By Morenike Folayan
New HIV Vaccine and Microbicide Advocacy Society

Professor Morenike Folayan
Professor Morenike Folayan
The 2017 Bioethics Forum has come and gone leaving a lot of thoughts for the 35 participants at the conference. The second edition of the bioethics conference was a two days meeting held at the Rockview (Royale) Hotel on the 13th and 14th of December 2017. The theme was ‘participation in research and research demand: striking the balance.’ In attendance were speakers and participants from the United States, Australia, Ghana, Senegal, Guinea and Nigeria.

The opening plenary speaker, Kris Peterson, highlighted how the economic meltdown in the United States made pharmaceutical industries turn to the Wall Street for financialisation of the pharmaceutical industry during the great depression. This in-effect meant that pharmaceuticals had to grow markets to enable them make the huge profits they need to pay back loans. One of the ways they have had to grow that market is to outsource significant number of their research to low and low-middle income countries where the costs of production of drugs are cheaper. The out-sourcing process also implies a significant fragmentation of the entire pharmaceutical enterprise in ways that makes the regulation of the entire industry practically impossible and unmanageable.

Another strategic approach is the development of alternative use of the same drug molecule or/and increase in marketing of drugs for prophylaxis and chronic illnesses. These forms of drugs have sustained long term demands thus are able to sustain the pharmaceutical markets for long. For this reason, there is an increase in the support of clinical trials by the pharmaceutical industry to identify disease risk and continue to lower the thresholds for these diseases. This in turn expands the market for these pharmaceuticals.

A recent event made the reality of this process titled ‘the economies of health through the lens of  the pharmaceutical industry by the forum organizers indeed a huge reality. The American Heart Association, American College of Cardiology and nine other organizations produced a new guideline lowering the threshold for treating hypertension with lifestyle changes and medication. Treatment is now recommended at 130/80 mmHg as oppose to 140/90 mmHg in January 2017. The implication of this is that 46% of the US adult population will now be considered hypertensive under the new guideline as opposed to 32% under the old guideline.

For the HIV prevention world, the renewed use of tenofovir based regimen for HIV prevention in addition to its continued use for HIV treatment was an all time booster for the pharmaceutical industry called Gilead. The medicalisation of the HIV prevention field continues to widen the prospect for pharmaceutical industries to invest in the field, make huge profits. While the field needs the investment of the pharmaceutical industries to help increase the HIV prevention armamentarium, it is equally important for HIV prevention advocates to keep an eye on the evolution of the pharmaceutical industries in this space so that the capitalism drive of the industry does not unwittily drive advocates and activists to promote clinical trials that continue to drive down the HIV prevention thresholds. 

The huge number of people chronically living with HIV infection that will continue to need first and second line drugs, salvage therapy is enough huge market for the pharmaceuticals. Medicalisation of HIV prevention is now expanding that space for the industry. We need to be watchful and ensure that the collective push of advocates for increased investment of pharmaceutical industries in the HIV prevention space does not end up getting we community members out-priced in our search to expand the armamentarium for HIV prevention. There is a need to strike a moral and ethical balance in this process.

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