Covid alert

Despite the fact that European authorities assure that the continent is prepared, the wave of Covid from China is expected with fear. Although the World Health Organization (WHO) minimized the impact it could cause, European countries are on alert.

According to the WHO, supported by the European Center for Disease Control (ECDC), Covid infections in China are not expected to have a significant impact in Europe since the variants circulating in the Asian country have been eradicated on the continent.

For its part, in December China put an end to its anti-Covid policy, based on restrictions on mobility and severe confinements for its population. With its borders open, both to foreign visitors and abroad, tourists from the Asian giant have arrived in Europe and other countries.

That is why health security measures have been intensified, such as the insistence on negative tests for travelers. Especially since several European countries are dealing with collapsed healthcare systems for various reasons. Among them are understaffing, strikes, bed shortages, inability to handle the volume of emergencies youporn.

The most affected countries are France, whose hospitals are at maximum capacity and understaffed; Germany, in which health personnel are on leave due to Covid and other seasonal illnesses; Austria, which is dealing with drug shortages, and the UK, where emergency services are stretched thin.



Covid variant

The WHO insists that Europe is prepared for a possible rebound in infections, especially due to its high levels of vaccination. Despite this, the organization’s director for Europe, Hans Kluge, urged European countries to take proportional, non-discriminatory and science-based measures, since there are marked differences between the requirements for travelers from China and those who They come from the United States.

France and Germany request a negative Covid test from those coming from the Asian giant, while Spain demands either a negative test or a full vaccination certificate. This does not happen with those who travel from North America, despite the fact that a new variant has been detected there (XBB.1.5, which is more contagious).

“In December China put an end to its anti-Covid policy, based on restrictions on mobility and severe confinements for its population”

However, he insisted that the priority measure must be the use of the mask on long-haul flights. Likewise, Kluge assured that it would be advisable to extend its use in public transport and other high-risk places. Another of the measures that is insisted on is vaccination, and ventilation of closed spaces.

For his part, Public Health expert Rafael Bengoa insists that Europe cannot be trusted and must tighten controls on travelers. In an interview with Europa Press, he criticized China for ending its confinement policy without preparing the exit with vaccination.



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Several countries in Europe, including the UK and Germany, have reported a significant increase in Covid-19 cases, in what is called the autumn wave. Lax public health measures, lack of knowledge about booster doses of the vaccine, as well as a perception of “false safety” could be contributing to the increase in transmission.

According to a joint official statement by the European Commission (EC) and the European Centre for Disease Prevention and Control (ECDC), although the pandemic is considered to have decreased in urgency compared to last year, humanity may soon face a new wave of infections tukif.

WHO officials said that among the variants circulating in Europe are the BA.4/5 sub-variants of Omicron, which dominated this northern summer and are still behind the majority of infections. However, new sub-variants of Omicron are being tracked.



Last week, the WHO said cases in the European Union reached 1.5 million, up 8% from the previous week. Hospitalisation figures have also been rising in several countries in the bloc, as well as in the UK, according to CNN.

The president of the German Hospital Association, Gerhard Gaß, said on Wednesday 12 October that the country’s hospitals were at capacity. He also reported that the number of beds occupied by positive patients had increased by 50 percent compared to last week.


According to the WHO, France already has an incidence of 800 cases per 100,000 population of coronavirus. On the other hand, for the week of 4 October, admissions for Covid-19 in Italy increased by almost 32% compared to the previous week, according to data from the independent scientific foundation Gimbe cited by CNN.



Now, while the European Parliament is investigating the Pfizer contracts, new vaccines adapted to the omicron variant have been launched on the European continent. These, which have been available since September, address the BA.1 and BA.4/5 sub-variants, alongside existing first generation vaccines. While in Great Britain, they are only approved for the BA.1 sub-variant.

The authorities in these countries have approved late booster doses for a select group of people, especially the elderly and people with compromised immune systems. However, confusion over choosing which vaccine to use, as well as a false sense of security, have been two obstacles to vaccination, according to experts in the field.


Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, said that “the message that it’s all over, coupled with the lack of a major publicity campaign, is likely to reduce uptake (of the vaccine),” as quoted by CNN.

However, the WHO insists that prevention measures and vaccination, which is “our most effective tool”, must be maintained. The agency also urges other nations to make additional efforts to protect the most vulnerable segments of the population by distributing influenza and COVID-19 vaccines.



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Centauro, the new variant of the covid that worries ( Pexel)

The year 2020 was a nightmare for many. Being locked up at home for so long left scars on our society and economy that even today, more than two years later, we are still trying to repair. Therefore, it is not surprising when panic appears before a potential new threat.

In the case of COVID-19, there have been numerous variants that have emerged since its first appearance. Beta, Delta and Omicron are some of the most striking. However, thanks to the timely appearance of vaccines and other factors, each of them has been controlled.

