Anti-malaria drugs in private sector crossing borders

By Esther Nakkazi

Subsidized anti-malarial drugs sold through private sector outlets are now crossing borders and getting repackaged to retail at prices far above the target of making them easily accessible to the public.

In 2010, the Global Fund started the Affordable Medicines Facility for malaria (AMFm) project with a financing model that would make Artemisinin-based Combination Therapies (ACTs) affordable and accessible to the public within 24 hours.

It was envisaged that the initiative would save at least 70,000 lives and lead to savings of about $65 per household annually, the amount an average family in Uganda spends on ACT for malaria treatment per year according to the Global Fund.

The project-financing model subsidized ACTs by 95 percent so that the consumer would pay a price over 1,000 percent lower than the usual price through the private sector outlets where about 60 percent of Ugandans go when they fall sick.

But the price has failed to be translated to the consumer as the ACTs are repackaged and resold to markets in Kenya, southern Sudan and DR Congo. The project has also been slow in taking off.

In Uganda, one of the nine pilot countries under the project, the ACTs cost up to Ush 20,000 ($8.5) although the targeted price after subsidizing them by the Global Fund was meant to be only Ush 1,200 ($0.5).

“We are now recovering more anti-malarials that are supposed to be sold through the private sector and they cost so much more,” said Dr. Diane Atwine head of the Medicines and Health Services Monitoring Unit (MHSMU).

The monitoring unit set up in 2009 to investigate the theft of drugs from government facilities so far has no records of the quantities of ACTs recovered but estimated that anti-malarials and antibiotics worth $ 2.5 million have been intercepted since November 2011. 

Artemisinin-based combination therapy is the World Health Organization (WHO) recommended first line treatment for malaria in public and private facilities.

Stakeholders have blamed the illicit ACTs trade by the private sector on the weak packaging, in blisters, which makes them susceptible to retailers. They remove the outer cover and put them in tins. However, its not only those that are prone but even those that are not repackaged.

The Global Fund ACTs packages do not bear the official price, which would inform consumers of the price. They only bear a green leaf as a logo, which apparently signifies affordability and effectiveness of the antimalarials, said Dr. Atwine.

The logo was also meant to distinguish the subsidized ACTs from others sold through the private sector and guide consumer choice. But there is no awareness by the public on their availability.

“It is also a mindset problem. People consider cheap things to be of low quality. Until there is enough awareness created, the skeptical public might take time to buy these drugs,” said Dennis Kibira, the medicines advisor at HEPS-Uganda.

According to Kibira, this would require a strong behavior change campaign, which has not taken place. While the project kicked off early 2010, the medicines arrived in April last year and the awareness campaign only starts next month.

Secondly, it was anticipated that the under the project ACTs would flood the market, in a sense of supply outstripping demand within a price regulated market but this has not happened.

“We thought drugs would flood the market but it has been slow. We now have funds for creating awareness through a national campaign so that the public can know that the ACTs are available at a subsidized rate,” said Dr. Peter Albert Okui, at the National Malaria control programme.

Research shows that ACTs are not readily available in Uganda and are only in as few as 1 in 25 private sector drug outlets. And only 6 percent of children access ACTs in 24 hours although it kills mostly pregnant women and children below 5 years old.

As close to homes as they can get, access to antimalarials within 24 hours would improve Ugandans health to reach the Abuja revised Roll back Malaria (RBM) target of 80 percent populations with no malaria.

Ends. 

FIRST VACCINE AGAINST FATAL VISCERAL LEISHMANIASIS ENTERS CLINICAL TRIAL

As disease expands global reach, Infectious Disease Research Institute teams up with India to target most deadly form of leishmaniasis

Press Release

SEATTLE, WA, USA (22 February 2012) The first clinical trial of a new vaccine for Visceral Leishmaniasis (VL) has been launched by the Infectious Disease Research Institute (IDRI), a Seattle-based nonprofit that develops products to prevent, detect, and treat diseases of poverty. The Phase 1 trial is taking place in Washington State, with a companion Phase 1 trial planned in India, an epicenter of the disease.

