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Medicine prices vary widely both between and within countries
On 30 November 2009 Health Action International (HAI), a global NGO on pharmaceutical policy issues, undertook a global “snapshot” of the price of ciprofloxacin, a commonly used off-patent antibiotic. The prices of the originator brand product and the lowest priced generic equivalent were collected.
Data were collected from 93 countries globally (including 14 from the Eastern Mediterranean Region) where the price for a 7 day treatment course of ciprofloxacin ranged between US$ 0.42 and US$ 131. An interactive map on HAI’s website presents the results and shows large price differentials across the world for this medicine (see www.haiweb.org/medicineprices). While the prices should not be considered representative, as great price variation exists within some countries, these “snapshot” prices are indicative of what people have to pay, when paying the full retail price, in those pharmacies on that day.
The findings confirm that prices can vary widely both between countries and within countries. Although the patent on ciprofloxacin expired a number of years ago, the price difference between the lowest priced generic and the originator brand (the ‘brand premium’) is significant in many countries. For example, Colombia showed the largest brand premium, with the originator brand priced at 60 times the lowest priced generic. Colombia also had the highest treatment cost for originator brand ciprofloxacin in the private sector: a patient in Colombia pays more than 200 times the price they would pay in five Asian countries where the price of generics was lowest – a difference of almost 20 000%.
The WHO Regional office for the Eastern Mediterranean collaborated with HAI and through its network of WHO country offices and Ministries of Health. Official prices were collected in 14 countries (Afghanistan, Bahrain, Egypt, Islamic Republic of Iran, Jordan, Libyan Arab Jamahiriya, Morocco, Pakistan, occupied Palestinian territory, Qatar, Somalia, Sudan, Syrian Arab Republic, United Arab Emirates, Yemen).
In the Eastern Mediterranean Region the average price for the originator brand (US$ 36.47) was twice the price in Southeast Asia (US$ 17.46) but less than in other regions. For lowest priced generics, the price in the Eastern Mediterranean Region (US$ 7.61) was more than in South-east Asian Region (U$ 1.19), African Region (U$ 4.55) and the Western Pacific Region (U$ 7.23).
In the Eastern Mediterranean Region the originator brand was 10.6 times the price of the lowest priced generic (similar to what was found in the WHO European Region). In other regions of the world, the price difference between originator and generic was even greater.
The average price of the originator brand shows very little variation across countries of different wealth. In contrast, the average price of generics decreased as the wealth of the country decreased. The use of low priced generic medicines is a significant step towards improving access to treatment. Generic ciprofloxacin is mostly available at a much lower price than the originator brand product, and in many cases, there is ample room to reduce the generic price further, making treatment more affordable.
“Governments need to further examine access to affordable essential medicines in their country and give it the priority it deserves. Being sick is enough of a misfortune; obtaining needed medicines should never result in choices between impoverishment, going without treatment or buying only a partial course of treatment”, said Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean.
For more information, a detailed briefing note is downloadable at the following link (www.emro.who.int/emp)
African health experts to discuss the impact of influenza in Africa
31 May 2010 – Geneva/Brazzaville/Cairo – Senior officials from African ministries of health and representatives of health partners and international agencies are scheduled to meet from 3-4 June in Marrakesh, Morocco, under the umbrella of the newly-created African Flu Alliance.
The Marrakesh meeting is being organized by WHO and a number of national, international and nongovern¬mental organizations as well as financial partners and agencies. It will be attended by representatives of African Ministries of Health and African research institutes; the Association pour la Médecine Préventive (AMP); the US Centers for Disease Control and Prevention (CDC) and the US National Institutes of Health (NIS); the German Technical Cooperation, GTZ; Fondation Mérieux, the Institut Pasteur International Network, the Fogarty International Center, (US) and the Programme for Appropriate Technology (PATH).
"We know that influenza has a significant impact on morbidity and mortality throughout Africa, but unfortunately, we don't have a great deal of data that shows this," said Dr Keiji Fukuda, Special Adviser to the WHO Director-General on Pandemic Influenza.
"Influenza is often seen as a problem for temperate countries. But, it is also a major threat to health in developing countries, including countries in tropical zones". Influenza viruses are important respiratory pathogens, and acute respiratory tract infections, such as pneumonia, are a major cause of death in Africa, particularly among children.
"The absence of adequate information, lack of awareness of the disease and other competing public health needs has meant that no specific interventions have been developed to reduce the impact of influenza in Africa," said Dr Sylvie Briand, Head of the Global Influenza Programme at WHO. A number of African countries have provided regular updates to WHO on the spread of pandemic influenza A (H1N1) 2009.
However, the impact of the pandemic on the African continent is not apparent, which indicates a need to strengthen surveillance systems to assess the effect of the pandemic across the continent.