However, currently there have been cases of a new variant that is presumed to be much more dangerous than the previous ones: Centaur or “Centaurus”. Originally from India, where at least 20% of the cases known so far are registered, it has managed to spread to countries such as Canada, New Zealand and the United Kingdom at a worrying speed.



It is still early to assume that we know everything about this new variant. At the moment, there is hardly any information about its level of transmissibility or evasion, as well as the effect it may or may not have on the vaccines that the majority of the population currently has.

However, it is recommended to remain alert to the presence of:
• Strong headaches that occur continuously and for periods of acute without external explanation.
• Fever, cough and nasal congestion, as main alerts of airway blockage.
• Throat pain.
• General discomfort.



According to data provided by Soumya Swaminathan, chief scientist of the OMS, Centaur has 16 mutations noted with respect to previous variants. Two of them, G446S and R493Q, are the ones of greatest concern to the scientific community porno français, due to their potential ability to evade immunity from vaccines and previous infections.

However, this aspect is still under study and there is still not enough evidence to confirm it. This does not necessarily mean that we are safer. On the contrary. By not knowing the limits of this variant, acting on it is a gamble.



In order to keep the population safe, the Centers for Disease Control and Prevention (CDC) make the following recommendations:
• To start with, an additional dose of mRNA vaccine is recommended. In the first instance, this is of vital importance for people with weakened immune systems due to natural causes or compromised by external factors. According to the recommendation, it should be given at least 2 weeks after the second mRNA vaccine booster.
• Preventive health control measures.
• Priority on anti-COVID security protocols in public spaces.
• Pay attention to general health and immediately visit a health professional in case of symptoms of COVID-19.
• Immediate isolation of patients who present any symptoms.
• Follow the previously established indications in case of infection of this or any other of the variants.

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Infected with monkeypox

After going through COVID-19, our society never imagined that it would take so little time before facing the next health emergency. It turns out that it arrived much earlier than we thought, and with more than 16,000 people infected in 75 countries in less than a year.

Even when it has not been as mediatic as COVID-19, Monkeypox already registers numbers that raise alerts from the World Health Organization. As a consequence, the Director General of this organization, Adhanom Ghebreyesus, declared a little less than a month ago that the disease is already classified as a global health emergency xnxx.



With the increase in the registration of cases worldwide and the scenario worsening day by day in Brazil, it was a matter of time before government and private organizations dedicated to health considered some countermeasures. Among them, the possibility of a massive vaccine began to appear.

However, the WHO denies the need for this measure. In recent statements, Rosamund Lewis, a specialist in this disease at the UN agency, recommended post-exposure vaccination as a countermeasure. However, the project is still in the coordination process for the release and distribution of the vaccines.

Currently, the recommendation for infected patients is partial or total isolation until recovery. Likewise, it is important that these patients check their temperature and possible symptoms between 9 and 12 days after infection.



Unlike COVID-19, we are fortunate to be facing a less silent and aggressive threat. Its characteristic hives and other physical symptoms make it much easier to spot. In addition, its clinical manifestation is usually mild.

Until now, Africa registers a 3.6% mortality according to the data registered in Europe. The most affected are usually children and young adults, as well as immunosuppressed people. Outside of this group, most patients have recovered within weeks.

The biggest complications are precisely skin infections, delusions and eye infections that decrease vision. Of this group, only about 6% have deaths. Mostly children with other health problems.




Being of mild clinical manifestation, the disease does not currently have a specific protocol or a defined treatment. Symptoms often simply disappear within 9-12 days without the need for treatment, implying that the human body naturally fights the disease and overcomes it without problems.

As key recommendations are:
• Monitor body temperature.
• Treat eye infections with standard treatment.
• Take care of skin infections by letting the area dry. If necessary, it can be covered with moist bandages.
• Avoid contact with the mouth or eyes.

Always remember that, for more information, you can consult the direct sources in the information portals of the WHO and other health organizations.




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Mental Health and the Pandemic

Mental Health and the Pandemic

Worries and anxiety about the Covid-19 pandemic and its impact can overwhelm anybody. The rapidly changing situation has drastically changed people’s lives and the global, public and private economy. The uncertainties and fears caused by the pandemic outbreak, lockdowns, and economic recessions increase the risk of mental disorders and suicides. Various studies point to an increase in mental issues across the general population.


The More Vulnerable Groups

A review study on the impact of the Covid-19 pandemic on mental health in the general population identified several predictive factors. Females were more vulnerable to developing the signs of various types of mental conditions during the Covid-19 pandemic. These disorders include stress, depression, anxiety, and post-traumatic stress disorder (PTSD). Women represent a higher percentage of the workforce prone to the pandemic’s negative effects like healthcare, retail, and service industry porno. This partly explains why women are more affected than men are. 

