India is taking a tough stand seeking the delinking of pharma research costs and access to medicines - but what is the alternative?

Wrong to say Indias drug quality is substandard Health Minister JP Nadda to TNM
news Public Health Friday, May 26, 2017 - 13:54

At the World Health Organisation’s (WHO) Seventieth World Health Assembly (WHA) in Geneva, India is among countries leading the charge on some of the most important resolutions this year. Having taken a tough stand supporting the delinking of research costs and accessibility to medicines, Indian Health Minister JP Nadda speaks to The News Minute (TNM) about what India is doing nationally to bolster its global stand and how affordable medicines can be made a reality in the world. Excerpts:

The News Minute: What were your broad goals in attending the Seventieth World Health Conference, and to what extent have you been able to achieve them?

JP Nadda: The main purpose of coming to the WHA this year was to see that the Director General is rightly elected, and we feel that with Dr. Tedros elected, the issues related to developing countries will also be in focus – we are ken on preventive and promotive healthcare. 

The other aspect of our visit was the focus on the Sustainable Development Goals (SDG) in the coming times, and the determinants we have to address, - these are also related to medicines and vaccines.

In the cancer-related resolution which has been brought, India has played a very important role in that. And that is related to early detection and cheap medicines for cancer. We wanted to take a stronger stand on this because India has done it. Now we are going for universal screening of health, and in 100 districts training has started. We will be going to all 600-odd districts for universal screening. At the age of 30, we will have screening for hypertension, high blood pressure, cervix cancer, breast cancer and oral cancer etc. So, India has taken a very important stand, and was active in the cancer resolution.

On the polio transmission plan and other surveillance issues, we have tried to see to it that support to India is continued from the WHO. It isn’t just about polio, the support helps us prevent other diseases also.  Vaccine safety and security is also an area is concern for us.

TNM: You have campaigned for Tuberculosis to be taken more seriously in the Anti-Microbial Resistance (AMR) list of the WHO. How well have India’s efforts paid off? And what is India doing internally to treat TB?

JPN: First of all, as far as Tuberculosis is concerned, India has taken a proactive stance. The SDG goal is 2030, but under the dynamic leadership of PM Narendra Modiji, we have decided that we will eliminate it by 2025. And for that we have taken up active, strategic plans. The national strategic plan is prepared now, and we are gearing up for it. We have rolled out the daily drug regimen. CB-NAAT machines are there in practically every district in India, we have 628 machines installed. We have 500 more coming in, and we want to take each one till the sub-divisional level so we can do early detection. We have gone for active survey of MDR cases. 

The loose end was notification of TB, which is ‘missed opportunities’, so we have made notification to the government by private players mandatory. Doctors have to tell us if they spot symptoms of TB.

As for the AMR, 11 ministries in India have come together to sign the Delhi Declaration to work together on the issue.

TNM: What are you doing to address the problem of increased antibiotic resistance in India?

JPN: Apart from the coordination between the ministries, we have a better regulatory mechanism now. Every antibiotic now has a red strip, it cannot be sold over the counter. We are addressing it at the source, which is the chemist, to see to it that antibiotics cannot be sold over the counter.

TNM: And there is compliance?

JPN: Yes, there is compliance.

TNM: But there are some chemists who still do it?

JPN: The law is very clear, and there are stray cases where it is violated, and we will address them.

TNM: What about awareness?

JPN: Yes, we are at a stage where we are advocating to people to make them understand what is over-dosage and what is under-dosage.

TNM: You have been pushing for the delinking of cost of pharmaceutical research and the price of the medicines, to increase affordable access to medicines. What cooperation are you expecting from the international community?

JPN: We are advocating it, we are very clear on it. We are also saying that TRIPS allows us to see to it that trade and commerce are not attached to health and human interest. We have to give people access to affordable medicine. We have to convince others for new systems for rewarding or granting funds for R&D.

TNM: But it all comes down to the money, whose job is it to figure it out? Who should take the lead?

JPN: It is the WHO which should take the lead. We are very clear about it and have taken a stand in every international forum. We have to develop a new system to see how R&D should be funded and rewarded, and how new drugs should come up. But accessible and affordable medicine is the primary goal.

TNM: Can you tell us a little more about what are these new ways of funding?

JPN: There have been various models of financing, and we are looking into it. The model should look at a product development partnership which should ensure that the products are accessible.  

TNM: But what is that model?

JPN: Right now, there are discussions around it. Most countries are not clear about it, we are also not clear about it. It is in the process of evolution.

TNM: How real is the criticism and perception that India has substandard quality of pharma manufacturing?

JPN: It is not real at all. Sixty percent of the world’s drugs are Indian – accessible, affordable, equitable and quality drugs. Our regulatory systems are very strong, many new steps have been taken. Nearly Rs. 2700 crores is being spent now to strengthen the system, labs and human resources. We have been certified by the WHO as having a functional regulatory system, both for medicines and vaccines.

TNM: So where is this criticism coming from? Why?

JPN:  The criticism is not coming from the right quarters.

It is with design. We now had a survey with all stakeholders, and only 3% of medicines were found to be substandard. We say we very clearly that we have good standards, and it is being accepted also. It is not for no reason that India is known as the pharmacy of the world.

TNM: Do you see public health becoming an election issue in India? Do you think it can create employment?

JPN: PM Modi ji is very clear that the quality of life must improve, and that is why health is an issue. That is why there is a thrust in the sector. From disease-centric health policy, we have come to preventive and promotive health policy. So, health is an issue.

As we enhance our health services, we need more quality human resources, then there is scope of increase in employment. We are also improving our medical education, so we are working in that direction.

TNM: Could some health sector issues piggyback on the total electrification dream India is trying to achieve by next year?

JPN: Yes, we will look into it, and it could be very useful to create our cold-chain system to store vaccines, and we will try to harmonize the two. 

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