How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand

New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral “free” trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce onerous disclosure and “transparency” provisions that facilitate industry involvement in decision-making around coverage and pricing of medicines (and medical devices). This paper argues that the US agenda, if successfully prosecuted, would be likely to increase costs and reduce access to affordable medicines for New Zealanders. This would in turn be likely to exacerbate known inequities in access to medicines and thus disproportionately affect disadvantaged population groups, including Māori and Pacific peoples.     

我国中药产品出口大洋洲的贸易现状及发展战略

随着“一带一路”重大倡议的实施,中医药的国际影响力逐渐增加,中药的国际化进程加快。中医药在澳大利亚具有深厚的发展基础,且澳大利亚与欧盟20多个国家生产质量管理规范（GMP）相互认证,因此我国中药产品在澳大利亚上市对于促进中药国际化具有现实意义。本文以“大洋洲”“新西兰中药”“澳大利亚药品”“澳大利亚中药”“中药出口”等为主题词,检索国家知识基础设施数据库（CNKI）和中国学术期刊数据库（CSPD）等数据库和相关研究报告,分析我国中药产品在大洋洲的准入政策和市场结构,梳理中药出口大洋洲的优势与局限,针对性地提出策略与建议,旨在为我国中药产品出口大洋洲的路径提供依据和参考。     

Trends in respiratory diagnoses and symptoms of firefighters exposed to the World Trade Center disaster: 2005-2010

Objectives

To compare the prevalence of self-reported respiratory diagnoses in World Trade Center-exposed Fire Department of New York City firefighters to the prevalence in demographically similar National Health Interview Survey participants by year; and, 2) to describe the prevalence of World Trade Center-related symptoms up to 9 years post-9/11.

Methods

We analyzed 45,988 questionnaires completed by 10,999 firefighters from 10/2/2001 to 9/11/2010. For comparison of diagnosis rates, we calculated 95% confidence intervals around yearly firefighter prevalence estimates and generated odds ratios and confidence intervals to compare the odds of diagnoses in firefighters to the National Health Interview Survey prevalence, by smoking status.

Results

Overall, World Trade Center-exposed firefighters had higher respiratory diagnosis rates than the National Health Interview Survey; Fire Department of New York City rates also varied less by smoking status. In 2009, bronchitis rates in firefighters aged 45–65 were 13.3 in smokers versus 13.1 in never-smokers while in the National Health Interview Survey, bronchitis rates were doubled for smokers: 4.3 vs. 2.1. In serial cross-sectional analyses, the prevalence of most symptoms stabilized by 2005, at ~ 10% for cough to ~ 48% for sinus.

Conclusions

We found generally higher rates of respiratory diagnoses in World Trade Center-exposed firefighters compared to US males, regardless of smoking status. This underscores the impact of World Trade Center exposure and the need for continued monitoring and treatment of this population.     

我国与GPA成员方及印度制剂产业外贸竞争力比较研究

产业的外贸竞争力决定其国际市场份额。对我国与GPA成员方以及印度的制剂产业外贸竞争力比较研究发现：我国制剂出口的国际市场占有率不足1%,贸易竞争优势指数为负值,显示性比较优势指数长期处于较低水平,制药产业外贸竞争力不仅与GPA成员相差悬殊,甚至明显落后于印度。因此,在我国制剂产业外贸竞争力取得长足进步之前,加入GPA难以改变目前我国单方面开放医药市场的现状,对我国制药产业很可能＂弊大于利＂。我国医药产业应借推行新版GMP和落实自主创新方略等政策的机会,加快企业＂走出去＂的步伐,争取在加入GPA之前成为真正的制药强国。     

The Jean Chrétien Pledge to Africa Act: patent law and humanitarian aid

This article evaluates the implementation of the World Trade Organization (WTO) General Council Decision in 2003, which resolved that developed nations could export patented pharmaceutical drugs to member states in order to address public health issues, such as HIV/AIDS, tuberculosis, malaria and other epidemics. The Jean Chrétien Pledge to Africa Act 2004 (Canada) provides authorisation for the export of pharmaceutical drugs from Canada to developing countries to address public health epidemics. The EU has issued draft regulations governing the export of pharmaceutical drugs. A number of European countries, including Norway, the Netherlands, France and Switzerland, are seeking to pass domestic legislation to give force to the WTO General Council Decision. Australia has shown little initiative in seeking to implement such international agreements dealing with access to essential medicines. It is argued that Australia should implement humanitarian legislation to embody the WTO General Council Decision, emulating models in Canada, Norway and the EU. Ideally, there should be no ‘right of first refusal’, the list of pharmaceutical drugs should be open-ended, and the eligible importing countries should not be limited to members of the WTO.     

The World Trade Center Attack: Lessons for disaster management

As the largest, and one of the most eclectic, urban center in the United States, New York City felt the need to develop an Office of Emergency Management to coordinate communications and direct resources in the event of a mass disaster. Practice drills were then carried out to assess and improve disaster preparedness. The day of 11 September 2001 began with the unimaginable. As events unfolded, previous plans based on drills were found not to address the unique issues faced and new plans rapidly evolved out of necessity. Heroic actions were commonplace. Much can be learned from the events of 11 September 2001. Natural and unnatural disasters will happen again, so it is critical that these lessons be learned. Proper preparation will undoubtedly save lives and resources.     

加入WTO后对我国医疗保障体系的影响及应对策略

世界贸易组织(WTO)对推动全球经济发展起着极其重要的作用，根据WTO《服务易总协定》的条款，加入WTO后，我国医疗卫生行业将全面向国际市场开放。该就目前我国医疗保障体系的现状、加入WTO对我国医疗保障体系的影响进行了分析，并研究了应采取的对策和建议。     

Intellectual property rights and challenges for development of affordable human papillomavirus,rotavirus and pneumococcal vaccines: Patent landscaping and perspectives of developing country vaccine manufacturers

The success of Gavi, the Vaccine Alliance depends on the vaccine markets providing appropriate, affordable vaccines at sufficient and reliable quantities. Gavi's current supplier base for new and underutilized vaccines, such as the human papillomavirus (HPV), rotavirus, and the pneumococcal conjugate vaccine is very small. There is growing concern that following globalization of laws on intellectual property rights (IPRs) through trade agreements, IPRs are impeding new manufacturers from entering the market with competing vaccines. This article examines the extent to which IPRs, specifically patents, can create such obstacles, in particular for developing country vaccine manufacturers (DCVMs). Through building patent landscapes in Brazil, China, and India and interviews with manufacturers and experts in the field, we found intense patenting activity for the HPV and pneumococcal vaccines that could potentially delay the entry of new manufacturers. Increased transparency around patenting of vaccine technologies, stricter patentability criteria suited for local development needs and strengthening of IPRs management capabilities where relevant, may help reduce impediments to market entry for new manufacturers and ensure a competitive supplier base for quality vaccines at sustainably low prices.     

The Day That the START Triage System Came to a STOP: Observations from the World Trade Center Disaster

The Fire Department of the City of New York--Emergency Medical Services (EMS) Operations is one of the largest EMS systems in the country. On a daily basis, this system responds to approximately 3,000 to 3,500 calls for ambulance requests. This equates to 1.2 to 1.5 million calls annually. As part of its response, EMS deals on a daily basis with multiple casualty and disaster-type situations. The magnitude of the attacks on the World Trade Center, however, was on a scale not previously seen by any system. This article is a case report of the September 11, 2001, incident.