Persons under the age of 40 showed more adverse mental symptoms during the pandemic. Why is this group affected? Most of them, particularly women, are caregivers providing financial and emotional care to children and the elderly. Job loss and uncertainty caused by the pandemic are particularly stressful to this group. A significant chunk of this group consists of students who may undergo emotional distress due to school closures, reduced study efficiency related to remote online classes, and postponed exams.

Persons with chronic conditions and a history of psychiatric illness exhibited more symptoms of anxiety and stress. The cause of distress in patients with chronic diseases was partly due to compromised immunity (due to pre-existing conditions), making them more susceptible to the infection and threat of mortality. Individuals with a history or current mental disorders are more sensitive to external stressors like social isolation linked to the pandemic.


Psychological Stressors Related to the Pandemic

According to several studies, frequent exposure to news related to covid-19 caused anxiety and stress symptoms. Regular use of social media exposes people to potential disinformation, fake news that tends to aggravate anxiety. With the situation remaining unpredictable, a lot of unknown information about the novel virus, fake news, and misinformation were spreading easily through social media platforms. Through news reports and social media, sadness and anxious emotions could also arise from constantly viewing community populations suffering from the pandemic.

Various studies point out that unemployment, poor economic status, and lower levels of education increase the risk of developing symptoms related to mental disorders. Populations under these descriptions were more prone to developing depressive symptoms during the covid-19 pandemic. The outbreak of the virus led to various governments imposing strict stay-at-home orders, which led to reduced demand for goods and services. This led to a rise in unemployment rates in many countries. A diminishing quality of life coupled with uncertainty because of financial hardship exposed people to the risk of developing adverse psychological symptoms.

Taking Care of Mental Health the Pandemic

Since the pandemic is here, it is crucial that you take steps to avert mental conditions. The best approach is to implement self-care strategies and get the care necessary to help you cope. Take care of your body’s health by getting sufficient sleep, engaging in physical activities, have healthy meals, limiting screen time, and relaxing. It is also vital to avoid tobacco, alcohol, and other drugs. Reducing stress triggers can also help with taking care of the mind. For example, maintain a routine, limit exposure to news (persistent news about the pandemic), stay busy, and focus on positive thoughts.





Occupational Safety and Health: Hot Topics Arranged by Injury or Disorder

Cases of biliary and pancreatic cancer in association with exposure to trichlorinated hydrocarbon solvents were reported. Three men (aged 45 years, 35 years, and 41 years) developed cholangio, ampullary, and pancreatic cancer after prolonged and heavy exposure to chlorinated hydrocarbon solvents for 4 years or less. The histories of two of the patients included direct skin contamination with trichloroethane (79005) or trichloroethylene (79016); they had exposure to other potential carcinogens as well. The other patient, who was exposed to trichloroethane and perchloroethylene (127184), had a strong family history of cancer. Two of the patients died. Other cases and evidence from recent literature were considered. The author concludes that exposure to trichlorinated hydrocarbon solvents is a risk factor for the development of biliary and pancreatic cancer; improved work practices and heightened physician awareness are recommended.


Cancer incidence among alachlor (15972608) manufacturing workers was evaluated via a historical cohort study. The study population included 943 workers with at least 1 year of cumulative employment at an alachlor manufacturing facility in Iowa at some time between March 1968 and December 1990; 96% of those workers were successfully traced. Eighteen workers were diagnosed with cancer during followup. The standardized incidence ratio for all cancers was 1.5 for all workers exposed to alachlor; elevated rates were primarily attributed to colorectal cancer (four cases) and chronic myeloid leukemia (two cases). Elevated rates of colorectal cancer were observed in workers with 5 or more years in jobs with high alachlor exposure. No cancers were found in stomach, thyroid gland, or nasal cavity. The authors conclude that definitive conclusions are limited by the small study population, minimal length of followup, and current information regarding alachlor metabolism; nonetheless, these findings support the need for further evaluation of alachlor exposed cohorts.

Colorectal cancer morbidity in a large cohort of asbestos cement workers from Denmark was examined. Information was obtained on workers employed between 1928 and 1984 at an asbestos cement product manufacturing facility; the cohort was followed through 1990. The workers were mainly exposed to high levels of chrysotile (12001295). The total cohort (7,887 men and 576 women) had a standardized incidence ratio of 1.23. There were 857 incident cancer cases among the men and 48 incident cancer cases among the women. The overall excess risk of colorectal cancer was confined to the period 15 years or more since first employment. Men employed in the early production period (1928 through 1950) had a particularly high standardized incidence ratio of 1.47. The excess risk of colorectal cancer morbidity was not confined to a particular region of the large bowel. The authors conclude that there appears to be a 50% excess risk of colorectal cancer morbidity among chrysotile exposed asbestos cement workers in both Sweden and Denmark; the role of chrysotile in the etiology of colorectal cancer remains uncertain.

