Pfizer, Cipla Pledge Better Access To Affordable Cancer Therapies In Africa
Executive Summary
Pfizer and Cipla have separately committed to expanding access to affordable oncology drugs in sub-Saharan Africa in collaboration with the American Cancer Society and the Clinton Health Access Initiative. The public-private alliances are expected to enable procurement of these medicines for the African nations at significant savings, which Cipla tells Scrip could be in the region of 20-30% initially.
The American Cancer Society (ACS) and the Clinton Health Access Initiative (CHAI) are hoping to rewrite the script for cancer patients in six sub-Saharan African nations, akin to the drug access initiatives taken in the HIV/AIDS segment several years ago.
ACS and CHAI have now sewn up what they termed as “ground-breaking” market access agreements with Pfizer Inc. and Cipla Inc covering 16 essential cancer drugs, including chemotherapies, to improve cancer care in these countries.
The agreements are expected to set “competitive prices” on these drugs, facilitating “substantial savings” to the governments of Ethiopia, Nigeria, Kenya, Uganda, Rwanda and Tanzania, while also ensuring improved quality of treatment. An estimated 44% of all cancer cases that occur in sub-Saharan Africa each year occur in these six nations.
The deal with Pfizer covers docetaxel, doxorubicin, epirubicin, fluorouracil, gemcitabine, leucovorin, methotrexate and paclitaxel. In the case of Cipla, the agreement includes anastrozole, bleomycin, capecitabine, cytarabine, and vinblastine. Three products - carboplatin, cisplatin and oxaliplatin - are common to both companies, which have traditionally been on opposite sides of the pricing and patents debate in the pharmaceutical industry.
Asked about the broad cost savings that Cipla is offering via the market access agreement, the company told Scrip that while it is difficult to measure these at this early stage as the drugs have to still reach institutions and pharmacies, these can be estimated to be “in the range of 20-30% in the beginning.”
“This alliance is set to bring the institution directly to the manufacturer and vice versa. Countries are planning to start sourcing their requirements from Cipla and one of the early [nations] to start the process is Ethiopia,” Cipla told Scrip.
The market access agreements were negotiated by CHAI, which received funding and “technical assistance” from the ACS for these efforts, a statement from the partners said. Pfizer could not immediately be reached for specific comments on the deal. (Also see "Panel: Pricing Dilemma Divides Industry Stakeholders" - Scrip, 26 Apr, 2016.)
Openness And Transparency
A top source with knowledge of such arrangements told Scrip that, as in the case of the HIV/AIDS drugs some years ago, it is hoped that such public-private partnerships can foster “openness and transparency”, so that production planning, volumes involved, and costing details can be worked out effectively.
“That’s how we arrived at prices that were acceptable to all for the HIV/AIDS drugs,” the source explained.
The tender system, the source believes, is generally flawed, with a “winner takes all approach” often at unrealistic prices. Quality concerns are also not uncommon within this system.
The CHAI/ACS statement noted that to help develop and sustain the “volume pricing structure” announced, they were working with IBM Health Corps, a pro bono consulting program, to develop and deploy ChemoQuant, a chemotherapy forecasting software, to help countries quantify their cancer medicine needs and plan budgets and procurement.
“Uganda is now beginning to use the software and five additional countries are expected to follow suit by year’s end,” the statement added.
Cohesive Strategy
While specifics around the pricing and procurement plans for the oncology therapies were not immediately clear, the agreements appear to be part of a cohesive plan that ACS and CHAI are implementing with African health ministries to improve patient access to affordable, quality-approved anti-cancers and increase procurement capacity by governments.
“This includes reducing reliance on middlemen and private distributors, stabilizing prices, rationalizing orders, streamlining registration of products approved by a stringent regulatory authority, and promoting the entry of international suppliers with a range of quality-approved products,” the statement from ACS and CHAI indicated.
They believe that African governments could move to cost-competitive, quality-approved medicines while reducing current costs by “more than half” through effective implementation of these programs.
Asked about efforts around streamlining the registration process of products in the region, Cipla Ltd. explained that that it has been a “discussion point” for years of harmonizing registrations on a regional level like the East, South and West Africa; there has been progress but the pace is “still to pick up”, it said.
“The role and commitments from the partners to the agreements is to ensure that drugs are available and regulatory hurdles smoothen. Cipla would ensure registrations as soon as it starts receiving orders from the countries to supply the product. All stakeholders will ensure that adequate permissions and waivers are in place for the initial shipments while registrations happen,” Cipla explained.
The Indian company, though, underscored that each country has its own regulatory body and hence it is mandatory to register the products in each of the designated nations. However, the arrangements allow Cipla to start supply of the drugs as soon as the requirements are placed and “in parallel” start the process of registrations, it added.
Mounting Cancer Burden
The public-private partnerships come against the backdrop of sub-Saharan Africa’s mounting cancer burden. In 2012, there were an estimated 626,000 new cases of cancer and 447,000 cancer deaths in the region. By 2030, the World Health Organization estimates that for every four deaths from HIV/AIDS in sub-Saharan Africa, there will be three deaths from cancer.
CHAI CEO Ira Magaziner noted that while cancer treatments and the tools for early diagnosis are readily available in developed countries, market forces and other barriers have limited access in Africa.
“As was done for the HIV/AIDS crisis before it, this public-private collaboration will help revolutionize cancer treatment in sub-Saharan Africa and has the potential to save thousands of lives each year,” Magaziner stated.
Cipla’s "crusade" in the HIV/AIDS segment - as chairman Dr. Yusuf Hamied has referred to the firm’s efforts in the past - is well documented. In 2001, the Indian company introduced the first triple once-daily “cocktail” for HIV/AIDS at less than a dollar a day - increasing access to AIDS medicines manifold in Africa and elsewhere.