You Don’t Succeed

When was the last time you heard about Africa’s development troubles? Not too long before the global economic disaster hit, the issue had finally permeated the mainstream media, which increased aid to the continent; since then, wealthy nations and the Western media have re-focused on their own problems. But it should come as no surprise that Africa’s struggles have persisted—and in some cases deteriorated even further. Of these, access to medicines remains a prominent dilemma: Canada took a lead role in finding a solution to this debacle earlier this decade, but our work ultimately proved futile because the legislation we passed (Bill C-9, now known as Canada’s Access to Medicines Regime or CAMR) was much too limiting. Following the tabling of Bill S-232 in the Senate this past Tuesday, though, that may no longer be the case.

Canada’s efforts to increase access to medicines came after a 2003 World Trade Organization (WTO) ruling permitted the production of generic versions of patented drugs, provided that they were sold to countries in desperate need of them. In response, Canada drafted Jean Chrétien’s Pledge to Africa Act (the JCPA, previously known as Bill C-9). The action itself exhibited a respect for the belief that health is a human right, but the legislation that eventually passed through the House of Commons and the Senate has been criticized for a number of fatal flaws. Chiefly, CAMR forces manufacturers to apply for and obtain a licence for each drug they wish to manufacture and export, and each licence only allows for export in a pre-set quantity to a single country, for a maximum of two years. The red tape is in abundance.
Because these problems inhibit CAMR’s usefulness, the legislation has been ineffective. For example, Canadian generic drug manufacturer Apotex Inc. offered to produce Apo Triavir, a generic fixed-dose combination of the antiretroviral drugs Zidovudine, Lamivudine, and Nevirapine shortly after CAMR was passed in May 2005, but up until 2008, not a single drug had gone out under the Regime. Antiretrovirals are commonly used in HIV treatment because they keep the amount of HIV—which weakens the body’s immune system—at a low level. Apo Triavir would have offered the three medicines in a single dose, thereby improving medical compliance, and Apotex was willing to produce it at the cost of US$0.195 per tablet, whereas the three medicines would cost $6.00 if purchased individually. An order was eventually sent to Rwanda last year, but Bruce Clark, Vice-President of Regulatory and Medical Affairs at Apotex, stated that its production was so convoluted and inefficient that his company would not use CAMR again unless amendments were made to it.
Of all the changes that various groups have requested, the Toronto-based Canadian HIV/AIDS Legal Network, the leading force behind the push to amend CAMR, is pressing hard for the one-licence solution in Bill S-232. Under this proposal, according to the Legal Network, “separate negotiations with patent-holders [would] no longer [be] required for each purchasing country and each order of medicines.” In short, the process would be significantly simplified and developing countries would be able to get assistance much more easily than they currently can.

Eowynne Feeney asking for a signed postcard at Toronto’s public education event. Photo courtesy of Eowynne Feeney.

Why the urgency now? Eowynne Feeney, the Legal Network’s Outreach and Development Coordinator, says the reasoning is two-fold: first, Liberal Senator Yoine Goldstein has only just become the first senator willing to table the amendments; and second, Apotex has offered to produce another fixed-dose combination that can be used to treat children living with HIV/AIDS if the amendments are passed. Sadly, despite all of the good that this could cause, the media and the public are largely unaware of Bill S-232 because it has been put forward in the Senate and not the House (the Legal Network is currently looking for a Member of Parliament to step up and support it in the House).
To supplant the attention that a House reading and MP support could garner, interested groups and Senator Goldstein are doing what they can to raise awareness. Last week the Legal Network hosted an Expert Panel in Ottawa that included Stephen Lewis and UNICEF Canada’s Executive Director Nigel Fisher, and on Wednesday the Legal Network and other bodies ran public education events in Toronto and five other Canadian cities. In Toronto alone, approximately thirty volunteers canvassed downtown street corners asking people to fill out postcards that will be sent to their Members of Parliament indicating that they support a one-licence solution. By the end of the one-hour event, more than three hundred had been signed.
The recent tabling has been encouraging for everyone who fought for adequate amendments to CAMR: a review of the legislation has been drawn out for far too long, and there was worry that nothing would be accomplished under a Conservative government that appears to dislike the Regime that was put forward by the Liberals. Finally, after years of hard work, there has been a breakthrough. But this is just the first step. Hopefully we’ll get it right by the end of this round of negotiations, because a third chance may never come around.

The article originally said that “the media and the public are largely unaware of Bill S-232 because it has been put forward in the Senate and not the House (the Bill need only be passed in the Senate because it is an amendment to something that has already been passed in the House),” a conclusion drawn from Eowynne Feeney’s research. In fact, the bill must also be passed by the House of Commons—not just the Senate—to become law.