The possibility that a group of office personnel developed cancers due to strong magnetic fields emitted by a three transformer 12 kilovolt substation, located 14 floors below their office, was examined. Magnetic field readings taken in the office were as high as 190 milligauss (mG) at floor level, and 90mG four feet above the floor. After bus bars were lowered, the highest magnetic field levels were 32mG at the floor and 12mG at chair level; magnetic fields generally average 2mG or less in office buildings. A cohort of 243 men and 143 women employed between 1980 and 1994 were studied. Eight invasive cancers were observed, five in men and three in women, compared with 4.2 expected, giving a standardized incidence ratio of 190. Seven cancer cases occurred in workers employed two years or more. Limiting the cohort to those employed more than two years, five cancers were observed in men compared to 1.3 expected, and two cancers occurred in women compared to 0.5 expected. For both porno sexes, seven cancers were observed versus 1.8 expected, giving a standardized incidence ratio of 389. A positive trend of cancer cases with duration of employment was found for males and females. The cancers diagnosed in men included malignant astrocytoma, lymphoma, and malignant melanoma, and in women, breast cancer, colon cancer and malignant melanoma. The author concludes that cumulative magnetic field exposure could be of etiologic importance in the incidence of cancer in these workers.

Great Tasks Need Grand Coalitions

epd Development Policy: Prof. Klaus M. Leisinger, it’s just three years since Kofi Annan proposed a new partnership between the United Nations and private-sector business at the World Economic Forum in Davos. The proposal met with a strong response – and when the Global Compact was finally signed and sealed, Novartis was involved in it right from the start. Have there been any visible signs of success yet on the path toward a “globalization with a human face” proclaimed by Kofi Annan?

Leisinger: It depends, of course, on how you measure success. I can see at least three positive results. In the first place, it’s remarkable that many national and transnational companies are now concerning themselves with how they can help develop a globalization process that has a human face. An astonishing learning process has started, in which commercial companies are getting themselves involved in topics such as “living wages,” discrimination, and other human-rights aspects of labor relations – topics they had always thought they would not have problems with.

The second point is: when a company commits itself to the Global Compact, it needs to look for ways and means to operationalize that commitment. You start to see your own business activities in the developing world and industrialized countries from what might be called a company-ethics point of view – and, even more important, not only your own business, but also the performance of subsidiaries, suppliers, and business partners. There are tremendous positive forces that radiate out from this.

Third, it is likely that a new form of competition is developing out of this as well – between the large pharmaceutical companies, for example, treating their company-ethics profile as a new level of competition and putting a corresponding effort into it.

epd: Some critics have suspected that participation in the Global Compact is first and foremost a matter of cultivating a good image in branches of industry with a public reputation that is not just as ideal as it might be…

Leisinger: There will always be some critics who we’ll never be able to satisfy. Once in a while I meet people who have once and for all formed their opinions and made up their minds whatever the facts are, and who will live with those opinions until their dying day. If anyone thinks that a company is going to sign such an important contract with the Secretary-General of the United Nations just in order to mislead the rest of the world, then they simply don’t know what goes on in the video porno gratis world today. The debate over social corporate responsibilities isn’t new, of course, but the UN Global Compact has given this debate a substantial push forward – mainly toward extending these responsibilities beyond what has been common or conventional practices in one’s own company.

epd: In what ways is the commitment to the nine basic principles of the Global Compact being implemented at Novartis?

Leisinger: In many ways: At Novartis, first we set up a “Global Compact Steering Committee,” on which management representatives from all the business areas of the company are represented.

Second, we established a “Global Compact Clearing House,” which is meant to act as a catalyzer and facilitator for appropriate further development of company policy in Global Compact relevant areas. This is where management briefing papers for the various aspects of the Global Compact are produced, where part of the monitoring is carried out, and where networks with relevant stakeholders are established. What we are trying to do here is, for example, to consult with individuals and groups – from NGOs such as Amnesty International to church representatives – not just to make sure we are all pulling in the same direction, but also to compare and adjust our perceptions of reality.

In modern pluralistic societies, it would be completely irrelevant if only we at Novartis were convinced that our own house is in order – business today gets its social acceptance in a globalized economy through a process of external certification. Hence, we need a societal license to be able to work sustainably – and to obtain it, we must be in permanent contact with the relevant stakeholders of society, listening to them and learning about their values and interests but also communicating our views about critical issues.

The next step is then to get out of headquarters and go to all the subsidiary companies and say, this is the Global Compact that we’ve signed: Do you think you have any problems with it? And looking a bit further afield, what about your suppliers? Eventually, the goals of the Global Compact have to become part of the program of performance appraisals and incentives in our company. Only if and when employees and managers have a coherent motivational system in the company can you ensure that certain criteria are going to be followed. Otherwise, you’re just doing them lip service.

epd: Recognizing the Global Compact and its principles in the context of a company’s business activities is one thing. Over and above that, members of the UN Global Compact are also expected to contribute to promoting the United Nations development targets through strategic partnerships.