Visceral leishmaniasis affects vital organs and bone marrow, destroying white and red blood cells. Because VL attacks the immune system, it has been called the parasitic version of HIV/AIDS.

“Visceral leishmaniasis is a persistent and deadly global health problem,” said Steve Reed, IDRI founder and Chief Scientific Officer, who led the over twenty years of preclinical vaccine work. “Our partnership with India will speed the development of an effective vaccine and accelerate control of the disease.”

Leishmaniasis takes several forms, all of which are caused by the Leishmania parasite and transmitted by infected sand flies. VL is most common in India, Nepal, Bangladesh, Sudan, and Brazil and causes about 500,000 cases and 50,000 deaths each year. Cutaneous leishmaniasis, the most common form of the disease, causes serious skin lesions and often leaves its victims permanently disfigured. Leishmaniasis occurs in 88 countries, affecting 12 million people.

While the disease can be treated, current treatments are too expensive, difficult to administer, or toxic for widespread use in poor countries. Drug resistance is also a growing problem, particularly in India. Left untreated, VL has a 90% case fatality, and death can come within two years—much more quickly than AIDS.

Furthermore, scientists warn that the geographical range for leishmaniasis is expanding. Spurred on by global warming, mass migration and rapid urbanization, cases are being reported in previously unaffected areas.

Given such challenges, a vaccine is considered essential to control and eliminate the disease.

“With this clinical trial, we hope to launch a new era in the fight against Visceral Leishmaniasis,” said Franco Piazza, Medical Director at IDRI and leader of the vaccine’s clinical development. “For the first time, an advanced vaccine to prevent this devastating disease is being tested in people.”

The IDRI vaccine, known as LEISH–F3 + GLA-SE, is a highly purified, recombinant vaccine. It incorporates two fused Leishmaniaparasite proteins and a powerful adjuvant to stimulate an immune response against the parasite.
The Phase 1 clinical trial will enroll 36 adult volunteers in Washington State. They will be randomly assigned to receive one of three versions of the vaccine, which differ in the amount of adjuvant included. The trial will evaluate the safety and immunogenicity of each version.
A second Phase 1 trial will take place in India, where IDRI is transferring its vaccine technology to Gennova Biopharmaceuticals. Last month, Gennova opened a vaccine formulation center that will be producing vaccines for neglected diseases in Pune, India, where the company is based.

In India, VL is known as kala-azar, a Hindi word that means black fever, named after the fever that ravages affected individuals, whose skin becomes dark gray.

“Kala-azar is a significant health problem across northern India and neighboring countries,” said Dr. Sanjay Singh, CEO of Gennova. “Bringing a vaccine to India will not only end deaths and disease, it will also help many of our poorest citizens to lead more productive lives and move out of poverty.”

Beginning later in 2012, the Indian vaccine manufacturer will produce the LEISH-F3 + GLA-SE vaccine. It will be then tested in healthy Indian adults, in collaboration with the Banaras Hindu University in Varanasi, India.

“We are very pleased to be working with IDRI on this vaccine, which is critically important to the many people who suffer from this disease in India as well as to the millions of people who are infected around the world,” said Dr. Shyam Sundar, Professor of Medicine at the University’s Institute of Medical Sciences.

Subsequent clinical trials will involve larger numbers of people who are at high risk of developing VL during their daily lives, because they are frequently bitten by sand flies. Only such large trials, conducted in real-life situations of disease exposure, will determine the full effectiveness of the LEISH-F3 + GLA-SE vaccine.

“Vaccines can do what medicines can’t – prevent the disease from even occurring,” said Dr. N. K. Ganguly, a highly distinguished biotechnology professor and advisor in India, and former Director General of the Indian Council of Medical Research (ICMR), New Delhi. “Only with an effective vaccine can we expect to control leishmaniasis in South Asia.”

