[e-drug] Pfizer fluconazole programme failing in Dominican Republic

["Eugene Schiff" <iecs96i@aol.com>]

E-DRUG: Pfizer fluconazole programme failing in Dominican Republic
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Subject:  Pfizer s Lethal Deceptions about its Diflucan Partnership Program Continue as Thousands of Dominicans living with AIDS remain without ARV Access

Pfizers Lethal Deceptions Continue:

Pfizers distributors continue to stock private pharmacies with overpriced for-profit Diflucan, while people living with AIDS continue to die without access to Diflucan or antiretroviral medicines in the Dominican Republics poorly equipped public hospitals.

For Immediate Release:

April 10, 2005 - Santo Domingo, Dominican Republic
by Eugene Schiff* 

For many months, Pfizer, the largest pharmaceutical company in the world, has aired advertisements, which are seen by millions of viewers internationally on CNN, extolling the virtues of its Diflucan Partnership Program, Pfizers commitment to fighting HIV/AIDS, and its efforts in reaching out those in need.  However, reality on the ground is another story. 

In the Dominican Republic, 90-95% of people living with AIDS currently lack ARV treatment access, which represents a very slight improvement in recent years, since a few years ago almost 100% of people living with AIDS had no access to treatment.  Even today, in 2005, the Dominican Government along with a score of international donor and advisory agencies have proved unable or unwilling to provide ARV medicines to most of those dying with AIDS who need these drug cocktails.  

The first line antiretroviral treatment costs less than a dollar a day (thanks to Indian generic medicines and bulk contracts negotiated by the Clinton Foundation).  The list of key institutions and decision makers providing significant resources related to HIV/AIDS to the island is a long one.  However, COPRESIDA (the strongly politically influenced Presidential AIDS Commission, which is the Principal Recipient of a massive multimillion dollar Global Fund contract), the Global Fund to Fight AIDS, TB, and Malaria based in Geneva, the World Bank in Washington, the Inter-American Development Bank, USAID (which provides considerable resources in the Dominican Republic for HIV/AIDS but stipulates no ARVs can be purchased through its funds), Family Health International, Conecta, UNAIDS, the Pan American Health Organization, SESPAS (the Dominican Public Health Department), the Clinton HIV/AIDS Initiative, Columbia University, and others have thus far been unable to effectively coordinate a significant expansion of the ARV access program to cover the 90% who need but remain without treatment, or even provide a particularly decent standard of care to the 10% who do receive ARVs.**

In this context, many people living with AIDS have no defense against a compromised immune system and therefore they are at even greater risk for developing potentially lethal fungal infections like oral candidiasis and cryptoccocal meningitis.  Fluconazole is used to treat these infections.  Pfizer manufactures Diflucan (fluconzaole), whose patent recently expired.  

For patients with suspected candidal esophagitis, 100-400mg of fluconazole is recommended per day for a minimum of 14-21 days.  For oral candidiasis 100mg/day fluconazole is recommended for 10-14 days.  For patients with recurrent vaginal candidiasis that is not responsive to topical therapy, 150mg fluconazole weekly may be considered.  For cyptococcal meningitis, 400mg/day fluconozole is recommended for 8 weeks for consolidation therapy or until cerebral spinal fluid cultures are negative after induction therapy, and then 200mg daily for chronic therapy to prevent relapse in AIDS patients.  (CDC/NIH Treatment Guidelines  Dec. 2004)

Pharmacies in the Dominican Republic currently sell fluconazole but the medicine is frequently unavailable in public hospitals.  Perhaps the most telling example of Pfizers commitment regarding access to Diflucan is that in private pharmacies in the Dominican Republic one 150mg tablet of Pfizers Diflucan costs (April 2005) 569 pesos or $20.32 USD per pill.  Generic versions of fluconazole can also be found for about $5 dollars per 150mg pill (which is still expensive for most poor Dominicans who need to take a several course treatment).  Generic fluconazole produced in Nicaragua costing less than two dollars has recently surfaced and can sometimes be found in government subsidized pharmacies known as boticas populars.  However, several physicians who frequently prescribe such medicines for AIDS patients expressed concerns that the quality of the poorly regulated medicines stocked in the government pharmacies is unknown.  Most importantly however, few if any of the dozen or so sites created by the Coordinating Unit for Integral Care (UCAI) which treat AIDS patients throughout the country have regular access to fluconazole for their patients, despite now stale promises made by politically minded health authorities month after month that the government is working on making medicines for opportunistic infections available in such sites.