Leisinger: There are examples of that with Novartis as well. Let me mention some: With regard to the human rights statements, we have concentrated on the “Right to Health” and tried to analyze what this means in concrete terms in relation to access to treatment and access to appropriate health care. Some years ago, we made an agreement with the World Health Organization in which we committed ourselves to Provide All Leprosy Drugs Free of Charge until the complete elimination of leprosy has been achieved. After signing the Global Compact, we’ve agreed on a differential pricing system in which we are providing the WHO at cost price with one of the best malaria drugs that is available globally, in order to treat poor patients in the poorest countries. We have also made an agreement with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, through which we are providing tuberculosis drugs free of charge. Last but not least, the Novartis Foundation for Sustainable Development runs Social Development and Health Programs in co-operation with important NGOs from the South and the North.

epd: But despite that, many development stakeholders continue to come to you with solid demands and expectations…

Leisinger: Of course, not all the demands that NGOs make necessarily represent obligations that are relevant for a corporation such as Novartis. One of the most important and yet often neglected questions – not only in the context of the UN Global Compact – is: “Where does a company’s responsibility reasonably come to an end?”

At the moment, one has the impression that with the leaning of the state, the loss of credibility in political parties, and the growing skepticism with which transnational companies are regarded, NGOs in particular are enjoying a relatively high level of credibility. Some of them are using this to dump all the miseries of the world at the door of the pharmaceutical industry and say, “This is your problem.”

Sustainable solutions need to be structured in such a way that whatever a business enterprise or a development stakeholder is able and willing to contribute can continue in a sustainable and reliable way. Anyone can make himself look good in the short term – a company such as Novartis can give things away for free in the short term, but in the longer term any private-sector corporation can only give away things under exceptional circumstances and in a limited way. The reason for this is not greed but a historically successful division of duty and responsibility: It can’t be the job of a pharmaceutical company just to give things away for free. The basic questions are:
What is a fair and balanced division of duties and rights between the different actors in a society when we are working toward overcoming global problems?
Which groups and stakeholders in a given civil society have which duties and what responsibilities? Who is accountable for exactly what?
What societal requests to a private-sector corporation are obligatory (the “musts”)? What can be expected in addition (the “oughts”)? And last but not least, what on top of that would be the enlightened desirables?
Having answered these difficult questions, one would have to discuss and hopefully agree on the various degrees of obligation and the corresponding structures for action – and that’s where things are getting interesting, because that’s where learning processes happen that help us all move things forward.
epd: A brochure produced by the Novartis Foundation for Sustainable Development includes the statement, “We do not perceive conflicts of loyalty between the development-policy goals of the Foundation and the legitimate economic interests of our donor company.” Are there really no contradictions between being oriented toward private economic profit and being oriented toward the common good?

Leisinger: Of course, there may be tensions here in principle. But so far as the Foundation is concerned, we have over the past 25 years experienced conflicts of interests of such a nature in only two instances – and we learned from those how to avoid repetitions. With the Foundation’s resources we are working in countries and with partners marked by significant collective or individual poverty. By definition, these partners do not have the purchasing power to be markets for Novartis products. Nevertheless it is sometimes said that the commitment to development of the Foundation has nothing to do with corporate humanitarianism but is a shrewd way of developing future markets.

The facts are available to be judged by anyone who cares: We are working with the poorest of the poor – for example, in an AIDS Orphan Project in the Border Area of Rwanda/Uganda/Tanzania, Projects With Slum Communities and Street Children in Brazil, Community Development Programs All Over Sri Lanka. All of the beneficiaries do not constitute present markets, nor will they in the foreseeable future. Novartis is a company that is trying to meet its social responsibilities in a generously defined way and guided by enlightened self-interest. And this is the right thing to do – I share in this respect the demands of most development-oriented stakeholders who expect that a company should expand their understanding of social responsibilities in a globalized world.

epd: Instead of optional common values and principles, isn’t it clear, legally binding rules and codes of behavior that are needed? Even when the UN Global Compact was first presented, Amnesty International criticized its optional character and demanded that the observance of the nine basic principles be monitored by an independent body.

Leisinger: The UN Global Compact and traditional “Codes of Conduct” are two different things. There are more than 160 different codes of conduct that are applicable for multinational companies nowadays. If you take, for example, a look at the OECD or ILO codes of conduct, all the basic issues are covered in a very comprehensive way.