One of the key objectives of the Marrakesh meeting is to raise awareness of the pressing need to strengthen surveillance capacity in Africa, and to prepare a roadmap of interventions and strategies to reduce the burden of influenza in the region in coming years.
More research and data will make it possible for policy-makers to develop the evidence needed to strengthen public health guidance and actions essential for limiting the impact of pandemic, zoonotic (Avian flu) and seasonal influenza on individuals and populations in the region.
The African Flu Alliance is a new initiative that seeks to promote collaboration and exchange of information among various stakeholders in Africa and beyond.
The Global Influenza Programme is WHO's specialist programme on seasonal, avian and pandemic influenza.
For more information please contact:
WWW.AFRO.WHO.INT For more information, please contact:
Sam Ajibola, Communications Officer , Brazzaville, + 47 241 39378;
Mark Bloch, Communications Officer, Geneva, +41 79 445 2280,
Omid Mohit, Technical Manger, Media and Communications , Cairo +20 -2- 227 – 65365;
Key findings released from the Global Adult Tobacco Survey in Egypt
Today, on 28 January 2010, the World Health Organization (WHO) Regional Office for the Eastern Mediterranean and Egypt’s Ministry of Health and Central Agency for Public Mobilization and Statistics launch important findings from the largest tobacco use monitoring survey ever conducted among adults in Egypt. This survey was conducted in 2009 in all of Egypt’s governorates, covering both males and females, aged 15 years and older, in a total sample size of 23 760. The implementation of the survey was a collaborative effort between the WHO Representative’s Office in Egypt, the Ministry of Health and the Central Agency for Public Mobilization and Statistics.
One of the key findings revealed by the survey is that 38% of Egyptian males use some form of tobacco product. Of this percentage, nearly 32% smoke cigarettes, about 6% smoke shisha and almost 5% chew tobacco.
The survey also revealed that the majority of Egyptian males who use any tobacco product belong to groups who either have no formal education or have some primary level education (approximately 52% and 50%, respectively).
Tobacco use constitutes a serious health burden on Egyptian society, and also on the health system, due to the cost of providing health care for smokers.
The Global Adult Tobacco Survey revealed an unexpectedly high rate of usage of smokeless tobacco, which had not previously been identified as a public health concern in Egypt. Usage of ‘chewed’ tobacco was shown to be as high as 5% among males and 0.3% among females. Contrary to popular belief, the survey found that adults consuming smokeless tobacco do so on a daily basis.
According to the survey, 0.6% of the Egyptian female population use some form of tobacco product. Of this percentage, 0.2% smoke cigarettes, 0.3% smoke shisha and 0.3% chew tobacco.
The survey also revealed that the majority of Egyptian females who use any tobacco product belong to groups who either have no formal education or have some primary level education (both 1.1%).
The survey showed that male cigarette smokers smoke an average of one pack a day while females smoke on average half a pack a day. 88% of current cigarette smokers smoke local brands.
Smoking in public places in Egypt is a serious public health threat. Exposure to second-hand smoke results in serious hazards related to both health and the environment. It is estimated that more than 70% of people are exposed to second-hand smoke in restaurants while about 49% are exposed to second-hand smoke in health care facilities.
Despite the fact that anti-tobacco laws in Egypt strictly prohibit smoking in public places, adherence is weak. Implementation, enforcement and compliance with these laws are important issues that need to be addressed at national level to reduce exposure to second-hand smoke, and thus the health risks associated with it.
One of the most important results of the survey relates to the economic cost of tobacco consumption which amounts to approximately 6% of the average monthly income of the Egyptian family.
This survey paves the way for the implementation of strong evidence-based policies targeted at all facets of the tobacco problem at the national level in Egypt, such as second-hand smoking and chewed tobacco, and for the implementation and enforcement of anti-tobacco legislation. Additional efforts must be exerted to target groups where there are high levels of tobacco consumption, such as males in the age group of 25–44 years, among whom the rate of tobacco consumption is around 46%.
It is also apparent that tobacco industry campaigns in Egypt have focused on the link between smoking and urbanization among Egyptian females based on the increase seen in tobacco consumption among female university graduates. This specific situation, in turn, needs to be addressed through a comprehensive multi-sectoral approach.
The Global Adult Tobacco Survey was conducted in 14 countries as follows: Bangladesh, Brazil, China, Egypt, India, Mexico, Poland, Philippines, Russian Federation and Ukraine, Thailand, Turkey, Uruguay and Vietnam. Egypt is the sixth country to launch the survey data. It is hoped that the Global Adult Tobacco Survey will be conducted periodically in Egypt to obtain comparable evidence-based data which will facilitate the evaluation of tobacco control activities as well as help compile a complete file on the tobacco epidemic in Egypt.
For more information, please visit the Tobacco Free Initiative:
Financial support for GATS was provided by Bloomberg Philanthropies. Technical assistance was provided by the Centers for Disease Control and Prevention, and programme support was provided by the CDC Foundation.
