BONELA is raising national awareness as to why intellectual property (IP) and access to medicines are relevant for everyone – and highlighting consequences when these issues are ignored.
According to the latest UNAIDS data (for 2016), Botswana has a HIV prevalence rate of 21.9% among adults. The country has committed to providing universal free antiretroviral treatment (ART) to people living with HIV, and 84% of adults and 60% of children who require ARVS are on treatment.
Access to essential medicines is a complex issue in Southern Africa and Botswana is no exception. Botswana is one of the first countries in Southern Africa to provide government aided ART to its citizens. However, with more people with HIV living longer, there is a need to assess Botswana’s options in accessing more affordable generic medicines for second and third line anti-retrovirals amid increasing resistance to first line ARVS, as well as access to affordable drugs for non-communicable diseases.
Our partner, the Botswana Network on Ethics, Law and HIV/AIDS (BONELA), is a non-governmental organization committed to integrating an ethical, legal and human rights approach into Botswana’s response to the HIV epidemic.
Making the connections
The laws and intellectual property protections that affect peoples’ access to medicines are not something that patients are typically aware of. For example, that the over-protection of pharmaceutical companies’, via unmerited patents, results in overpriced drugs that stretch health budgets beyond their limits.
“When an individual is prescribed ARVs, they just want to know they’re receiving the best possible care. The majority of people have been unaware that IP is often a key underlying factor that can affect the availability and effectiveness of the treatment they receive,” says Felistus Motimedi, BONELA’s Programmes Manager. “We want to improve patient literacy, which will bring increased demands for optimal treatment. You can’t demand optimal treatment unless you know it’s being denied to you – that’s where our workshops, media outreach and advocacy work come in.”
You can’t demand optimal treatment unless you know it’s being denied to you – that’s where our workshops, media outreach and advocacy work come in – Motimedi
Broadcasting the barriers
Motimedi describes the “urgency” required in raising awareness. “It’s a public interest issue,” she says. “The public response to our radio and media coverage was encouraging, people ‘got it’. It’s so important that we break down this technical-sounding issue – i.e. intellectual property, so that people can see the personal relevance to them. The real consequence at the end of the day is that a drug that can save your life may not be available to you unless we tackle these issues.”
BONELA view this public engagement work as an important part of its strategy, as increased public awareness and support can bolster its advocacy work with the government, including the Ministry of Health (MoH), the National AIDS Coordinating Body (NACA), as well as Botswana’s patent office, Companies & Intellectual Property Authority (CIPA).
BONELA has also carried out workshops with civil society organizations working on health. “They’re in a prime position to advocate on these issues which directly affect their work and priorities,” says Motimedi. “However, similarly to the broader public, many participants expressed that they hadn’t felt that ‘trade’ issues were relevant to their work, even those who have worked in the system for a long time. It’s opened a new world, and a new avenue for advocacy in fighting for health for all.”
The workshops both resulted in advocacy plans, which BONELA will combine into one shared action plan. Actions include:
- Getting more CSOs on board, and consulting with them one-on-one.
The more CSOs involved, the more impact. Collaboration will be strengthened and capacity in this area built.
- Increase engagement with the government working groups and ministries, including the MoH, NACA, and CIPA.
- Engage with MoH on procurement, including obtaining a list of patented essential drugs and prices, and promote the use of TRIPS flexibilities where access barriers are causing a public health issue.
- Following on from that, engage with Ministry of Foreign Affairs on IP and TRIPS issues and their effect on the medicines. BONELA wants a commitment that any Bilateral Trade Agreements do not hinder full exploitation of TRIPS flexibilities.
- Continue the public awareness campaigns and ensure that communities are treatment literate.
The Global Fund to Fight AIDS, TB and Malaria has requested a country proposal with regards to the sustainability of Botswana’s HIV response. BONELA has drafted a paper on the use of TRIPS flexibilities to submit to this via the CCM. Botswana, and indeed all countries, must be able to exert its right to use these flexibilities to protect public health, without facing pressure or backlash from pharmaceuticals. In the face of a broken patent system that allows exorbitant prices on essential medicines, the flexibilities, such as issuing compulsory licenses, are life-lines for governments with overstretched health budgets. These flexibilities are necessary in reducing the price of medicines, so that everyone can receive optimal treatment.
The real consequence at the end of the day is that a drug that can save your life may not be available to you unless we tackle these issues – Motimedi