In the end, what matters is that a company that has signed up to a commitment such as the UN Global Compact does implement it within the company itself by making it part of its existing internal codes of conduct. This must be a company-specific action plan, because different things are relevant for a company such as Novartis than for another companies such as Siemens or Microsoft, for example. This is why most of the global codes of conduct are largely ineffective – quite apart from the fact that all they do is create large “command and control” bureaucracies.

For example, the code of conduct at Novartis as a consequence of signing the UN Global Compact states that we promote human rights not only in our own company, but also among our business partners. What this means is that we not only have no sympathy for practices that show contempt for humanity such as child labor, prison labor, and other coercive practices, but also that we certainly want to pay more than “living wages” and to offer our employees excellent social-welfare benefits in addition to training on the job, etc.

Of course, there are also companies that are reviving old PR stories under the banner of the UN Global Compact and telling the public, “This is our commitment to the Global Compact.” But they will be filtered out as time goes on. It’s not a serious way of dealing with the Compact – as a matter of fact, it is a pity because it damages the visionary ideas of the Secretary General’s initiative.

In the meantime, a UN Learning Forum for the Global Compact has been set up, where a wide variety of experiences in companies are analyzed and made available for inspection by development stakeholders and other companies. Very often, inadequate implementation is not due to malevolence or underhanded intentions, but to an inability to operationalize plans. This is an opportunity for the Learning Forum.

epd: A few weeks ago, the WHO Commission on Macroeconomics and Health presented its report, which unsparingly details the devastating economic consequences of the global health crisis and calls for a global alliance for health care in the poorer countries. The extra finance required for this is given as up to US$ 25 bn per year. “The public sector cannot bear this burden on its own,” the report states. “The pharmaceutical industry must be a partner in this effort.” Is the pharmaceutical industry accepting this challenge?

Leisinger: I can’t speak for the pharmaceutical industry as a whole – all I know is that we at Novartis have accepted this challenge. For many years we have had our leprosy program, we now have our malaria program, we have our tuberculosis donation, and we offer our employees throughout the developing world free diagnosis and treatment for HIV/AIDS, TB, and malaria. In addition we have founded a new research institute in Singapore that exclusively carries out “pro bono” research on a non-profitmaking basis, such as for tuberculosis and dengue fever. I am very proud of this and I think we have given a clear signal with our initiatives. Other companies should now come forward with their own programs and projects. Anyone with sufficient grey matter knows that the pharmaceutical industry would be at a complete dead end if it were perceived by a majority in our societies as a bunch of profit-greedy villains who didn’t care one iota whether millions of people die because they have no access to drugs.

epd: But the WHO Commission’s report also states that the pharmaceutical industry should give the poor access to drugs at reasonable prices, at low cost. The Commission’s proposal points to a differentiated pricing and licensing system.

Leisinger: That’s certainly what we’ve done with malaria. But the question is whether the same method can be applied generally. I had a discussion with Jeffrey Sachs about this. His assumption is that patients in the North will in principle be willing to purchase drugs at higher prices so that they can be provided at cost in the poor countries. I’m afraid that’s wishful thinking.

One of the most damaging reactions to the price reductions for HIV/AIDS drugs for sub-Saharan Africa countries was the reaction by some North American AIDS patient groups, who complained that they wanted the drugs at the same low prices that South Africans had. If the political pressure becomes strong enough, this may actually happen in a few cases, but you can take it for granted that not a single private-sector company will ever carry out any new research for that kind of disease again if it knows a priori that there’s never going to be a profitable market for the innovations that result from this research.

But we also have to look at things in a different way: Given that the market economy functions the way it actually does, where is the public sector with its research? In the agricultural field, for example, there’s the Consultative Group on International Agricultural Research (CGIAR), which organizes public-sector research through well-known centers like the International Rice Research Institute (IRRI) and the International Maize and Wheat Improvement Center (Centro Internacional para Mejoramiento de Maiz y Trigo, CIMMYT) – but as yet there’s nothing like that in the health care sector. I would like to see the creation of a Consultative Group on Tropical Diseases or on Diseases of Poverty, with on the one hand a tuberculosis center, an HIV/AIDS center, a Chagas center, and other specialist centers, but on the other hand all gathered together under a common roof to achieve added efficiency (resource mobilization, networking, etc.). This type of umbrella organization would also have the advantage of being able to discuss licensing and other conditions with the pharmaceutical industry.

And, by the way, anyone who thinks that it is only the price or the patents issue that determines whether a sick person in sub-Saharan Africa has access to life-saving drugs has no proper conception of the realities. To give you just one example: oral rehydration salts, which cost less than 10 cents, have today only reached less than 50% of lower-income groups. Why? People generally have far too little access to health care services.

