Introduction to Medicines and Health in

Malaysia

Fifa Rahman, LLB, MHL

Policy Manager, Malaysian AIDS

Council

Malaysia

• 44% of Malaysian males are current tobacco smokers. Ministry of Health, Malaysia, Global adult tobacco

survey 2011 factsheet. http://www.moh.gov.my/images/gallery/Report/GATS_Malaysia.pdf (2011, accessed 6 November 2012)

• 21% of Malaysians are diabetic Hew FL and Hussein Z. Diabetes – the new Malaysian epidemic. The Star Online [Internet]. 2012 Jul 22 [cited 2012 Jul 22]; Available from: http://thestar.com.my/health/story.asp?file=/2012/7/22/health/11702759&sec=health

• breast cancer, accounting for 18% of all cancers. Malaysia. Ministry of Health. Non-Communicable Disease Section. National cancer registry report 2007. Putrajaya: Ministry of Health; 2007

• 14,986 deaths related to HIV/AIDS Ministry of Health statistics, Malaysia

Malaysia• Pharmacists recommended generic substitution for 84.7% of the

brand name medicine requests. Chong CP, Hassali MA, Bahari MB and Shafie AA. Generic medicine substitution practices among community pharmacists: a nationwide study from Malaysia. Journal of Public Health 2011; 19(1): 81-90.

• 2005, Procurement of meds RM1.12 billion. Ministry of Health, Malaysian Statistics on Medicine 2005

• In 2007, MYR 800 million ($ 260 million) Babar ZUD, Ibrahim MIM, Singh H, Bukahri NI, Creese A. Evaluating drug prices, availability, affordability, and price components: Implications for access to drugs in Malaysia. PLoS Med 2007; 4(3): e82. doi:10.1371/journal.pmed.0040082

• 14.7% increase in drug expenditure in 2007 as compared to 2006. Ministry of Health, Malaysian Statistics on Medicine 2007

• Most expensive drug for breast cancer Herceptin, MYR 8000 ($2,600) per cycle, 17 cycles needed, costs MYR 136,000 ($44,000) Breast Cancer Welfare Association Malaysia, personal communication.

• In the state of Malacca from 2011-2012, budget for medicines procurement was reduced from MYR 49.61 million ($16m) to MYR 35.30 million ($11.4m) Citizen Journalists Malaysia http://cj.my/post/41297/krisis-catuan-bekalan-ubat-di-hospital-melaka-berlarutan/

• Treating a lung cancer patient costs an average of MYR 44,725 ($14,455) per year per patient. Aljunid S.M, Rizal A.M, Abrizah A, Sharifah Z.S.Y, Zarihah M.Z, Rahmat A, Zulkifli A, COST OF SMOKING AMONG PATIENTS WITH LUNG CANCER (2006)

• Mean household income of MYR 4,025 ($ 1,313) per month. Department of Statistics, Malaysia, Household income and basic amenities survey report 2009. http://www.statistics.gov.my/portal/index.php?option=com_content&view=article&id=1640&Itemid=169&lang=en (2009, accessed 6 November 2012)

How/Where Negotiations Carried Out

Fancy hotel, stakeholder presentations, stakeholder briefing, confidentiality agreements, Barbara Weisel, decisions by political leaders.

Threatening Meds Provisions in the TPPA

• Patent extensions~ Liow Tiong Lai

• Patenting of surgical, diagnostic, therapeutic method.• Data exclusivity• Patenting of new uses and forms

Original med (HIV) Original med + salt (HIV) Original med + salt (cures cancer) 7 years data exclusivity 12 years data exclusivity (biologic) make it into liquid etc etc

South Africa

Here’s the Whopper!

12 years of data exclusivity for biologic medicines.

Eg. Nexavar, Herceptin, Glivec, Pegylated Interferon

Impact?• Delay of generic medicines – Jordan – $18 million per year

~ Abbott, Ryan B. et al. ‘The price of medicines in Jordan: the costof trade-based intellectual property.’ (2012) 9(2) Journal of Generic Medicines 75-85

• ECOSOC Report of the Secretary-General: ‘fundamental objectives… painfully evident… higher than the gains… consistent increase’

~Para 3, IP Rights and Human Rights, Report of the Secretary-General, E/CN.4/Sub. 2/2001/12

• Anand Grover: ‘undermine the safeguards… developing countries… TRIPS… countries need… assess… potential health violations… all stages of negotiation…’

~Para 69 and 70, UN General Assembly, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental

health, Anand Grover, A/HRC/11/12 (31 March 2009)

Things Americans Say (and do)

• US abstained from voting on UN Resolution on access to medicines – “encourage innovation” (13 June 2013) http://www.keionline.org/node/1748

• “Nothing that has been proposed in TPP would constrain the Malaysian government from subsidising medicines” Paul Allen Brown, article in Malaysian Insider, 29 May 2013

http://www.themalaysianinsider.com/litee/sideviews/article/trans-pacific-partnership-tpp-regional-free-trade-agreement-negotiations-clarifying-some-issues-paul-a.-brown/• Fifa Rahman in response:

http://www.themalaysianinsider.com/sideviews/article/a-response-to-paul-allen-brown-fifa-rahman