The Phase 1 clinical trials are being funded by the Bill & Melinda Gates Foundation, which also recently announced a global partnership with the World Health Organization and 13 pharmaceutical companies to control or eliminate 10 neglected tropical diseases, including leishmaniasis.

About IDRI

The Infectious Disease Research Institute (IDRI) is a Seattle-based not-for-profit organization committed to applying innovative science to the research and development of products to prevent, detect, and treat infectious diseases of poverty. By integrating capabilities, including early stage drug discovery, preclinical testing, manufacturing, and clinical trials, IDRI strives to create an efficient pathway bringing scientific innovation from the laboratory to the people who need it most. For more information about IDRI’s Leishmaniasis vaccine program, visit http://www.idri.org/press-2-20-12.html

US partners with Uganda Army to fight HIV/AIDS

Press release.

KAMPALA 15/2— The U.S. Mission Uganda has given the Uganda People's Defense Forces (UPDF) vehicles and equipment to launch three complete mobile army surgical units to expand access to mobile male circumcision in all five UPDF divisions. The seven vehicles and assorted equipment, valued at approximately $763,000, were funded by the U.S. Department of Defense and the President's Emergency Plan for AIDS Relief (PEPFAR).

Research has shown that safe medical male circumcision (SMC) is over 60 percent effective in reducing male HIV infection, and is an important part of the Combination Prevention Package, which includes condoms, being faithful to your partner, and knowing your HIV status.

Since 2009, the UPDF has opened four static sites (in Bombo, Gulu, Mbarara, and Katabi) to provide SMC. Due to high demand for SMC and the movement of UPDF forces, these static sites could not serve the entire force. The three mobile army surgical units donated by the U.S. Mission Uganda can travel to areas where there are no fixed facilities, or where the facilities are too small to circumcise more than a few men in a day. These teams will help the UPDF meet its goal of circumcising 60,000 men over the next three years.

The U.S. Government has broadly supported the UPDF's HIV prevention, care, and treatment programming for the last three years. The joint effort also includes HIV counseling and testing, prevention of mother-to-child transmission (PMTCT), antiretroviral treatment, and addressing tuberculosis and HIV co-infection.

Government avails more cancer drugs

Press release (Uganda Media Centre) 

5th February 2012

Yesterday, Saturday the 4th of February, as Uganda joined the rest of the world to promote International World Cancer Day, the government announced it is driving the expansion of the Uganda Cancer Institute at Mulago.

The government set up the Uganda Cancer Institute in 1967 in collaboration with the National Cancer Institute in the US to provide a base for clinical and investigative research for possible causes and treatment for cancer. This put Uganda in the lead in the fight against cancer in Africa.

According to Dr. Jackson Orem, the Director Uganda Cancer Institute “The government is erecting a six storied building that will house two cancer theatres, wards for the patients, Intensive Care Units and storage of tissue for research and future reference.”

A plan has also been put in place to train more oncologists and other cancer specialists to boost the current human resource. “ICU is charged with identifying the right people for training and they undergo training both here and abroad,” said Dr. Orem.

It is alarming that out of all new cancer cases diagnosed per year the majority of cases are reported too late. “The government would therefore like to remind the public that there are free cancer treatment drugs and other services at UCI Mulago that are accessible free of charge to all Ugandans.”Hon. DR. Christine Ondoa, Minister of Health said yesterday.

The institute has one of the best drugs that treats leukaemia (Glivec) in the world. There is also a provision for private cancer patients that would like to pay for their own treatment.

Orem, however warned that cancer cases are on the increase worldwide,Hon. DR. Christine Ondoa, Minister of Health called upon the public “to be vigilant about their health and report infections early for treatment. Let us create awareness, of prevention and available treatment, let us work together to reduce new infections.”

Hon. DR. Christine Ondoa, Minister of Health.

