The flight from DC arrived at Brussels International at 7:30 this morning - and as of 3:30 in the afternoon we were still waiting for our connection to Monrovia. The crowd has been building around the Brussels Air check-in stand as more and more people are beginning to suspect that we won't fly out today. Actually, the controversy is over whether the "replacement" jet will fly to Dhaka first, or Monrovia. At their most impassioned, the crowd had split and was chanting back and forth, in the airport, "Dha-ka," "Mon-ro-vi-a." Personally, I think I'd almost rather leave tomorrow morning at this point than arrive at 2 or 3 this morning.
On a positive note, I've had more than enough time to dig into the background reading I received from the CHAI team (and augmented with a couple books from the World Bank Library). Reading about the impact of intellectual property rights to HIV/AIDS treatment in development countries has been among the more interesting subjects of today. A significant part of crafting an efficient/effective supply chain for any medical treatment is selecting the proper product line. The controversy comes in determining how much flexibility [the host country] has in purchasing generic drugs. While big name manufacturers (such as GlaxoSmithKline, Merck & Co, Roche, and Bristol-Myers Squibb) have generated HIV/AIDS tests and treatments that are more specific (meaning they produce a fewer false positives) and sensitive (meaning they detect HIV before it has reproduced large quantity antibodies), these innovative drugs come at a price. A price that aflicted populations in developing nations (and developed nations at that rate!) cannot pay.
Subsequently, public policy has intervened. During 2001 negotiations in Doha, Quatar, the WTO wrote a clause into the Trade Related Agreemnet on Intellectual Property Rights (TRIPS) allowing developing nations to source generic forms of patented drugs. Generic competition has since been hugely successful in driving down the costs of ARVs (antiretrovirals) in many developing nations. In fact, the generic supply has reduced the costs globally from 10,000 USD/patient/year to 350 USD/patient/year. Brazil, for example, has used generic brands to dirve down the ARV costs by 82% in 5 years. Kind of sheds a dimming light on how over-priced drugs must be in developed nations like our own, eh?
Naturally, pharma-lobbiests argue that such concessions threaten the incentive they offer their research and development teams. I see little merit to this argument because the patent holders still increase their revenues through sales to developing nations. In most instances, either international organizations or the developing country governments offer an "honorarium," if you will, to the patent holders. In more recent years, country and county governments have engaged in parallel trading. Parallel trades occur when developing nations coordinate with developed nations to import generic drugs that are neither produced domestically nor available at a subsidized cost from the patent holders. The patent holder profits from these sales as well because the exporting producer of the generic drug already paid its royalties. All of which leads me to wonder in what form pharmaceuticals lobby the WHO (World Health Organization) and what happened in 2001 to generate more development-friendly trade agreements.
This was just one of a handful of new topics I'm exploring as I prep for this job. I'm continuously excited about how "scaleable" this experience will be. The stated objective is the improvement of the HIV/AIDS procurement and supply chain managment standard operation procedure (PSM SOP) ... but I feel like this experience will be relevent to more diverse work down the road.
On a (way) lighter note - I get to play in Brussels tomorrow! Our flight was rescheduled for Sunday a.m. (fingers crossed) which gives me more than 30 hours in Belgium's capital. I'm headed to the city center tomorrow with a few unbelievably interesting people - one Stanford professor of management, one UNMIL (UN Mission in Liberia) officer, a World Bank-er, and a carpenter from Oregan who's headed to Liberia to meet his newly adopted daughter. We'll hit a couple tourist sites, and keep waffles and beer top on the list... but maybe not together.