As an international medical humanitarian organization, Doctors Without Borders/Médecins Sans Frontières/(MSF) is calling on the Canadian government to invest more in cryptocurrencies. No, not that crypto. Instead of Bitcoin or the like, Canada should dedicate resources to fighting cryptococcal meningitis, a disease that ranks second only to tuberculosis as the world’s leading cause of death for people living with HIV. With Montreal currently hosting the International AIDS Conference, it is an ideal time for Canada to make a safe investment with good benefits for human health.
Cryptococcal meningitis (CM) is a fungal infection of the tissues that cover the brain and spinal cord. It is an example of what is known as an “opportunistic infection”: one of the most common and most serious in people with weakened immune systems, including people living with advanced HIV. It is fatal if left untreated. Most CM deaths occur in settings where timely access to diagnosis and treatment is not available, including many of the countries where MSF operates.
The importance of access to effective treatment for CM is highlighted in new World Health Organization (WHO) Guidelines being presented at the conference. The recommended drugs (flucytosine, fluconazole, and liposomal amphotericin B (L-AmB)) are not new and are all on the WHO list. Model List of Essential Medicineswhich establishes medicines that should be available in all functional health systems at an affordable price.
Unfortunately, even in high-income countries, these drugs are not always affordable or available. For example, after a Canadian company, Bausch Health (formerly Valeant), acquired market rights more than a decade ago, the price of flucytosine in the United States went up to 9,000 percent of that in Europe. And although Bausch manufactures flucytosine in Manitoba, this drug is not sold in Canada.
Meanwhile, while L-AmB is available in Canada, it remains prohibitively expensive for most of those who need it around the world. In sponsored content promoting the International AIDS Conference, the pharmaceutical company Gilead claimed that “anyone living with HIV…should benefit from the latest scientific innovations and have access to medicines,” but has could not deliver in its 2018 pledge to ensure L-AmB is affordable and accessible in low- and middle-income countries. This drug is vital not only for CM, but also for a wide range of other conditions that MSF treats around the world. East It includes mucormycosis, the “black fungus” that wiped out COVID-19 patients in India in 2021, and visceral leishmaniasis (kala-azar), the parasitic disease that causes the most deaths after malaria.
As a board member of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Canada not only has a responsibility to contribute financially to the replenishment of the Global Fund, but also to show leadership in ensuring that the funds raised can be use to deal with opportunistic infections with insufficient funds. like CM.
Canada should also invest in research and development of new and improved tools to address these diseases. For example, the Neglected Global Diseases Initiative at the University of British Columbia is currently developing a new oral formulation of amphotericin B; an effective oral formulation would be easier to use for CM and kala-azar than the current injectable form, particularly in the low-resource settings where MSF operates.
Unfortunately, new drugs or new formulations that address important public health needs, but are unlikely to make massive profits, face a difficult path from the laboratory to the patient. Government support can fill that gap; it can also help prevent future access problems by adding strict affordable access requirements as a condition for such support to ensure that public investment prioritizes public health over private profit.
Investments in domestic manufacturing capacity in the wake of COVID-19 could be similarly structured to ensure that Canada manufactures the medicines the world needs at affordable prices, rather than subsidizing already profitable products that the pharmaceutical industry chooses to sell. .
Adam R. Houston is the medical policy and advocacy officer for MSF Canada. He lives in Victoria, BC
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