Fred Opolot
Executive Director/ Media Centre

Uganda signs Production Sharing Agreements with Tullow Uganda Limited

Press Release : www.petroleum.go.ug

The Government of Uganda has concluded negotiations with Tullow Uganda Limited for Petroleum Exploration licences over Exploration Area 1and Kanywataba Prospect and issued a Production Licence over the Kingfisher Field on February 3rd 2012 at Amber House, Kampala.

The two Exploration Licences in the PSAs and the Production Licence have been issued under Sections 9 and 22 respectively of the Petroleum (Exploration & Production) Act, Chapter 150 of the Laws of Uganda, 2000.

Government and Tullow Uganda Limited entered into a Memorandum of Understanding (MOU) regarding the development of the petroleum resources discovered in Exploration Areas 1, 2 and 3A. The parties to the MOU, recognizing the time lost during the tax dispute over the sale of Heritage’s interests in Uganda to Tullow Uganda Limited, agreed to grant new licences over the Kanywataba Prospect Area and Exploration Area 1, for Six months and One year respectively.

It was agreed that Tullow could apply for the Kingfisher Field in accordance with Section 20(3) of the Act. Tullow duly applied for a production licence over the Kingfisher Field which has been granted today.

The PSAs for Kanywataba Prospect and EA1 have the following provisions among others:

a) Minimum Work Programme together with the Minimum Exploration Expenditure.
b) An Advisory Committee consisting of representatives from Government and the Licensee to review and approve all annual exploration work programmes, budgets and production forecasts.
c) An Initial Royalty based on progressive incremental production and an additional Royalty as a percentage of the value of the recovered reserves.
d) State Participation by Government or its Nominee at Production Level.
e) Cost Recovery limits for Oil Production and Gas Production set at different levels.
f) Production Sharing based on incremental production after deduction of Initial Royalty and the Cost Recovery
g) A Signature Bonus of US$ 200,000 and US$ 300,000 respectively upon signing of the PSA to Government.
h) Each of these two PSAs in addition have provisions for a discovery bonus of United States dollars two million (US$2,000,000).
i) All taxes will be paid in accordance with to the Laws of Uganda. The rate of income Tax presently stands at 30%.
j) A requirement to train and employ suitably qualified Ugandan citizens in addition to payment of annual training fees to Government.
k) Payment of annual surface rentals computed differently for exploration and production phases per square kilometre.

One of the key aspects that delayed the signing of these PSAs was the issue of Stabilisation and the proposal by Oil Companies to Export the Crude Oil. Government’s proposal to revise the standard Stabilisation Clause was accepted by Tullow and has been adopted in the PSAs signed today. In addition, they have agreed to Government’s policy of establishing a refinery in the country and consideration for export of crude will be made as more reserves are discovered in the country.

The Albertine Graben, the area with the potential for petroleum production in the Western rift valley of the country is now subdivided into eleven Exploration Areas (EAs). Out of these, EA1, EA2, EA4B, EA5 are licensed to Tullow Uganda Limited, Tullow Uganda Operations Pty Ltd., Dominion Uganda Limited and Neptune Petroleum Uganda Limited, respectively.

The EA1 licence area lies in the Pakwach Basin, and covers a total area of 3,058 square kilometres. The area covers parts of the districts of Nebbi, Nwoya, Kiryandongo, Masindi and Buliisa. The Kanywataba prospect area and the Kingfisher Production Area formed part of the original EA3A prior to relinquishment by Heritage. Kanywataba prospect covers a total area of 171 square kilometres and lies in Ntoroko District, while Kingfisher Production area measures 344 square kilometres and lies in Hoima and Kibaale Districts.


Contact:
The Permanent Secretary
Ministry of Energy and Mineral Development
Email; psmemd@energy.go.ug Web; www.energyand minerals.go.ug / www.petroleum.go.ug Tel. 0414-344414

East Africa progress on polythene bag elimination

(Press Release) … if assented to, law shall sustain environment and protect human and animal lives
East African Legislative Assembly, Kampala, Uganda, February 3, 2012: The EAC Polythene Materials Control Bill, 2011 passed in the House late yesterday evening . The Bill thus inches closer to an Act of the Community should the EAC Heads of State assent to the same.

