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Hopes that Novartis deal on tuberculosis will spur donations for HIV and malaria

BMJ 2004; 328 doi: (Published 09 January 2004) Cite this as: BMJ 2004;328:70
  1. Fiona Fleck
  1. Geneva

    A pledge last month by Swiss pharmaceuticals giant Novartis to donate $7m(£3.9m; €5.5m) worth of drugs to 500 000 patients with tuberculosis in poor countries over the next five years has raised hopes that other drug companies will follow suit to fight HIV/AIDS and malaria.

    Under an agreement with the World Health Organization on 19 December, Novartis will provide drugs to help poor countries obtain and distribute drugs to patients with tuberculosis. Two million people die of the disease every year, many of whom have HIV infection or AIDS. There are signs that the tuberculosis epidemic is growing.

    Aside from discounting of patented drugs (such as antiretrovirals for HIV/AIDS) and a recent trade waiver to allow companies making generic drugs to manufacture copies of patented drugs, this is the first time that a major drug company has made a large financial donation.

    Instead of procuring vast quantities of drugs, which require sorting, Novartis is manufacturing ready made “patient kits” for the duration of patients' six month treatment course. The first packs are due to be delivered this spring in several countries—expected to include the Philippines, Tanzania, Algeria, Syria, and Turkmenistan.

    The packs contain blister packs of 28 daily doses. Instead of taking four separate pills a day, patients take a single pill containing four different drugs for two months and a single pill containing two drugs for four months.

    This is expected to keep counterfeit drugs out of the chain and lessen the burden on healthcare workers, who will now only need to give patients access to their daily dose and make a note that they have taken it. And it will be easier for patients to follow their treatment.

    The fixed combination drug approach is central to WHO's goal of providing antiretroviral drugs to some three million patients with HIV/AIDS in poor countries by 2005, but so far it has been unclear how such large supplies of these drugs would be financed. Unlike tuberculosis, the treatment does not stop after six months, and, as it is likely to be difficult to get funding, any arrangement is likely to set a precedent.

    Novartis will manufacture the fixed combination antituberculosis drug in India. These will be administered under the DOTS (directly observed short course) system of strict surveillance to prevent patients from stopping treatment, which can lead to multiple drug resistant tuberculosis strains.

    “Novartis has become a major force in the fight against tuberculosis,” said Dr Lee Jong-wook, WHO's director general. “We hope others in the pharmaceutical industry will follow the example for TB drugs and others … especially HIV and malaria.”

    The deal, which has taken 18 months to broker, was initiated by Novartis, whose chief executive officer, Daniel Vassella, recently told a news conference that he had had tuberculosis as a child.

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