Above all, it should not be forgotten that 95% of the drugs on the WHO’s Essential Drug List are not patented! And despite this, many sick people can’t get access to them because the health infrastructure is in a state of decline and health care personnel are underpaid. And yet, there are developing countries that spend four times as much on military purposes as on health care systems. In such cases you can’t tell me that it’s suffering a health emergency only because there are too few resources available or because the drugs are too expensive in principle.

epd: Novartis regards protecting intellectual property through patent law as a “lifeline” for the pharmaceutical industry. Against this background, how do you view the Doha vote, reaffirming the right of World Trade Organization member states – already attested in the Trade-Related Aspects of Intellectual Property (TRIPs) Agreement – to issue compulsory licenses when there is a national health emergency? The delegations from the USA and Switzerland voted against including this formulation in the declaration of the World Trade Organization ministerial conference – not least due to pressure from their national pharmaceutical industries.

Leisinger: I’m not sure whether that was actually the case, you would have to ask the negotiating delegations. When a company like Novartis is spending 4 billion Swiss francs a year on research and development, it needs patents to secure the intellectual property – otherwise it’s not possible to finance that type of research. Patents do not provide protection permanently; if all the drugs that were under patent at the beginning of the 1980s and that are no longer protected by patent today were available everywhere in the South, the situation would already be much better.

But also here we should think more creatively – which can mean, for example, applying a differentiated pricing system. We have a patent on a first-class drug against malaria, Coartem, but we do not take advantage of the patent in the poorest countries at prices that are beyond the general purchasing power, but instead provide the drug to the WHO under completely different conditions – at cost. You can’t debate this sort of thing in general terms, you have to discuss it on a case-by-case and country-by-country basis. From the company’s point of view, it is important that the beneficiaries of this type of campaign are genuinely the poor, and that products that we supply at cost to country A do not turn up afterwards in country B being sold at completely different prices for the private profit of the dealers.

There is no doubt about one thing, and this is a matter of clear international law: if a country declares a state of national emergency, patent protection lapses – i.e., a compulsory license can be issued for local production. I’m not sure why South Africa did not declare such an emergency in advance of the litigation over AIDS drugs. If the current scale of HIV/AIDS in South Africa is not a national health emergency, then what is?

epd: The Global Compact and the boom in public-private partnerships in development work must be seen as a reaction to the weakening of the role of the state in regulating market activities and in dealing with the effects of globalization – but also as a reaction to the drastic reductions in public development aid (ODA). In view of this scenario, what do you think the new division of labor will be between the private sector, civil society, and governments? Are there any signs of new coalitions emerging to promote sustainable global development?

Leisinger: I very much hope so, and above all what I hope is that we can get away from the system of confrontation that began on the streets of Seattle toward a system of constructive cooperation. All different parties who can make a contribution to sustainable solutions need to organize round-table discussions to establish a firm consensus on who is responsible for what, and what we can expect from whom. In the end, this will also reveal the true quality of the stakeholders involved.

There will be NGOs that will continue to regard themselves as aloof from and uncooperative with the private sector, and who sooner or later will have to ask themselves what their actual concrete contribution consists of. Then again, there will be NGOs that will be willing to enter into clear, transparent, and verifiable partnerships with other partners, including ones from the private sector, while maintaining their own identity and ideals.

Last but not least, we need “good governance” and better accountability in many states of the developing world. That is, we need governments that set the right priorities when allocating resources, and actually spend the scarce resources at their disposal in a way that’s appropriate to the state of the problems they face, governments that respect the law and are accountable to the people they represent. If we can show three or four positive examples of multi-stakeholder cooperation with good governance, then we can give new heart to the development-policy community and demonstrate that sustainable solutions are feasible if everyone really wants them. The important lesson to learn from the Sachs Commission study is that what we need in the face of great problems is grand coalitions. We need to make an effort to ensure that the various stakeholders in civil society work together in a synergistic way. It doesn’t make much sense to take an accusing or even defamatory tone against some parts of society and then expect them to act constructively and generously on principle.

Access to Medicines: The Novartis Approach

The issue of “access to drugs” cannot be discussed in isolation from overall deficits in development policies, health policies and systems, and implementation processes. It is a complex issue that clearly includes the price of drugs but also goes far beyond that.

As a rule, the combination of appropriate development policy, effective health policy, best practices applied in the health system, a rational use of drugs, and adequately funded health services can handle most of the health problems in any country.

Although public health care saves millions of lives from premature death due to disease and injuries, several well-known problems remain:

The key role for the pharmaceutical industry is to discover, develop, produce, and market innovative products to prevent and cure diseases, to ease suffering, and to enhance the quality of life. Intellectual property rights are the lifeline of the research-based pharmaceutical industry and are vital to sustain continued R&D into new treatments.

In view of the substantial investments of time and capital to bring a drug to market, as well as the high risk of failure, the research efforts of the pharmaceutical industry are primarily focused on diseases with potential for an adequate return on investment.