The Bill moved by Hon Patricia Hajabakiga, Member from Rwanda aims at providing a legal framework for the preservation of a clean and healthy environment through the prohibition of manufacturing, sale, importation and use of polythene materials.

Justifying the move to have the regional law in place, Hon Hajabakiga stated that the Bill is intended to control the use of polythenes while advocating the total ban of plastics. The mover notes several dangers of plastics and polythene materials notably soil degradation through burning of wastes, harmful emissions of toxics and the endangering of human and animal lives.

She further indicates that while plastics can be burned, they emit chemicals and the corresponding photo-degradation has consequential impact on human and infrastructure. Countries such as Bangladesh, Botswana, Israel, Rwanda and France among others have since enacted a similar law, Hon Hajabakiga said.

The Chairperson of the Agriculture, Tourism and Natural Resources Committee, Hon Safina Kwekwe whose Committee the Assembly mandated to look through the Bill, remarked that the Committee had met various stakeholders in the Partner States during the public hearings. The meetings were called to create awareness of plastics and visit plastic manufacturers with a view to interfacing with them and suggesting for improvements on the Bill.

In its report, the Committee states that Rwanda which has an existing law in place supported the Bill while requesting for inclusion of a clause on alternatives to polythene materials as well as an incentive programme. Uganda enacted a law for the control of polythene materials in 2009 although the law is yet to be fully implemented. There are challenges with respect to disposal of such wastes owing to absence of recycling facilities, the Committee reported.

Stakeholders in Kenya were of the view that while polythenes are an environmental menace, a balance needs to be struck between eradicating them on the one side and the promotion and protection of investments on the other.

The stakeholders in Kenya suggested adjustment to specifications of polythene materials other than a total ban and the introduction of a levy to allow the National Environmental Management Authority (NEMA) to manage the waste.

The United Republic of Tanzania and the Republic of Burundi also support the Bill, but on the understanding that only plastic bags should be banned and not all polythene materials. In Zanzibar, the report notes - issues concerning the environment are non-union and in 2008, the isle took the initiative to ban the use of plastics with a three year transitional period, expiring last year, provided for in the law.

Stakeholders during public hearings however raised counter arguments including loss of income, jobs and reduced revenue affecting the economies. The issue of measuring of the microns, the House was told, is expensive even though it was suggested that balancing of revenues earned by governments compared to the very act of checking the environment should be taken into consideration.

During debate, majority of the Members rose in support of the Bill. Hon Emerence Bucumi hailed the Assembly’s decision to protect the environment noting that the region should emulate Rwanda’s example.

“We must protect the environment and share common interests in our desire to ensure a healthy environment,” Hon. Bucumi said. Hon. Christophe Bazivamo remarked that plastic bags were not only a menace to the environment but also harmed livestock. Other Members in support were Hon. Dr. George Nangale and Hon Margaret Zziwa.

Kenyan Assistant Minister for EAC Hon. Peter Munya reiterated the Council of Ministers’ support for the Bill. “Polythene waste is a major hindrance in urban and rural areas and attempts to ensure solid waste management is thus essential and welcome. The envisaged law in the Council’s view, shall control pollution and save both flora and fauna,” he said.

“Further attempts to ban the plastics in the region have not been entirely successful in the Partner States save for Rwanda and it is now time to collectively act,” Hon Munya added.

The Minister also presented mind boggling statistics of the use of plastic bags noting that the continent was most affected. Amendments that sailed through during the debate include a change in title with the replacement of the word polythene with plastic to read “The East African Community Plastic Control Bill”. This, Members agree has a wider scope and is consequential.

The Bill shall now go through the succeeding stages of assent with the Speaker of the Assembly expected to submit the amended copies to the Heads of State for assent. Should it be assented to (signed) to by the five Heads of State, the East African Community Plastic Control Bill shall become law. In event that one or more Heads of State do not assent to the Bill, it shall be returned to the Assembly.