Eight months ago, Agua Buena exchanged sent a series of letters with Konji Sebati (Pfizer) and Joseph Saba (CEO Axios) regarding the poor management, tedious and broken website application for the Diflucan program, and the situation regarding Diflucan access in the Dominican Republic, which has changed little since.  After this publicity, one institution, the Instituto Dominicano de Estudios Virologicos along with ASOLSIDA (an association of people living with AIDS) decided to apply to the Diflucan Program, and submitted an application last November 2004.  The application was approved, yet five months later the medicines have still not arrived.   

Axios, which is based in France and manages Pfizers Diflucan Partnership Program, has expressed that they are helping to expedite this process.   Last week, Axios inquired with the IDEV in Santo Domingo for information about shipping addresses and port of entry, despite the fact that such information was provided in the application, and that this information could and should be readily available from Pfizers local office here in the Dominican Republic any time during the past five months.  The lethally incompetent management of this program by Pfizer and Axios continues to this date.  Instead of becoming concerned about such delays, or even providing a donated supply of Diflucan in the midst of these month-long delays, Pfizer has left the philanthropy to Axios and continues to offer Diflucan for $20 dollars per pill as part of its for profit operations here.  Furthermore, the partnership program website proclaims that since 2001 the Diflucan Partnership Program will be made available for life to those eligible patients and institutions, but the IDEV apparently must reapply to the program to renew the contract each year, a potentially tedious process indeed.

Strict stipulations state that Diflucan administered by the Dominican Virology Insitute can only be used for AIDS patients, while absurdly, others with fungal infections must continue to pay Pfizers exorbitant market price for the same product.  Even if and when free Diflucan become available at the privately administered Instituto Dominicano (IDEV), it is not clear how quickly access to Diflucan will be assured in the public sector throughout the country, where it is needed the most.  When the Diflucan Partnership Program arrives in the Dominican Republic, which will hopefully be soon, the damage will have already been done for those who have already died due to lack of affordable fluconazole and ARV medicines.  Many have died in part because Pfizer Inc. continues to price Diflucan out of range of most Dominicans, a twisted partnership indeed.  

Pfizer estimates that cryptococcal meningitis affects 10% of people living with AIDS, and esophageal candidiasis affects approximately 30% of AIDS patients.  

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**PLWA in the Dominican Republic who are fortunate enough to win the grueling and often humiliating lottery-like process of entering the National Program, which provides free ARV medicines (if they are still alive at the end of this struggle) remain without assured access to timely and affordable CD4 tests, without Viral Load tests, without many medicines for opportunistic infections, often without readily available second line therapy, without tests for viral resistance, without nutritional support, and without assistance with transport to get to the clinic (a real challenge for unemployed lower-income PLWA) for numerous follow-up appointments, lab tests, etc. Many of these services are provided as needed in other settings in the developed world and also in some successful ARV programs in resource poor settings, but in the Dominican Republic these important services remain special privileges which only a lucky few can obtain (often not even those who may need them most) or else can afford to pay for on their own.**
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*Eugene Schiff - Caribbean Region Coordinator
Agua Buena Human Rights Association
www.aguabuena.org 
809-858-1337  (mobile)
809-274-6252 (tel/fax - Santo Domingo)
eugene.schiff@gmail.com
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Richard Stern - Agua Buena Director
San Jose, Costa Rica
Tel/Fax: 506-234-2411
rastern@racsa.co.cr
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Guillermo Murillo - Agua Buena Assistant Director
San Jose, Costa Rica
Tel/Fax:  506-430-5979
memopvs@racsa.co.cr 
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Mabel Martmnez -  Agua Buena - Centroamirica; Honduras/Nicaragua
legreec@yahoo.es
         
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Jaime Argueta -  Agua Buena - Centroamirica; Guatemala/El Salvador
highlander213@navegante.com.sv

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