Low-income countries

In Chapter 4 Aidan Hollis examines three proposals in considerable detail. The first is an Advanced Purchase Commitment by sponsors, who offer an explicit subsidy in advance for innovative products. The subsidy offer includes a fixed-dollar amount per unit as well as a commitment to purchase a specific number of units at that price. The second proposal is that sponsors pay annual rewards based on the therapeutic effectiveness of innovative drugs. The third approach is to offer a patent extension on patented products to pharmaceutical companies if they successfully developed a vaccine for a disease such as HIV/AIDS that is highly prevalent, particularly in some low-income countries. Hollis concludes that the third approach is an extremely inefficient way to reward innovation. By contrast, the second approach could correct the market failure directly by rewarding innovative drugs according to their therapeutic effectiveness, which is measurable by cost-effectiveness analysis, a topic discussed later in greater detail in Chapters 10 and 11. 

In effect, of course, such diseases are the ones primarily prevalent in low-income countries. Figure 4.1 shows diseases according to total disability-adjusted life years (DALYs) lost to each disease or condition. (A DALY is a standardized measure of health outcomes.) Some diseases are grouped together for convenience. The vertical axis shows the weight of each disease in low- and lower-middle-income countries, relative to its weight in high-and upper-middle-income countries. A disease responsible for 6% of lost... 

Figure 4.1. Diseases by global importance and by relative importance in low- and medium-low-income countries. Notes The figure shows selected diseases and conditions according to global DALYs lost and the relative weight of each disease or condition in developing countries. If the relative weight is 2, that indicates that that disease is twice as likely to be responsible for a randomly selected lost DALY in low-income countries as in high-income countries. AH data abstracted from World Health Organization (2004).

Even non communicable diseases have worse health impacts in low-income countries because of inadequate diagnosis and treatment, but their share of lost DALYs is not as high because communicable diseases are responsible for so many lost DALYs in low-income countries. 

Berndt, E. R., and J. A. Hurwitz. 2005. Vaccine Advance Purchase Agreements for Low-Income Countries Practical Issues. Health Affairs 24(3) 653-665. 

Fig. 1. Guide for management of asthma in low income countries (adapted and modified from lUATLD, 2007).

It has to be noted that many of these novelties are highly effective and also that mostly they are extremely expensive. Undoubtedly, as the usage of bi-ologicals will increase, the cost should come down. However, this does not seem to be happening at an impressive rate and a new form of inequality between rich countries and low-income countries is becoming a threat. Academic leadership should persuade authorities to reduce customs duties and manufacturers to reduce prices for developing countries. 

Infectious and parasitic diseases account for one-third of the disease burden in low-income countries - in fact for over half of Africa s disease burden. In contrast, infectious and parasitic diseases account for only 2.5 per cent of the burden of disease in high-income countries" (Kremer and Glennerster 2004). Given the relationships between poverty and disease, fighting poverty is a key to improving health in the developing world. However, poverty and disease are two sides of the same coin while poverty promotes disease, disease itself devastates the economies of entire communities. 

Low-income countries with poor administrative capacity can seek technical assistance to manage the procurement process (Leach, Paluzzi, and Munderi 2005). Strengthening regulatory bodies and judicial systems is critical, as provision of counterfeit or substandard drugs can harm the public and should be penalized. To further eliminate substandard suppliers from the tendering process, both pre- and post-qualification procedures can... 

Infectious diseases are now the leading cause of death worldwide (25% of all world death is caused by infectious diseases and 45 % in low-income countries), the main cause of death among children (65%), and the third leading cause of death in the United States. In particular, diarrhea, human... 

Enarson PM, Enarson DA, Gie R. Management of tuberculosis in children in low-income countries. 

Brena, B.M., L. Arellano, C. Rufo, et al. 2005. ELISA as an affordable methodology formonitoring ground-water contamination by pesticides in low-income countries. Environ. Sci. Technol. 39 3896-3903. 

The synthesis of FQ (Fig. 20) is simple and quite economical, which renders FQ attractive for the development of an antimalarial drug intended for use in areas, concerned by malaria, that are mostly overlaying with low-income countries. FQ was obtained starting from the commercially available AQV-dimethyl-1-ferrocenylmethanamine. The ferrocenic aldehyde results from a C-C bond formation, a two-step sequence involving metallation with tert/o-butyllithium and a reaction with DMF. This step has been previously studied and the 1,2 orientation of the two substituents of the cyclopentadienyl has been unambiguously established [125], The aldehyde is converted to the corresponding oxime, which is then reduced to the primary amine. The SNat reaction between the amine and 4,7-dichloroquinoline leads to the desired FQ [121]. 

Figure 1. Model of core and frame system of local agriculturally oriented societies in (sub) tropical low-income countries...

The social status of those employed in agriculture is decreasing. Even the students in the low-income countries prefer to study subjects such as economics and business studies or communication technologies. Agricultural studies and research are predominantly oriented towards conventional land use systems. 

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