 

For more information, contact: Bobi Odiko, Senior Public Relations Officer; East African Legislative Assembly; Tel: +255-27-2508240 Cell: +255 787 870945, +254-733-718036; Email: bodiko@eachq.org Web: http://www.eala.org Arusha, Tanzania

Bujagali Hydropower project to earn Carbon Credit Income

By Esther Nakkazi

Uganda’s Bujagali Hydropower Project has been approved as a Clean Development Mechanism (CDM) and sustainable development project by the Netherlands, the designated Authority for this activity.

As a CDM it could earn about $17 million per year from selling certified emission reduction (CER) credits to industrialized countries, as part of their emission reduction targets, under the Kyoto Protocol of the UN framework Convention for climate change.

“It is like a thank you on a project that will save the environment not only on site but on electricity usage as pressure on the environment will be reduced. It will also earn us some revenue,” said Mr. Bukenya Matovu the head of communications in the Ministry of Energy and Mineral Development.

Under the deal, the Uganda Government will receive 60 percent of the carbon credit income and 40 percent will go to Bujagali Energy Limited (BEL) the project sponsor which will also control the revenue.

The 250-megawatt project is the largest private investment ever in East Africa, and now becomes the only capital-intensive project in Africa to be financed through carbon credit income, a key decision that equity financiers of the project considered before financing the project.

Investment experts say it is now common international practice that hydropower projects apply for CDM validation as it presents investors especially in poor investment climates like Uganda with additional financial incentive and security through the carbon credit revenue stream.

In the Bujagali case it was a key factor in the decision to invest made by Sithe Global, the main shareholder in BEL and equity investor in the project.

BEL is a project- specific company owned by Industrial Promotion Services

Kenya Limited (IPS Kenya) and SG Bujagali Holdings Ltd, an affiliate of Sithe Global, an American power company majority owned by private equity giant, The Blackstone Group based in the USA.

According to the ERM Group, the world’s largest provider of environment, health and safety certification, Bujagali qualifies to be a CDM because of the technology applied- hydropower replacing fossil fuel electricity generation.

The technology will result in reductions of greenhouse gas emissions in Uganda particularly targeting CO2 emissions that in the absence of the project activity would have been generated by diesel and heavy fuel oil generators. It will also avoid the need for future oil fired generation, says the ERM Group validation report released this month.

The project will also not create emissions as it is a renewable energy (hydropower) project, and has no fossil-fuelled power to supply to the grid. If at all, from the two emergency stand-by diesel generators on site, the annual diesel would be less than 1 percent of emissions reduction, a reasonable amount, according to ERM certification and verification services (ERM CVS).

Bujagali hydropower project has a total installed capacity of 250 MW and is estimated to be fully operational by June 2012 to generate 1,305 GWh (net) per year to the electricity grid.

According to ERM CVS, the Bujagali CER revenue presents to the Uganda government a secure stream of revenue that will provide a buffer from the foreign exchange rate risk and from the default on its commitments to purchase electricity from BEL.

The carbon credit revenue for Bujagali will be in foreign currencies either US $ or Euros which will help the government offset the foreign currency exchange risks associated with meeting the electricity payments that it faces.

The Power Purchase Agreement spells out that Uganda Electricity Transmission Company (UETCL), purchases from BEL all power produced by the Bujagali Project, under a sovereign guarantee by the government of Uganda.

But, Ugandan consumers pay for electricity in Uganda shillings while BEL to be paid $116 million per year after the project starts running- is paid in US Dollars, which creates an exchange rate risk for the government as the Uganda shilling fluctuates significantly against the US dollar. For instance the shilling declined in value against the US $ by about 50 percent since 2000.

CDM is the main source of income for the UNFCCC Adaptation Fund. The project was validated on its project design documents, site assessments and resolution of outstanding issues.

ends