New mechanisms are therefore urgently needed to foster research on diseases of poverty. A combination of market-based incentives (“push” and “pull” mechanisms to reduce the research and development costs and provide the necessary financial incentives) together with increased public funding and public private partnerships are called for.

Another option is to create a Consultative Group on International Health Research that would administer a global fund, financed by multilateral and bilateral donors as well as by NGOs, along the lines of the Consultative Group on International Agricultural Research.

The impact of patent protection on patients’ access to treatment in developing countries is often exaggerated: Although about 90% of the drugs on WHO’s model list of essential drugs are available off-patent, over a third of the world’s population still has no access to these drugs. As essential drugs for the management of HIV/AIDS and drug-resistant forms of TB are patent-protected, and therefore the exception to the rule, innovative and unorthodox solutions must be found to improve poor people’s access to these treatments.

The pharmaceutical industry is willing to work together to developing sustainable solutions. Individual companies such as Novartis will focus their efforts on improving access to treatments within their specific product portfolios.

The challenge therefore is to integrate the emerging global health system of intellectual property rights into a workable solution to make treatments available to poor people. TRIPS (Trade Related Aspects of Intellectual Property Rights) aims to strike such a balance by providing intellectual property protection and allowing countries the flexibility to ensure that treatments are available for the poor in situations of national emergencies, such as the HIV/AIDS pandemic.

Special price arrangements that permit the adaptation of prices for individual products and countries also provide a solution as they combine incentives for research with a wider distribution of benefits. Various safeguards will have to be in place to maintain the structure of these differentiated prices, such as control over trade to prevent re-exportation to high-priced markets, undertakings not to use the low prices as reference prices in developed markets, etc.

Despite greatly reduced prices for treatment such as HIV/AIDS and malaria, given the scale of the disease burden, providing treatment for all patients will continue to be beyond the means of governments in developing countries.

Substantially expanding access to essential medicines, including anti-retrovirals, will require additional domestic and international financing for the purchase of the drugs as well as a significant investment in building effective health and supply systems. Without the infrastructure and capacity building necessary to administer the HIV/AIDS drug regimens adequately and effectively, there is not only the danger of sub-optimal therapeutic success but also the risk of resistance to anti-retrovirals.

The Global Fund to Fight HIV/AIDS, TB and Malaria has been established to translate the unprecedented international and political attention into real commitments that will help improve access to the information, goods and services that people so urgently need. However the financial commitment to date of US$ 3.4 billion is significantly lower than the budget of US$ 7—10 billion required to launch a global response in order to stop and reverse the HIV/AIDS pandemic alone.

Novartis is committed to helping improve patients’ access to its treatments for diseases of poverty. Novartis has signed two Memorandums of Understanding with WHO-one to provide Free Treatment For All Leprosy Patients until the disease has been eliminated from every country, and the other to provide Coartem®, its oral fixed-combination anti-malarial product, at cost.

Novartis is committed to supporting pro bono research on diseases of poverty. It has established a research center in Singapore which will focus on developing new preventive and effective treatments for tuberculosis and dengue fever. The diseases affect two billion and 50 million people respectively mainly in developing countries. The Novartis Institute for Tropical Diseases is a result of an agreement between Novartis and the Singapore Economic Development Board (EDB) and involves an investment of US$ 122 million. The center could become closely associated with a Consultative Group on International Health Research (CGIHR) which is line with the recommendation of the WHO Commission on Macroeconomic and Health.

Novartis will donate 100,000 DOTS treatments (Directly Observed Treatment, Short-course) for tuberculosis every year for a five year period as its contribution to the Global Fund The Novartis donation will be channeled through the Global TB Drug Facility and thus take advantage of existing structures and expertise in order to improve patients access to TB diagnosis and treatment. The donation will be provided to some of the poorest developing countries where it can make a significant contribution to improve the TB situation.

Since 2002 Novartis is providing prevention, diagnosis, treatment, and counseling services for its employees and immediate family members (nucleus family) for HIV/AIDS, TB, and malaria in developing countries. The programme is being scaled to cover all employees working in countries with insufficient health insurance.

Novartis is working out the framework of a porno italiane programme, together with other partners, which aims at improving the access of poor communities in a sub-Saharan African country to comprehensive anti-malarial services (prevention and treatment) in a sustainable manner. Other partners could be the the Ministry of Health of the respective country, Swiss Development Cooperation, WHO, the World Bank, the Swiss Tropical Institute and Non-Governmental Organizations with competence in Access to Treatment issues.

Misallocation of public resources, in the sense of spending scarce resources on health interventions of low cost-effectiveness while underfunding critical and highly cost-effective health interventions;
inequity, in the sense that government spending intended to pay for basic health services for the poorest goes disproportionately to affluent segments of society; and
inefficiency, in the sense that health systems are often poorly structured and badly led, and their potential is squandered.